GS Paper II

News Excerpt: 

India set to eliminate kala azar this year with no block in the country reporting more than one case per 10,000 people.

About Kala Azar:

• Kala-azar or Visceral Leishmaniasis is a protozoan parasitic disease, spread by sandfly bites. 
• Sandflies are brown and have hairs on their bodies. The flies are infected with the parasite called ‘leishmania donovani’.
• The vector sandfly is known to live in cracks and crevices of muddy houses, especially in dark and humid corners. According to the WHO, there are 3 main forms of leishmaniases, of which kala-azar is the most serious form.
• visceral also known as Kala-azar (the most serious form because it is almost always fatal without treatment),
• cutaneous (the most common, usually causing skin ulcers), 
• mucocutaneous (affecting mouth, nose and throat).
• The disease is endemic in Bihar, Jharkhand, Uttar Pradesh and West Bengal. An estimated 165.4 million people are at risk, according to data from the National Centre for Vector Borne Disease Control Programme (NCVBDC).
• Bangladesh became the first country in the world to be officially validated by the World Health Organisation (WHO) for eliminating kala azar as a public health problem.

Symptoms of Kala Azar In India:

• The skin may become dry, thin and scaly in patches, and hair may be lost. 
• Irregular bouts of fever over many days, 
• Weight loss, 
• Enlargement of the spleen and liver.
• Anaemia

Kala Azar in India:

• In West Bengal, the districts where the maximum number of cases were registered include Darjeeling, Malda, Uttar Dinajpur, Dakshin Dinajpur and Kalimpong. 
• The districts of Birbhum, Bankura, Purulia, and Murshidabad have also reported a few cases, while none have been detected in Kolkata yet.
• From more than 50 districts across four states, the disease was found to be higher than elimination levels in just four districts in Bihar and Jharkhand.
• India recorded 530 cases and four deaths due to the infection till October this year, compared to 891 cases and three deaths in 2022. 
• There were 1,357 cases and eight deaths recorded in 2021. There were also 286 reported cases of post-kala azar dermal leishmaniasis (PKDL) till October 2023. It involves completely curing the skin condition is essential as it can act as a reservoir for the parasite.

Elimination of Kala Azar From India:

India’s first target year for kala-azar elimination was 2010. This was later pushed to 2015, 2017 and 2020. Three key interventions helped India achieve the elimination targets this year.

• Spraying Indoor: The sandflies that transmit the infection usually breed in the crevices of mud walls. When there is effective indoor residual spraying, it prevents the breeding of flies and reduces the spread of diseases.
• Reducing crevices in ‘kaccha’ walls: Gerrard soil that is found in Jharkhand and neighbouring areas was used to plaster the walls and crevices. This soil does not come off easily and ensures that breeding doesn’t happen and reduces the breeding areas.
• ASHA Workers Initiative: Under this, the ASHA (About Accredited Social Health Activist) network was given the task of ensuring that people with PKDL complete their treatment. While one intravenous dose of the antimicrobial drug amphotericin B is effective in curing kala-azar, medicines have to be taken for at least 14 days or more for PKDL.

Further Challenges:

• Compliance is poor: One of the drugs used for the treatment is teratogenic, i.e., it results in abnormal development of the foetus during pregnancy. The drug cannot be given to children and pregnant women. 
• There is a need to ensure the availability of drugs such as paromomycin, used to treat those with HIV and kala-azar.
• Kala-azar tends to relapse in HIV patients, so adding the second-line treatment, such as paromomycin along with amphotericin, is important.
• Ensure strong surveillance to pick up even the few cases that come up. 
• Most of the kala-azar cases were reported from four states — Uttar Pradesh, Bihar, Jharkhand and West Bengal but now,  sporadic cases from other states are also being reported. 
• The medicine is not available in India, although it can be procured from the WHO. 

Way Forward: 

• Support National Kala-azar Elimination Programmes technically to produce updated guidelines and make disease control plans. Develop evidence-based policy strategies and standards for this programme and monitor their implementation.
• Always monitor disease trends and assess the impact of control activities which will allow raising awareness for disease.
• Promoting research and use of effective leishmaniasis control, including safe, effective and affordable medicines, diagnostic tools, and vaccines.