In his 2017 Budget speech finance minister Arun Jaitley had announced a slew of disease elimination targets with much fanfare. One of them – the 2017 deadline for elimination of Kala Azar just whooshed past. The number of KA endemic blocks has actually gone up in Bihar and Jharkhand and a related condition called Post Kala Azar Dermal leishmaniasis (PKDL) that may act as a reservoir of fresh KA infections is also on the rise.
Kala-azar is a slow progressing indigenous disease caused by a single-celled parasite of the Leishmania family. In India Leishmania donovani is the only parasite causing the disease. The parasite is found in abundance in the bone marrow, spleen and liver. Post Kala-azar Dermal Leishmaniasis (PKDL) is a condition when Leishmania donovani invades skin cells, resides and develops there and manifests as dermal lesions. Some kala-azar cases develop PKDL after a few years of treatment. According to data from the National Vector Borne Disease Control Programme, till October 2017, there were 4906 KA cases in India and 1661 of PKDL – four more than the year before.
The missed KA deadline was discussed in a health ministry meeting last month when a long pending request to the ministry of rural development for the construction of concrete houses in endemic districts was identified as a major reason for the delay in elimination. Elimination is defined as reducing the annual incidence of Kala-azar to less than 1 case per 10,000 population at the sub-district level.
The Empowered Programme Committee (EPC) of the National Health Mission discussed in its December 22 meeting the failure to eliminate KA. Dr P K Sen from NVBDCP said in the meeting that active case finding is the real reason for the increased numbers rather than actual increase in incidence.
“Dr Jagdish Prasad, DG, DGHS further added that the KA vector needs to be eliminated to eliminate Kala Azar. As the endemic blocks have majority of houses made from wood, it is very difficult to eliminate the vector as it dwells in the wooden structure and escapes various measures to kill it. Hence to break the infection transmission solution for this issue is to build pucca houses for people in these areas. Secondly even after treatment of Kala Azar patients completely, it is the Post Kala Azar Dermal Leishmaniasis (PKDL) cases which then becomes source for future KA cases,” read the minutes of the meeting.
