• India is on the verge of eliminating kala-azar (visceral leishmaniasis) as a public health problem, having maintained fewer than one case per 10,000 people in endemic areas for two consecutive years, meeting the World Health Organisation (WHO) elimination criteria. 

• If this trend continues for another year, India will be eligible for WHO certification of kala-azar elimination, joining Bangladesh as one of the few countries to have achieved this.

WHO certification criteria:

To be certified for elimination, a country must:

• Prove local transmission has been interrupted for a set period.

• Show there are systems in place to prevent re-emergence of the disease.

Key facts about kala-azar:

Second deadliest parasitic disease after malaria in India, caused by the protozoa parasite transmitted through infected female sandfly bites.

Symptoms: 

• Irregular fever 

• Weight loss 

• Enlarged spleen and liver 

• Anemia.

• Over 95 per cent of untreated cases can lead to death.

• India’s efforts led to 595 cases and 4 deaths in 2023, and 339 cases with one death in 2024 so far.

Progress in eliminating kala-azar:

• Historically, Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh reported the highest number of cases, with Bihar accounting for over 70 per cent of India’s total cases.

• The Union government's approach to eliminating kala-azar involves multiple strategies, including improving housing, electrification, and health infrastructure. 

• The National Kala-azar Elimination Programme operates under the National Vector Borne Disease Control Programme (NVBDCP), which is part of the National Health Mission (NHM). 

Key actions include:

• Pucca Housing and Electrification: Programmes like PM-AWAS Yojana and rural electrification improve living conditions, reducing the sandfly breeding grounds that transmit the disease.

• Testing and Treatment: The government provides diagnostic kits, medicines, and sprays to states, alongside active case detection and treatment to control kala-azar outbreaks.

• High-Level Reviews and Incentives: Regular monitoring and rewards for states that make progress toward elimination encourage consistent efforts.

• International Cooperation: India’s collaboration with Bangladesh and Nepal through a tripartite MoU shows a regional commitment to eliminating kala-azar in the South-East Asia Region.

Key preventive measures include:

• Spraying insecticides in affected areas, particularly in and around homes, reduces sandfly populations.

• Using insecticide-treated bed nets helps protect individuals from sandfly bites while sleeping.

• Application of skin or clothing repellents provides an additional layer of protection.

• Constructing pucca houses, sealing cracks in walls, and maintaining cleanliness reduces the sandflies' breeding grounds.

• Access to clean water and improved sanitation helps prevent the environmental conditions that facilitate sandfly breeding.

• In endemic areas, the WHO recommends administering preventive drugs to the population to control the spread of the disease.

Treatment of kala-azar:

• The treatment for kala-azar requires timely administration of drugs to prevent fatal outcomes. Since drug resistance and treatment failure are risks, combination therapies are recommended. 

Common treatments include:

• Sodium Stibogluconate: An antimonial drug used for many years in treating kala-azar.

• Meglumine Antimoniate: Another antimonial drug used in combination with others.

• Combination Therapies: The WHO advises using a combination of drugs, such as sodium stibogluconate with amphotericin B or paromomycin, to improve treatment efficacy and reduce the risk of resistance.

(The author is a trainer for Civil Services aspirants.)