In a landmark achievement, Bangladesh has become the first country in the world to be able to eliminate kala-azar, a neglected tropical disease that affects the poor.
The World Health Organization (WHO) certified Bangladesh for this achievement at the Southeast Asian Countries Regional Meeting (SEARO) on Tuesday.
Regional Director Dr Poonam Khetrapal Singh felicitated Health Minister Zahid Maleque at the meeting in New Delhi.
“Congratulations Bangladesh for becoming the first country globally to be validated for elimination of visceral leishmaniasis or kala-azar as a public health problem. Regional Director Dr Poonam Singh today felicitated the Minister of Health Zahid Maleque,” the SEARO office said on X.
“Bangladesh achieved an elimination target of less than one case per 10,000 population at the sub-district level in 2017 and sustained it despite disruptions caused by the Covid-19 pandemic.”
Bangladesh was also felicitated for the elimination of lymphatic filariasis, commonly known as elephantiasis, as a public health problem.
Dr Singh presented an award to Health Minister Zahid Maleque for this milestone.
Eliminating neglected tropical diseases has been a regional flagship priority since 2014 for the WHO.
What is kala-azar?
Kala-Azar, also known as Visceral Leishmaniasis, is a disease of the viscera - the internal organs, particularly liver, spleen, bone-marrow and lymph-nodes. It is caused by a parasite called Leishmania Donovani.
The vector of the disease is the sand-fly. Kala-Azar is highly lethal and difficult to achieve a complete cure. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia.
The disease affects some of the world’s poorest people and is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of financial resources.
Bangladesh could eliminate it due to a holistic approach from case detection to treatment, Dr Abu Nayeem Mohammad Sohel, who worked with the government’s kala-azar elimination program for five years, told Dhaka Tribune.
Socio-economic development also contributed to the elimination. “People living in mud-built houses and close to the cow sheds are getting the infection because the sand-fly lives in such an environment. But now due to socio-economic improvement, housing conditions have been improved,” he said.
What is Lymphatic Filariasis?
Lymphatic filariasis, commonly known as elephantiasis, was a major public health problem in Bangladesh.
In 2001, Bangladesh established its national program to eliminate lymphatic filariasis which was endemic in 19 of its 64 districts. It is a disease that cripples and has significant social and economic impact on the affected communities.
Between 2001 and 2015, high coverage mass drug administration campaigns were rolled out in all endemic districts. Alongside, systematic and high-quality transmission assessment surveys were carried out by well-trained programme personnel between 2011 and 2021, according to the WHO.
Elephantiasis occurs when filarial parasites are transmitted to humans through mosquito bites.
The infection is usually acquired in childhood with painful and disfiguring visible manifestations appearing much later in life, often in the form of enlargement of body parts causing pain, severe disability, and associated stigma.
“Bangladesh’s achievement is commendable and follows strong political commitment, tireless efforts by health authorities, partners and the communities. It is also a result of innovative approaches and meticulous implementation of elimination strategies,” Dr Poonam Khetrapal Singh said in May while acknowledging Bangladesh’s achievement.
The elimination journey
Bangladesh witnessed the first outbreak of kala-azar in 1824 during British rule. It remained prevalent till 1960. Massive spraying for malaria eradication programs also helped control kala-azar in the 70s.
“In independent Bangladesh, we first saw the outbreak in 1994. And then it was prevalent in different districts mostly in the areas of Ganges basin,” Dr Abu Nayeem Mohammad Sohel said.
It was widespread in 134 upazilas under 34 districts. Mymensingh district was the most endemic area.
“We took a special program for kala-azar elimination in 2008 and ensured treatment to all. In 2012, there was door to door spraying in the affected areas. The government even started distributing costly drugs for free from 2014 to prevent relapse and complications,” he said.
“And due to those efforts, we could achieve the public health elimination target in 2016. WHO acknowledged that in 2018 and then according to protocol we had to retain this elimination level of less than one case per 10,000 populations for three consecutive years. Then due to Covid-19, the official declaration was delayed a year further,” he said.
In 2021, there were only 99 new cases and this year so far 78 cases were detected in Bangladesh.
According to WHO, there are three main forms of leishmaniasis: visceral, cutaneous that affects the skin, and mucocutaneous that affects mouth, nose and throat.
The visceral form is mostly found in Bangladesh, India and Nepal.
An estimated 700,000 to 1 million new cases occur annually in the world. Only a small fraction of those infected by parasites causing leishmaniasis will eventually develop the disease. Most cases occur in Brazil, east Africa and India.