Kala-Azar Elimination Program

The government of Nepal has committed to the regional strategy to eliminate Kala-azar and with India and Bangladesh is signatory of the memorandum of understanding that was formalized during the World Health Assembly held in May 2005 on Kala-azar elimination, with the target of achieving the disease elimination by 2015.

In 2005, Epidemiology and Disease Control Division (EDCD) of Department of Health Services  formulated a National Plan for the Elimination of Kala-azar which is divided into three phases: Preparatory Phase: 2005-2008; Attack Phase: 2008-2015 and Consolidation Phase: 2015 onwards. The overall goal of the plan is “To contribute to improving the health status of vulnerable groups and at risk populations living in Kala-azar endemic areas of Nepal through the elimination of Kala-azar so that it is no longer a public health problem”. The target is: “To reduce the annual incidence of Kala-azar to less than 1 per 10,000 populations at the district level by 2015”. Expected outputs of the Plan are six related to the different components of the system that has to be strengthened in order to achieve the elimination goal. One of the outputs is to develop a functional network that provides diagnosis and case management with special outreach to the poorest.

The national plan was revised in 2010 as National Strategic Guideline on Kala-Azar Elimination in Nepal which recommended rK39 as a rapid diagnostic test kit and Miltefosine as the first line of treatment in Kala-azar except in some situations. Kala-azar is a vector-borne disease caused by parasite Leishmania donovani, transmitted by the sand fly, Phlebotomus argentipes. The disease is characterized by fever for more than two weeks with spleenomegaly, anaemia, and progressive weight loss and sometimes darkening of the skin. In the endemic areas, children and young adults are its principal victims. The disease is fatal if it is not timely treated. Kala-azar and HIV/TB co-infections have emerged as a health problem in recent years.

Over the last decade, there have been some significant advances both in the diagnosis and treatment of Kala-azar. The rK39 dipstick test kit, a rapid and easily applicable serological test has been widely used in the Indian subcontinent including Nepal. The national programme to eliminate KA in Nepal has made this test kit available upto PHC centre level of programme districts. The recently revised national guideline has recommended introducing Liposomal Amphotericin B and combination regimen for KA and PKDL treatment in Nepal and MIltefosine, the only available oral drug and current treatment of choice in the country, will be gradually phased out.