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Kala Azar-free tag only a year away for India

By, New Delhi
Feb 05, 2025 05:16 AM IST

India is on track to be declared free of Kala Azar by 2024, achieving elimination targets set by WHO after decades of efforts against the deadly disease.

India is a year away from being declared free of Kala Azar, a deadly parasitic disease that has plagued the subcontinent since the 19th century, a moment that would mark a significant milestone against an illness that once influenced popular culture.

Kala Azar-free tag only a year away for India
Kala Azar-free tag only a year away for India

Official health surveillance data shows the country has maintained disease levels below World Health Organization’s elimination thresholds for two consecutive years, setting the stage for official WHO certification if the trend continues.

“All endemic blocks have achieved the target of less than one case per 10,000 population by the end of 2023, which highlights the success of the government’s decades-old elimination programme,” a senior government official said, asking not to be named

Kala Azar, known medically as visceral leishmaniasis, ranks as the second deadliest parasitic disease globally after malaria. The name derives from Hindi and Persian words meaning “black disease”, referring to the characteristic skin darkening in patients. In India, the disease is transmitted exclusively by the Leishmania donovani parasite through sandfly bites. The disease dominated popular culture in the country in 50s.

Union health minister JP Nadda said India reached the elimination target in 2023, ahead of the global 2030 target under sustainable development goals. “The efforts are going to be towards sustaining the same for the country to be declared Kala Azar free by the WHO,” Nadda said.

Government data shows a steady decline in cases: 818 cases and three deaths in 2022, dropping to 524 infections and four deaths in 2023, and further decreasing to 438 and two deaths in 2024. Bihar and Jharkhand, traditionally the most affected states, reported 242 and 150 cases respectively last year. West Bengal documented 32 cases, Uttar Pradesh 12, and Sikkim two.

The disease manifests in three forms: visceral (affecting internal organs), cutaneous (skin), and mucocutaneous (mouth, nose, and throat). The visceral form proves fatal in 95% of untreated cases.

India’s battle against Kala Azar dates to the earliest documented outbreak in 1824-1825 in Jessore, now in Bangladesh, which claimed approximately 750,000 lives over three years. Before DDT use, eastern Indian states experienced cyclical outbreaks lasting about 10 years, with 10-15 year intervals between epidemics.

A WHO report details the historical pattern: “Before DDT became available, periodic outbreaks of Kala Azar occurred in the eastern Indian states of Assam, Bihar, Jharkhand and West Bengal and eastern parts of Uttar Pradesh, lasting for about 10 years, with inter-epidemic periods of 10-15 years.”

The National Malaria Eradication Programme of 1950 marked a turning point by introducing indoor residual insecticidal spraying, significantly reducing sandfly populations. However, as the WHO documented, “A resurgence occurred in the 1970s with gradual spread, after removal of insecticidal pressure, coupled with a relaxed surveillance system and continued occurrence of post-kala-azar dermal leishmaniasis, a skin manifestation of Kala Azar sequelae and a potential reservoir of disease.”

The government launched its first centrally-sponsored control program in 1990-91, achieving early success by reducing cases from 77,102 with 1,419 deaths in 1992 to 22,625 cases with 277 deaths by 1995. Officials revised the program in 2000 to target elimination, though deadlines shifted twice.

Recent success stems from comprehensive socioeconomic interventions. The government provides financial incentives to ASHA health workers for case identification and treatment follow-up, offers wage loss compensation to patients, and ensures free diagnosis and treatment at community health centers in endemic areas. The program also fosters competition among states and districts through performance incentives.

Health experts attribute the breakthrough to the Comprehensive Case Management Programme model, which established universal access to diagnosis and treatment while enhancing surveillance. The program demonstrated an 85% reduction in cases, leading to the incorporation of its practices into the national vector-borne disease control program.

If current trends hold, India will eliminate a disease that has burdened its public health system for over two centuries, marking a significant victory particularly for the country’s rural poor communities most affected by the disease.

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