Kala-azar (Visceral Leishmaniasis) Elimination in Bangladesh: Successes and Challenges

Abstract

Visceral leishmaniasis (VL) also known as kala-azar is a major public health problem in Bangladesh. A national VL elimination program was initiated in 2008 in Bangladesh after the signing of a memorandum of understanding between the Government of Bangladesh, India, and Nepal in 2005 for the elimination of VL from these three countries by 2015. Following the strategic plan of the VL elimination program of the three countries, the national program in Bangladesh was established in 2008. Based on information in the directorate general of health services, expert opinions in a recently held advocacy meeting in Dhaka and on available scientific literature, we report here the successes and challenges of the national VL elimination program in Bangladesh. The program prepared the national kala-azar elimination guidelines and strategic plan for VL elimination in consultation with the technical working group for VL elimination and VL experts in Bangladesh and abroad, including the World Health Organization-The Special Programme for Research and Training in Tropical Diseases (TDR). The program trained health staff from all VL endemic hospitals in proper diagnosis and treatment, stratified the country according to VL burden, and introduced the rapid diagnostic test and oral treatment with miltefosine at no cost for patients. Integrated vector control management with indoor residual spraying and the distribution of commercial, long-lasting, insecticide-treated bed-nets were also studied and then implemented. VL burden has declined, but is still far from the target of VL elimination. Thus, the program must continue to maintain these activities and also introduce new activities to involve community participation in the program. The program is facing challenges regarding the shortage of human resources and logistics because of a scarcity of resources. To maintain the success of the program, support from national and international donor agencies and policy makers will be necessary. Other options for the treatment of VL patients as well as for vector control must also be considered.