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A look at Visceral leishmaniasis (VL) or Kala -azar and Neglected Tropical Diseases (NTDs ) in India


In a statement to The Hindu in 2011, Peter Hotez  had said that with more than half of the major Neglected Tropical Diseases (NTDs ) attaining endemic proportions in India and South Asia, the economic loss attributed to these diseases was significant He  indicated that close to $1 billion per year was lost due to lymphatic filariasis (Kala-azar) alone. Peter Hotez is the President of the Sabin Vaccine Institute in the United States.

The WHO classifies the neglected tropical diseases to be those which are not in the purview of the policy makers of a nation. According to its description, these diseases affect the poorest sections of the society and carry a high burden of mortality and morbidity. Nearly one billion people suffer from one of the NTDs. The burden of these diseases is the highest in India and South Asia. According to an article published in 2011, titled A Disproportionate Burden of NTDs found in India and South Asia, tropical diseases scientists said that although India and South Asia had made significant economic progress, NTDs continued to perpetuate a cycle of poverty among its most disadvantaged populations. The disease is most common in agricultural villages where houses are frequently constructed with mud walls and earthen floors, and cattle and other livestock live close to humans.

An estimated 1.3 million new cases and 20 000 to 30 000 deaths occur annually worldwide due to Kala-azar.According to the National Vector Borne Disease Control Program of India, (NVBDCP) the main states that are under risk for this particular disease are Bihar, Jharkhand, Uttar Pradesh and West Bengal,  with an estimated 165.4 million population at risk in the 4 states. Bihar accounts for at least 80% of the cases in India.

Last year  in September, the former Health Union Minister , Dr. Harsh Vardhan set a target of eliminating Kala-azar from Bihar by 2015. According to reports, this initiative would include the use of the Ambisome injection, which costs $18 each, will be funded by WHO and other agencies. Ambisome, experts said will prove to be a milestone because of its 98% efficacy. The decision to use the injection came following reports in August that the injection had cured 16 patients with this disease. The high rates of coinfection between HIV and Kala azar is also a cause of concern for the NVBDCP as this also raises the cost of treatment to the government and patients.Antiretroviral treatment reduces the development of the disease, delays relapses and increases the survival of the co-infected patients.


The WHO states that Kala-azar  can be prevented through available technologies, political commitment and community participation. Bangladesh, India and Nepal signed a memorandum of understanding in 2005 to eliminate Kala-azar. Most of these countries have the goal to eliminate the disease by end of 2015. To achieve this the NVBDCP has acknowledged that there need to be more awareness programs to increase treatments for the disease and to build the capacities of the ASHA and ANWs  in the infected areas. A paper published last year though does look at the reasons why India will not reach its goal for elimination by this year. According to its author some of the main reasons for this are the vector control practices of the government. However, the central government at the moment is hopeful of eradicating the disease in Bihar at least with the help of the Gates Foundation.

To read more about the signs and symptoms of Kala-azar, click here

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