India is on the verge of eliminating visceral leishmaniasis, more commonly known as kala azar. The country has seen a significant reduction in the number of reported cases and deaths from the disease, closely aligning with the elimination target set by the World Health Organization (WHO). In the global context, India’s neighbour, Bangladesh, became the first nation to be validated by the WHO for eliminating kala azar as a public health concern.
Understanding Kala-Azar
Visceral leishmaniasis, also referred to as kala-azar, is a slow-progressing disease originating from the protozoan parasite of the genus Leishmania. In India, Leishmania donovani is the only known cause of this affliction, which is alternatively named as Black Fever or Dumdum Fever.
Transmission and Symptoms
The agent responsible for the transmission of kala-azar is a species of sandflies – Phlebotomus argentipes. The disease manifests itself through symptoms including fever, weight loss, along with spleen and liver enlargement. Without proper treatment, kala-azar can prove fatal in 95% of cases.
Recent Developments in India
In 2023, India recorded a total of 530 cases and four deaths from kala-azar. These numbers mark a decrease when compared to previous years. A related condition, post-kala azar dermal leishmaniasis (PKDL), accounted for an additional 286 cases.
About Post Kala-azar Dermal Leishmaniasis (PKDL)
PKDL develops when Leishmania donovani penetrates and proliferates within skin cells, causing skin lesions. Although typically following treatment for kala-azar, there is newfound belief that PKDL may occur independently of the visceral stage. More research is required to understand the progression of PKDL, with the term ‘visceral stage’ referring to the initial phase of kala-azar, in which the parasite affects internal organs.
Kala-Azar Treatment in India
The primary treatment method for kala-azar in India is the administration of an injectable known as liposomal amphotericin B. For patients suffering from PKDL, a 12-week course of oral miltefosine is generally prescribed, with the dosage adjusted according to the patient’s age and weight.
India’s Strategies for Eliminating Kala-Azar
India has been implementing several strategies to counter the spread of kala-azar. Among these are strict monitoring of indoor residual spraying to control sandfly breeding, use of Gerrard soil for wall plastering to reduce sandfly habitats, and ensuring completion of the PKDL treatment via the ASHA (Accredited Social Health Activist) network.
It should be noted that the WHO aims to eliminate Kala-azar by 2030, as outlined in their Neglected Tropical Diseases Road map. The Indian Government launched a centrally sponsored Kala-azar control Programme in 1990-91. Initial aspirations within the National Health Policy (2002) were to eliminate kala-azar by 2010. This target was later updated to 2015, and now it stands at 2023.
