For decades, 40 million people have been at risk of visceral leishmaniasis (VL) in Bangladesh. The first recorded VL outbreak occurred in 1824 when 75,000 people died. The disease, which is also known as kala-azar, re-appeared in the country in the early nineties. From 1994 to 2015, there were 110,756 reported cases from 45 districts. The victims of the disease are the poorest of the poor and many of those affected live in areas adjacent to VL areas in India, over the border.
VL could be eliminated from the Indian sub-continent as a public health problem given its unique epidemiology, its ability to be diagnosed with a rapid test and the existence of the effective single dose injectable drug for treatment (AmBisome®). To fight against this deadly disease, the Governments of Bangladesh, India and Nepal first signed a Memorandum of Understanding (MoU) to eliminate kala-azar as a public health problem (defined as less than 1 case per 10,000, at the sub-district level) by 2015, later extended to 2017 in the Dhaka Meeting of the Health Ministers of Bangladesh, India, Nepal, Bhutan and Thailand.
The national kala-azar elimination program of Bangladesh began in 2007 and has made impressive progress. The target of the elimination was achieved in 96% of the endemic upazilas in 2015 and 100% in 2016. In April 2017, still 100% of upazilas (100 programme upazila among 489 upazilas in total national geographical distribution) had achieved this. Overall the number of reported VL cases has also declined dramatically from 9,379 in 2006 to only 176 in 2018, while the level of underreporting has reduced due to better access to treatment services. By the end of 2018, the elimination threshold in Bangladesh 100% of upazilas has been maintained.
Even though case reduction to less than 1 per 10,000 people in all kala-azar endemic upazilas has been achieved in Bangladesh, it is not sufficient to obtain certification as kala-azar eliminated country. The elimination threshold must be maintained for 3 years followed by a WHO validation process. The elimination programme in Bangladesh must sustain its achievement in its consolidation and maintenance phases and beyond in order to prevent periodic epidemic peaks of VL which have been happening over decades.
The general objective of KalaCORE has been to support the Government of Bangladesh in implementing the National Kala-azar Elimination Programme’s (NKEP) activities with the target of achieving and sustaining kala-azar elimination as a public health problem in Bangladesh with the involvement of the public, private and community stakeholders. Further information can be found on KalaCORE Bangladesh website http://kalacorebd.com/