Kala-azar Visceral Leishmaniasis (VL) (NVBDCP)

Kala-azar or Visceral Leishmaniasis (VL) is a chronic disease caused by an intra-cellular protozoan (Leishmania species) and is transmitted to man by the bite of the sand fly. It is currently a major problem in Bihar, Jharkhand, West Bengal and some parts of Uttar Pradesh. The Government of India has targeted the elimination of Kala-azar with the aim of reducing the annual incidence of cases to <1 per 10,000 population in block level.

Important facts

There are 3 main forms of leishmaniasis - visceral (also known as kala-azar, which is also the most severe form of the disease), katanius (most common) and mucocutaneous.
Leishmaniasis is caused by the protozoan leishmaniasis parasite, which is transmitted by the bite of an infected female phlebotomine sandfly.
The disease affects the world's poorest people and is associated with malnutrition, population displacement, poor housing, a weakened immune system and a lack of financial resources.
Leishmaniasis has been linked to environmental changes such as deforestation, dam construction, irrigation schemes and urbanization.
It is estimated that 700 000 to 1 million new cases occur annually.
Only a small percentage of people infected with the parasite leishmaniasis eventually develop the disease.

Signs and symptoms

Loss of appetite, paleness and weight loss with progressive weakness.
Splenomegaly: the spleen rapidly enlarges to a massive enlargement, usually soft and not tender
Liver: enlarged spleen, soft and smooth surface, sharp edge
Lymphadenopathy: not very common in India
Skin: dry, thin and flaky and hair can be lost.
Anemia: develops rapidly

Kala-azar removal program

Visceral Leishmaniasis is amenable to elimination in South-East Asia Region of WHO. The agreement, signed by Bangladesh, Bhutan, India, Nepal and Thailand, aims to eliminate Kala azar in 2017 or earlier.

Goal

Improve the health status of vulnerable groups and populations at risk living in endemic areas of Kala-azar by eliminating Kala-azar so that it is no longer a public health problem.

Target

Reduce the annual incidence of Kala-azar to less than one per 10,000 populations at the APS block level.

Objective

To reduce Kala-azar in vulnerable, poor and un-reached populations in endemic areas
To reduce Kala-azar case fatality rates to a negligible level
To reduce PKDL cases to interrupt Kala-azar transmission
To prevent the appearance of co-infections due to Kala-azar and HIV / TB in endemic areas.

Strategy

Elimination of parasites and disease management
Early case detection and complete treatment
Strengthening of the reference

Integrated vector control

Indoor residual spraying (IRS) or environmental management for maintenance sanitation and hygiene

Support interventions

Behavior change communication for social mobilization or inter-sectoral convergence
Capacity development through training and monitoring and evaluation
To accomplish the Kala-azar elimination objective, the Government of India is providing 100% support for endemic States since 2003-04.
The initiatives undertaken for the elimination of Kala-azar are like follow: a Diagnostic tool, ie RDK for Kala-azar has been introduced in all endemic Kala-azar districts.
Effective oral medication: miltefosine has been introduced and expanded in all affected districts as the first line of treatment.
Interior residual spray with DDT 50% for vector control.
Incentive to the Kala-azar patient towards the loss of wages during the period treatment.
Free dietary support for the patient and an assistant accompanying the patient.

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