Treating visceral leishmaniasis in India
Visceral leishmaniasis (VL) a neglected tropical disease also known as black fever or kala azar, is the second most fatal parasitic infection globally. As recently as 2014, VL infected thousands of people in India. The mortality rate if untreated is about 95% of infected individuals, with people in low income, heavily populated areas being most affected. Because of these high numbers, the government of India and Ministry of Health at national and state level focused on multifaceted approaches to increase visibility of the disease and promote early prevention and intervention strategies. By 2023, India had decreased the number of cases from the thousands to less than 500 cases.
Problem Statement
VL is a tropical disease with a lengthy latency period that allows it to be transmitted unknowingly through populations, especially in low income areas where people have limited access to healthcare and live in close proximity to one another.
Context
VL is transmitted via the female sandfly which bites humans and other animals for a blood meal in order to produce eggs. Sand flies can be infected with the VL parasite, which then gets transmitted to the human or animal hosts. The V.L. parasite infects its human host for up to two years before it begins to cause inflammation of the spleen and liver. However, during this time, the parasite can be transmitted from one person to another unknowingly. If left untreated, the disease is fatal for 95% of those who are infected. Additional risk factors can make people more susceptible to the parasite, including malnutrition. Overpopulated areas are susceptible to increased sandfly populations. Medical treatment for VL consists of antiparasitic and antifungal medications.
Factors within the Problem Situation
- Lower income areas have a harder time paying for testing and treatment
- Pesticides failed to eliminate the problem
- Disease latency makes it difficult to detect and treat VL
- Rates of the disease were incredibly high to begin with
Implementers/Actors/Stakeholders
- Ministry of Health officials (at every level including national, state, and local)
- Joint VL. elimination initiative supported by World Health Organization
- Donors that have invested aid and other resources in this issue and area
- Policy makers within the government and external stakeholders that influence policy (lobbyists, experts, political appointees, media)
- Representatives of civil society that might be impacted by the issue such as religious and community leaders from various castes and social classes, educational institutions, agricultural cooperatives
- Community members in affected areas in India, Bangladesh, and Nepal
Intervention
Beginning in the 1990s, but then with more focus in the 2000s, the Indian Ministry of Health in a joint effort with physicians and epidemiologists embarked on a program that targeted the spread, treatment and general lack of knowledge around the disease. Their intervention was multifaceted, targeting first the lack of awareness of the disease and then addressing the overcrowding, lack of testing and general costs of care.
Additional Information
Moore and Lockwood. (2010). Treatment of Visceral Leishmaniasis.
CDC. (2024). Clinical Testing and Diagnosis for Leishmaniasis.
Tripathi. (2024). Expert Q&A: How India took on a deadly neglected tropical disease.
