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India to seek WHO certification for eliminating disease.

Overview of Kala-Azar (Visceral Leishmaniasis)

• Cause: Kala-azar is caused by the protozoan parasite Leishmania donovani, transmitted by the bite of infected female sandflies (Phlebotomus argentipes in India).
• Symptoms: Includes irregular fevers, weight loss, swelling of the spleen and liver, severe anaemia. If untreated, it is fatal in over 95% of cases.
• Affected Areas: Historically, Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh report the highest number of cases, with Bihar alone accounting for over 70% of India's cases.

India's Achievement in Kala-Azar Control

• Current Status:
  • India has managed to maintain Kala-azar case numbers below 1 per 10,000 population for two consecutive years.
  • This meets the WHO's criteria for elimination certification.
• 2023 and 2024 Statistics:
  • 2023: 595 cases and 4 deaths.
  • 2024 (so far): 339 cases and 1 death.

WHO Certification for Elimination

• WHO's Target: The World Health Organization aims to eliminate Kala-azar as a public health problem by 2030.
• Elimination Criteria: A country can be certified when:
  • Local transmission is interrupted for a specified period.
  • There is a system in place to prevent re-emergence of the disease.
• Global Context: Bangladesh is the first country to have eliminated Kala-azar, receiving WHO certification in October 2024, after reporting fewer than 1 case per 10,000 people for three consecutive years.

India's Kala-Azar Elimination Strategies

• National Health Policy (2002): Initially set the target to eliminate Kala-azar by 2010, revised multiple times, and is now aiming for 2030.
• Key Strategies:
  • Active Case Detection: Identification and treatment of all cases.
  • Vector Control: Targeting sandfly breeding grounds through insecticides and environmental management.
  • Community Awareness: Educating the public on disease prevention and early diagnosis.
  • Improved Surveillance: Ensuring rapid diagnosis and treatment access, including the use of the rK39 diagnostic kit.
  • Integrated Vector Management: Combining insecticide spraying with environmental changes to reduce sandfly populations.

Challenges and Areas of Focus

• Root Causes: Persistent issues like poverty, inadequate sanitation, and malnutrition contribute to the spread of Kala-azar, particularly in rural, impoverished areas.
• Long-term Solutions:
  • Strengthen vector control and improve sanitation.
  • Address socio-economic factors like poverty and displacement.
  • Invest in research for vaccines and new treatments.

Public Health Impact and the Way Forward

• Elimination Milestone: If India continues to reduce cases, it will join Bangladesh in eliminating Kala-azar as a public health threat.
• Sustaining Gains:
  • Surveillance and quick response to new cases remain critical.
  • Expand access to rapid diagnostic tools and effective anti-parasitic treatments.
  • Focus on inter-sectoral convergence, integrating efforts from various government sectors, including health, sanitation, and housing.