India to seek certification from WHO for eliminating Kala-azar

• India could be at the threshold of eliminating Kala-azar as a public health problem with the country having managed to keep the number of cases under one in 10,000 as per the World Health Organization (WHO) parameters for elimination certification for two consecutive years now.

Highlights:

• India is on the verge of eliminating Kala-azar (visceral leishmaniasis) as a public health problem. The country has maintained a case rate of less than one per 10,000 people for two consecutive years, meeting World Health Organization (WHO) criteria for elimination certification.
• If India sustains these numbers for one more year, it could become the second country, after Bangladesh, to achieve this distinction.

Kala-azar: A Major Parasitic Threat:

• Kala-azar is the second deadliest parasitic disease in India, after malaria, caused by a protozoan parasite transmitted through the bite of infected female sandflies. Symptoms include:
  • Irregular fevers
  • Weight loss
  • Enlarged spleen and liver
  • Anemia
• The disease is highly fatal, with over 95% of untreated cases leading to death. In 2023, India reported 595 cases and four deaths. In 2024, the country has registered 339 cases and one death so far.

India's Progress and WHO Elimination Certification:

• The WHO requires countries to demonstrate less than one case per 10,000 people for three consecutive years to grant elimination certification. Bangladesh achieved this milestone in 2023, and India is now poised to follow suit if the numbers hold for another year.

Historical Challenges and Policy Adjustments:

• India’s National Health Policy initially set the goal of eliminating Kala-azar by 2010. However, this target was revised several times, moving to 2015, 2017, and later 2020, as part of the WHO’s Neglected Tropical Disease (NTD) Roadmap. Despite not meeting earlier targets, India is accelerating efforts to meet the 2030 goal set by WHO.
• Kala-azar is especially prevalent in states like Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh. Bihar alone accounts for over 70% of India's Kala-azar cases. Poor sanitation and favorable climate conditions in these areas provide ideal breeding grounds for sandflies. However, increased public awareness, better vector control, and timely diagnosis and treatment have significantly reduced cases.

Government Strategies to Combat Kala-azar:

• India’s Kala-azar elimination program focuses on several key strategies:
• Early Diagnosis and Case Management: Identifying cases early and ensuring complete treatment.
• Vector Control and Surveillance: Reducing the sandfly population through insecticides and environmental management.
• Community Awareness Campaigns: Educating the public about preventive measures and symptoms.
• Monitoring and Evaluation: Continuous surveillance and reporting to track progress.
• Inter-Sectoral Convergence: Coordinating efforts across various sectors to tackle root causes like poor sanitation and poverty.
• The Health Ministry’s integrated approach aims to maintain the low incidence rates by focusing on vector management, rapid diagnostic tools, and accessible treatment.

The Road Ahead: Sustaining Gains and Long-Term Solutions:

• While India is nearing the threshold for Kala-azar elimination, experts stress the importance of addressing underlying issues like poverty, inadequate sanitation, and vector control to prevent a resurgence. Dr. K. Madan Gopal from the National Health Systems Resource Centre highlighted the need for ongoing surveillance, improved diagnostic capabilities, and investment in research for vaccines and new treatments to ensure long-term success.
• The success of the Kala-azar program represents a significant public health achievement, and India’s efforts to maintain low transmission rates will be crucial in securing the WHO elimination certification.

Prelims Takeaways:

• National Health Policy (2002)