India’s neighbours Nepal and Bangladesh are doing a better job of eliminating kala azar (visceral leishmaniasis or VL), which causes fever, weight loss, anaemia and disfigurement. If untreated, it destroys the liver and spleen and kills 95% of those infected. Nepal has eliminated (less than one case/10,000 population) it in all its sub-districts and Bangladesh in more than 97%. India has eliminated the disease in around 85% of the 625 affected sub-districts and targets to reach elimination levels in all sub-districts by the end of 2017.“The World Health Organisation’s (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,” said Dr Dirk Engels, director of the department of control of NTDs, WHO.A big challenge for India is post-kala-azar dermal leishmaniasis, which is a complication of where an acute skin rash appears six months to one or more years after apparent cure. Unlike in most cases in Africa, it rarely heals spontaneously in India, where it becomes a reservoir for the epidemic, particularly in inter-epidemic periods.