India remains the main focus of visceral leishmaniasis (VL) disease burden in the South Asia. The States of Bihar and Jharkhand remain the most endemic for VL infection.
India has made good progress towards VL elimination. In 2013, 13,869 cases were reported, representing a drop of over 50% from 2010. Since 2013, absolute case-load has decreased (6,245 cases were reported in 2016) owing to significant control efforts. A number of factors are likely to have contributed to this fall in numbers, however, one of which is the natural epidemiological trend of VL.
The department overseeing India’s VL strategy is the National Vector Borne Disease Control Programme (NVBDCP). Major components of the stretegy have been the introduction of single day AmBisome treatment and the change of insecticides. KalaCORE was responsible for rolling out of the first component. In early 2017, the NVBDCP published a new roadmap for the elimination of VL in India as a public health problem in the ‘Accelerated Plan for Kala-Azar Elimination’).
As the 2017 elimination target approaches, there is an increasing sense of political urgency for this goal to be met. It has become clear was that there also needs to be a focus on sustaining elimination targets so that a resurgence does not occur in the mid-long term; or if it does, that cases are detected early and managed appropriately.
Challenges
Building on opportunities
Objectives
The active-case detection programme has begun its phase 1 roll-out in Bihar. Preparations (village mapping, approvals from government, liaising with district and block officials and training of front line workers) have been completed and field work has begun. In 3 days of "real" field operations 10 field teams (one person from IPE Global: India and one government staff member) covered 2760 households, equivalent to approximately 14,000 people. Most of the households were situated in very poor communities. We found 122 suspect cases of VL and PKDL.
We also introduced active-case searching through the Behaviour change communication (BCC) teams of New Concepts. Under this component the team from NC, after the Information Education Communication/BCC session (community group session), searched for any suspected VL or PKDL cases. This was done mainly through asking questions to the communities they interacted with, or by asking community health workers or other key people in the community. The teams have been able to identify more than 1,800 suspected cases of VL or PKDL, of which 211 were confirmed as VL and 35 as PKDL. These confirmed cases were then referred to PHC (via a referral slip). However, only 50% of these individuals went to the PHC for confirmatory diagnosis. We are looking at ways to increase this proportion.