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The Union Minister for Health and Family Welfare, Dr. Anbumani Ramadoss has asked the states to adopt a two-pronged strategy for elimination of Kala-Azar in the country. Addressing a review meeting on the subject held recently, the Minister underlined urgent need for close monitoring and supervision of programme implementation at all levels with appropriate micro-planning in consultation with inter-sectoral partners including civil society organizations so that there is ownership of the programme and equal participation by them to fight the disease.
The Minister said that the Government is providing 100 per cent assistance in cash and kind to four endemic states namely, Bihar, Jharkhand, Uttar Pradesh and West Bengal under the Kala-Azar Control Programme for insecticides and Anti-Kala-Azar medicines as well as resource based IEC, capacity building and case research activities. He stated that there was need for a commitment in this regard and that goals could only be achieved if there are conscious efforts on part of the states in respect of effective programme implementation and continual monitoring.
Leishmaniasis, commonly known as Kala-azar, is a disease which is transmitted by sand flies. It is a major public health problem in 88 countries, spread over 4 continents, with an yearly incidence of 1.5 million cases of cutaneous infection and over 0.5 million of visceral cases. More than 90% of the visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan.
In India, Kala-azar has been an age-old disease and is still persisting and causing sufferings to many. It is presently endemic in parts of four States namely, Bihar, Jharkhand, West Bengal and Uttar Pradesh. An estimated 129 million population is exposed to the risk of Kala-azar in the endemic districts of these four States out of a total of 147 million at risk in the South East Asia Region.
Historically, with the launching of insecticidal spraying under National Malaria Control Programme/National Malaria Eradication Programme since 1953 and 1958 respectively, the disease declined to negligible proportions due to collateral benefit of insecticidal pressure on the vector of Kala-azar, with consequent interruption of transmission. However, withdrawal of insecticidal spraying from erstwhile malaria endemic areas resulted into gradual build up of vector population that ultimately led to resurgence of Kala-azar.
The disease is prevalent mostly among lower socio-economic groups of the population in rural areas, the marginalized and disadvantaged. It is often labelled as a disease associated with poverty since the living habits of these marginalized populations facilitate vector breeding and malnutrition with lowered immunity make them predisposed and susceptible to infection. Children and young adults, representing economically productive sections are the most vulnerable groups, although all age groups are affected.
Realizing the need for concerted efforts to tackle this problem, Government of India initiated an organized control programme in endemic areas in 1990-91 and intensified it in 1991-92. The programme strategy includes early case detection and complete treatment, interruption of transmission through vector control by residual insecticidal spraying in affected areas, communication for behavioural impact and social mobilization, public-private partnership, capacity building through training and operational research. The strategy has been successful in bringing down the annual disease incidence by 70 per cent and disease associated mortality by 89 per cent in 2004 (22699 cases and 150 deaths) as compared to 1992 (77099 cases and 1419 deaths).
However, due to certain operational constraints, the disease is persisting in pockets of the above-mentioned four States. Moreover, in recent years (2003 & 2004) the trend of Kala-azar in the endemic states is showing an increasing trend. This is a source of concern as the country has effective insecticide DDT for vector control and effective indigenous anti Kala-azar medicines for treatment.
Since December 2003, Government of India provides 100% assistance in cash and kind to four endemic States namely, Bihar, Jharkhand, Uttar Pradesh and West Bengal under Kala-azar Control Programme, for insecticides and anti-Kala-azar medicines as well as resource based IEC, capacity building and case search activities and operational wages for spray workers. The Government of India also meets freight charge for DDT transportation up to consignee level.
The Government, in its National Health Policy-2002, has envisaged Kala-azar Elimination by 2010. To augment our efforts in this direction and give thrust to improvement of availability of and access to quality health care services to rural people as well as community empowerment and mobilization, the Prime Minister has launched the National Rural Health Mission (NRHM) on April 12, 2005. The Mission is a commitment for upliftment of the rural poor, marginalized, vulnerable sections of society towards paving a healthy nation.
Government of India has also signed a Tripartite Memorandum of Understanding (MoU) with Nepal and Bangladesh in May 2004, on elimination of Kala-azar from the South East Asia region by 2015, to mitigate poverty and strengthen health development efforts in the country and South East Asia Region.
As a follow-up of this tripartite agreement, a technical committee meeting was held in Rajasthan attended by officials of India, Nepal and Bangladesh.
The meeting has decided to synchronize spraying activities and share information on large movements of population from endemic areas across the borders as well as incidents of drug resistance. Coordinated action can go a long way in containing the disease. Conscious effort on the part of the affected states for effective programme implementation and continual monitoring will help in speedy eradication of Kala-azar.
*Information Officer, PIB, New Delhi
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