India’s Push for WHO Certification in Eliminating Kala-azar

India’s Push for WHO Certification in Eliminating Kala-azar

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India is on the verge of achieving a significant milestone by seeking certification from the World Health Organization (WHO) for eliminating Kala-azar as a public health problem. The country has maintained the required criteria for elimination—less than one case per 10,000 people for two consecutive years.

About Kala Azar:

Kala-azar, also known as visceral leishmaniasis, is the second deadliest parasitic disease after malaria in India.

The disease is caused by the protozoan parasite Leishmania donovani, transmitted through the bite of an infected female sandfly.

Kala Azar is a parasitic infection transmitted by sandflies. It causes fever, weight loss, spleen and liver enlargement. 

It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anemia.

Most cases occur in Brazil, east Africa and India.

Kala-azar is a treatable and curable disease, which requires an immunocompetent system. 

If left untreated, it can be fatal in 95% of cases.

PKDL or Post Kala-azar dermal leishmaniasis, is a well-recognised complication which causes scaly skin patches and nodular lesions in people who have been apparently cured of Kala Azar up to two years of the initial infection.

Leishmania-HIV co-infection refers to the People living with HIV and who are infected with leishmaniasis have high chances of developing the full-blown disease, high relapse and mortality rates.

Patients only need an IV drip of the medicine, which takes about two hours, for the infection to be cured.

There are 3 main forms of the disease:

Visceral leishmaniasis (VL), also known as kala-azar, is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anemia.

Most cases occur in Brazil, east Africa and India.

Cutaneous leishmaniasis (CL) is the most common form and causes skin lesions, mainly ulcers, on exposed parts of the body. These can leave life-long scars and cause serious disability or stigma.

Mucocutaneous leishmaniasis leads to partial or total destruction of mucous membranes of the nose, mouth and throat.

India’s Progress Towards Elimination:

To achieve WHO certification, India must maintain a rate of fewer than one case per 10,000 people for another year. This would make India the second country, after Bangladesh, to eliminate Kala-azar as a public health issue.

India’s National Health Policy (2002) originally aimed to eliminate Kala-azar by 2010, but this goal has been revised multiple times to 2015, 2017, and finally 2020.

The WHO set a global target to eliminate Kala-azar by 2020, which has now been extended to 2030 due to delays.

WHO Certification Criteria: A disease is declared eliminated when a country can prove that local transmission has been interrupted for a specific time period and there are preventive measures in place to avoid a resurgence. India’s elimination certification depends on maintaining less than one case per 10,000 people at the sub-district (block PHCs) level for two consecutive years.

Vulnerable Regions:

The highest number of Kala-azar cases come from Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh.

Bihar alone accounts for 70% of the country’s cases, driven by factors like poor sanitation and climate conditions, which are conducive to sandfly breeding.