For decades after decades, 30 million people have been at risk of kala-azar in Bangladesh. The first outbreak of visceral leishmaniasis (VL), also known as kala-azar, happened in 1824 when 75,000 people died. The disease re-appeared in the country in the early nineties. From 1994 to 2013, there were 109,266 reported cases from 136 Upazilas (sub-districts). The victims of the disease are the poorest of the poor and many of those affected live in areas on the border to VL affected areas in India.
VL can be eliminated from the Indian sub-continent as a public health problem due to its unique epidemiology, its ability to be diagnosed with a rapid test and existence of an 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 cases 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 begun 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 (489 upazilas in total) had achieved this. Overall the number of reported VL cases has also declined dramatically from 9,379 in 2006 to only 168 in 2016, while the level of underreporting has reduced due to better access to treatment services.
Even though case reduction to less than 1 per 10,000 people in all kala-azar endemic upazilas (sub-districts) has been achieved in Bangladesh it does not suffice to obtain certification as kala-azar eliminated country, unless achievements are continued for three years and validation by the WHO is completed. 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 is 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/