Health Ministers from Bangladesh, Bhutan, India, Nepal and Thailand Tuesday signed a Memorandum of Understanding to collaborate in the elimination of Visceral Leishmaniasis (kala-azar) from their countries . Over 147 million people in the South-East Asia Region are at risk of contracting this life-threatening disease, mainly in Bangladesh, India and Nepal, with recent, sporadic cases being reported from Bhutan and Thailand as well.

Phlebotomus papatasi sand fly–a vector of leishmaniasis Image/CDC
Phlebotomus papatasi sand fly–a vector of leishmaniasis

As over 50% of the cases in the three main affected countries occur in areas close to international borders, besides strong national efforts, countries also need close collaboration to control and eliminate this disease. Areas for collaboration among the five countries will include mutually agreed mechanisms of resource mobilization; exchange of information; inter-sectoral collaboration; research; capacity building and technical support.

Kala-azar is debilitating and often fatal if left untreated. It is transmitted by sandflies which breed in moist soil, caves, cracks in mud walls and rodent burrows. The poorest of the poor, particularly in communities living in remote, rural areas are most vulnerable to this disease. Associated with malnutrition, poor housing and illiteracy, kala-azar prolongs the cycle of poverty as people cannot afford treatment and therefore cannot work.

Elimination of kala-azar means reducing the cases to a level where it is no longer a public health problem. The target is to achieve less than one kala-azar case per 10 000 population annually, at the district or sub-district level.

“Kala-azar elimination is within our reach and WHO is committed to it”, said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia. “We now have field- friendly diagnostic tools and effective medicines for its treatment. WHO has negotiated for an assured free supply of the treatment drug to endemic countries till end-2016, with a likelihood of this arrangement being extended for another five years” she added.

The elimination strategy will include access to early diagnosis and treatment, particularly of the most vulnerable populations together with stronger disease and vector surveillance and integrated vector management with emphasis on improvement of the environment, social mobilization, research and networking. Elimination of kala-azar will contribute to mitigation of poverty and strengthen health and development efforts in the affected countries.