:: 63 :: Healthline Journal Volume 6 Issue 1 (January - June 2015) Letter to Editor Kala-azar elimination efforts in India: A chronicle and challenges Geetha Mani , Raja Danasekaran , Kalaivani Annadurai 1 1 1 1 Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India. Dr. Geetha Mani, E mail: drgeethammc@gmail.com Assistant Professor, Department of Community Medicine, Correspondence : Abstract : Key words : Kala-azar (KA), the dreadly visceral form of Leishmaniasis is fatal if untreated. India alone accounts for 50% of the global burden. Though India's endeavours against KA date back to 1991, KA control and elimination has eluded us so far. Considering the high KA burden and its health and socioeconomic implications, India has accelerated its efforts to achieve KA elimination by 2015, which has been summarised in this paper. Kala-azar; elimination; India Dear Editor-in-Chief, Kala-azar (KA), meaning "black sickness" or "deadly disease" in Assamese, is the most severe visceral form of Leishmaniasis and one among the world's neglected tropical diseases (NTD). It affects the poorest, most vulnerable and remote population, with a high degree of fatality if untreated. The disease is endemic in 98 countries; with approximately 500000 people suffering from KA. KA is the second major parasitic killer after malaria . Five countries namely India, Bangladesh, Nepal, Brazil and Sudan share 90% of global KA burden. Three of above countries are in South-East Asian Region (SEAR) where an estimated 200 million are at risk. India alone accounts for 50% of the global burden of KA. Early KA control efforts in India dates back to 1991. Kala-azar control programme was launched in 1992. Various factors favour KA elimination in India: Man is the only reservoir (anthroponotic) unlike the zoonotic form of KA in Mediterranean and Middle East regions; Phlebotomus argentipes is the only vector; KA is localised in 54 endemic districts across 4 states and effective field-based diagnostic kit and safe drugs are available. But review of past efforts reveal that the burden of KA and the control efforts are complicated by various social factors such as poverty, poor nutritional status, increased population movements, civil conflicts and warfare, ecological changes that increase human contact with sand fly vector, prevalence of HIV infection, parasite [1] [1] [1] [2] [1, 3] [2] [2] [3] [3] [3] [3,4] resistance to antileishmanial drugs, inadequate access to healthcare and treatment. National Health Policy (2002) deadline for KA elimination was extended from 2010 to 2015. The tripartite (India, Bangladesh, Nepal) Memorandum of Understanding (MoU) in 2005, called for aggressive action to reduce KA incidence to less than 1 per 10000 inhabitants per year in endemic areas at sub-district level by 2015. Between 2008 and 2014, India has recorded 72.5% reduction in the number of cases and 92.7% reduction in the number of deaths. With the reporting of sporadic cases in Bhutan and Thailand, these countries have joined India, Bangladesh and Nepal in signing another MoU in September 2014 for collaborated efforts to eliminate KA in the respective countries. Following strategies were recommended: improving access to early diagnosis and treatment; stronger disease and vector surveillance and integrated vector management with strong emphasis on environmental improvement, social mobilization, research and networking. Following the MoU, the Government of India released a National Roadmap for KA elimination (NRKE) by 2015 with specific emphasis on coordinated active and passive case search, notification of all cases of KA, use of low-cost indigenous diagnostic kit developed by Indian Council for Medical Research (ICMR), supply of synthetic pyrethroid for house-spraying in endemic areas and administration of single dose liposomal Amphotericin B (LAmB) for all positive patients. [1, 3, 4] [3] [4] [5] [6] [6] [3, 7]