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Nepal and Bangladesh handle kala-azar better than India

Bangladesh and Nepal. Copyright: <a href=''>bogdanserban / 123RF Stock Photo</a>
Bangladesh and Nepal are outperforming India in the treatment of kala-azar.

Nations bordering India are much more successful at reducing the incidence of kala-azar (visceral leishmaniasis) than India, reports the Hindustan Times. Despite India significantly dropping the prevalence of kala-azar — a reduction of 82 percent — its neighbouring nations of Bangladesh and Nepal have done better.  

Nepal has eliminated kala-azar, defined by the World Health Organization (WHO) as a reduction of disease cases to below one per 10,000. This is the case in all sub-districts of Nepal, displaying an even reduction in cases on a nationwide level.

Bangladesh has eliminated the disease in 97 percent of all sub-districts. India is in a similar situation, eliminating the disease in 85 percent of the 625 affected sub-districts, though some areas remain prone to infection.

Kala-azar was recently featured in the government’s health budget, in which they pledged to eliminate the disease nationally. As discussed in a previous Health Issues India article, this promise has been made by many governments in the past.  The disease however, keeps recurring.

Kala-azar is caused by protozoan parasites and spread by female sandflies. The disease can recur if there is any one individual left untreated, as they act as a potential reservoir of parasites that can then be passed on if the individual is bitten by sandflies. Progressing to post-kala-azar dermal leishmaniasis, the parasites are hosted within a patient’s skin cells. In this stage of the disease the parasites are easily taken up by sandflies and spread to other individuals.

Kala-azar has the potential to be fatal. The disease affects the liver and spleen and can cause swelling, fever, anaemia and weight loss. Given time, or in combination with other conditions, the disease can kill the patient.

Without sustained control schemes, the chance of recurrence allows the disease to spread again, this has prevented India from eradicating the disease for many years. Recent news has seen the disease appear further north than usually expected, with reports of cases occurring in Uttarakhand. An expansion of the number of affected states would further complicate efforts to control the disease.

India intends to eliminate kala-azar before the end of 2017. Whether such a goal is possible is debatable due to the recurrent nature of the disease. The goal is at the very least ambitious. Dr Dirk Engels, director of the department of control of NTDs, WHO, says that the WHO global elimination target for VL is 2020 but “it’s good when a country or region sets ambitious targets to bring down incidence earlier,”

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