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Feature Vector borne disease

India’s ambition to eliminate visceral leishmaniasis

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6671 (Published 07 November 2014) Cite this as: BMJ 2014;349:g6671

Kala Azar elimination – Progress in India

Kala Azar is a major public health problem in the eastern part of India specially Bihar, parts of eastern Uttar Pradesh, West Bengal, Jharkhand, and adjoining areas of Nepal. Efforts are being made by the Government of India in eliminating Kala Azar by 2015. The disease is one of the targets under the National Vector Borne Disease Control Programme (NVBDCP) under the Ministry of Health of Health and Family Welfare, Government of India. This centrally sponsored programme was launched in endemic areas in 1990-91. The activities included identification of the disease, provision of medicines, insecticide spraying for vector control with DDT upto 6 feet height from the ground twice annually. As per the available reports, during 1992 to 1995, there has been 70.66% decline in annual incidence, 80.48% decline in deaths from Kala Azar; and during 1992 to 2003, the decline in incidence and deaths due to Kala Azar were 76.38% and 85.20% respectively (1). The number of deaths over the years since 2002 till June 2007 is shown in Table 1.

Despite efforts, there are problems in the elimination process. Some are highlighted in the recent article by Burki T (2) such as lack of specific treatment for post kala azar dermal leishmaniasis (PKDL) which may act as reservoir for future transmission, hidden undiagnosed cases, asymptomatic carriers, co-infection with HIV which may flare up the disease severity (less of a problem in India so far) etc. The main problems are the favourable environmental factors such as presence of humidity, vegetation, persistence of sandfly vector which keep up the transmission cycle intake. Breaking the cycle needs a more concerted effort with participation of the people in removing the breeding areas of sand fly, keeping a clean environment as envisaged under the clean India drive by the Central Government, use of newer medicines such as Ambisome and making it available at the health centres, proper surveillance, monitoring and evaluation of the programme. Unless these activities are done the target of eliminating Kala Azar by 2015 seems to be a distant dream for India. The earlier target set under the National Health Policy by 2010 seemed to be unrealistic.

References

1. Kala Azar or Visceral leishmaniasis. http://nvbdcp.gov.in/kala-azar.html accessed on 8th November 2014.

2. Burki T. India’s ambition to eliminate visceral leishmaniasis. With introduction of a new drug, cana the new government keep its promise to rid India of kala azar ? BMJ 2014;349:g6671

Competing interests: No competing interests

08 November 2014
Mongjam Meghachandra Singh
Professor,
Reeta Devi
Maulana Azad Medical College, New Delhi; co-author-Indira Gandhi National Open University, New Delhi
Department of Community Medicine, MAMC, New Delhi and School of Health Sciences, IGNOU, New Delhi