Reports show that there has been an uptick in the cases of Kala-azar or Visceral Leishmaniasis in Bihar’s Muzaffarpur district. This raises concerns about the effectiveness of the state government’s efforts to eliminate the disease by 2022. The state of Bihar has missed the Kala-azar elimination target four times since 2010. Originally, the first deadline set under the National Health Programme was in 2010, which subsequently got moved to 2015 due to nonfulfillment. Unfortunately, as a result of the government’s inability to eliminate Kala-azar, the deadline has been further extended to 2022.
Understanding Kala-Azar or Leishmaniasis
Visceral leishmaniasis, referred to as kala-azar in India, is a Neglected Tropical Disease (NTD) that affects almost 100 countries, including India. Symptoms include recurring fever, significant weight loss, swelling of spleen and liver, and anaemia. The fatality rate can go up to 100% within two years in developing countries if treatment is not sought.
This disease is caused by the Leishmania parasite and is transmitted through sand fly bites. There are three types of leishmaniasis: Visceral leishmaniasis that affects various organs and is regarded as the most serious form; Cutaneous leishmaniasis that causes skin sores, and Mucocutaneous leishmaniasis that results in skin and mucosal lesions. Visceral leishmaniasis, or Kala-azar, if left untreated can prove fatal in over 95% of the cases.
Why is Bihar Missing its Kala-Azar Elimination Deadlines?
Several factors contribute to Bihar’s failure in meeting its elimination target. First, the initiatives for eliminating Kala-azar lack direction which leads to cyclical resurgences of the disease. Secondly, widespread poverty, particularly among Dalits, Other Backward Classes, and Muslims, has resulted in a high number of infections. However, it is noteworthy that official data reflect a declining trend in the number of Kala-azar cases in Bihar over the last decade. It fell from 23,084 in 2010 to 2,712 in 2020.
National Kala-azar Elimination Programme
The National Health Policy-2002 initiated the goal of Kala-azar elimination by 2010, which was later pushed to 2015. Following continued concentrated activities and political commitment, India signed a Tripartite Memorandum of Understanding (MoU) with Bangladesh and Nepal to eliminate Kala-azar from the South-East Asia Region (SEAR). The elimination goal is set at maintaining the annual incidence of Kala-azar to less than 1 case per 10,000 population at the sub-district level in India. At present, all programmatic activities are implemented through the National Vector Borne Disease Control Programme (NVBDCP), a part of the National Health Mission (NHM).
About National Vector Borne Disease Control Programme
NVBDCP operates as the central nodal agency for prevention and control of six vector-borne diseases, namely, Malaria, Dengue, Lymphatic Filariasis, Kala-azar, Japanese Encephalitis, and Chikungunya in India. The program falls under the domain of the Ministry of Health and Family Welfare.