Villages In Bihar Research Articles

"I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India.

Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.

Gulf householding: implications of gulf migration for social reproduction

ABSTRACT This paper introduces the idea of ‘Gulf householding’ to reflect on migrant households that send their members to the Arab Gulf states for work and rely on material and non-material supports for formation and sustenance of households. Millions of households in the global South receive remittances from the Arab Gulf states, amounting to more than US$135 billion annually, and this vast amount of household income is a manifestation of Gulf householding. The paper examines the implications of Gulf householding for social reproduction by centreing on key spheres of household activities. Empirically, this study draws on interviews with Gulf migrant households at a village in Bihar, India. This research reports that access to the Gulf labour market and remittances shapes the quality of life of Gulf households. This study suggests that research on Gulf householding across multiple countries and regions has the potential to underscore the complex development processes from below.

Understanding Custom Of Forced Marriages: An Exploratory Study Of Bihar

There is a new trend arising among the villages of Bihar which is to abduct the Groom. The Grooms are abducted under gun points by the bride's family and are made to marry under force or threatening. Due to forced marriage practices, the women's married at an early and young age, so they never are independent and are not given enough time by their family to develop their skill or opportunity for self-dependent. Other-hand dowry and property were a huddle for women's lives, the patriarchal society introduced these practices for their benefit, but these practices of dowry became cursed for women's life. The study of forced marriage is not only an exercise study of marriage that is unorthodox and taboo in India, but it has a larger economic, social, political, etc. The issue of forced marriage is a very taboo subject from rural India through which we can enrich the understanding of gender politics, body politics, bio-politics and its intersection with the economic, political, social and cultural aspects that play a part in such rituals and events.

Field-friendly anti-PGL-I serosurvey in children to monitor Mycobacterium leprae transmission in Bihar, India.

It has been amply described that levels of IgM antibodies against Mycobacterium leprae (M. leprae) phenolic glycolipid I (PGL-I) correlate strongly with the bacterial load in an infected individual. These findings have generated the concept of using seropositivity for antibodies against M. leprae PGL-I as an indicator of the proportion of the population that has been infected. Although anti-PGL-I IgM levels provide information on whether an individual has ever been infected, their presence cannot discriminate between recent and past infections. Since infection in (young) children by definition indicates recent transmission, we piloted the feasibility of assessment of anti-PGL-I IgM seroprevalence among children in a leprosy endemic area in India as a proxy for recent M. leprae transmission. A serosurvey for anti-PGL-I IgM antibodies among children in highly leprosy endemic villages in Bihar, India, was performed, applying the quantitative anti-PGL-I UCP-LFA cassette combined with low-invasive, small-volume fingerstick blood (FSB). Local staff obtained FSB of 1,857 children (age 3-11 years) living in 12 leprosy endemic villages in Bihar; of these, 215 children (11.58%) were seropositive for anti-PGL-I IgM. The anti-PGL-I seroprevalence level of 11.58% among children corresponds with the seroprevalence levels described in studies in other leprosy endemic areas over the past decades where no prophylactic interventions have taken place. The anti-PGL-I UCP-LFA was found to be a low-complexity tool that could be practically combined with serosurveys and was well-accepted by both healthcare staff and the population. On route to leprosy elimination, quantitative anti-PGL-I serology in young children holds promise as a strategy to monitor recent M. leprae transmission in an area.

Comparison of collection methods for Phlebotomus argentipes sand flies to use in a molecular xenomonitoring system for the surveillance of visceral leishmaniasis.

The kala-azar elimination programme has resulted in a significant reduction in visceral leishmaniasis (VL) cases across the Indian Subcontinent. To detect any resurgence of transmission, a sensitive cost-effective surveillance system is required. Molecular xenomonitoring (MX), detection of pathogen DNA/RNA in vectors, provides a proxy of human infection in the lymphatic filariasis elimination programme. To determine whether MX can be used for VL surveillance in a low transmission setting, large numbers of the sand fly vector Phlebotomus argentipes are required. This study will determine the best method for capturing P. argentipes females for MX. The field study was performed in two programmatic and two non-programmatic villages in Bihar, India. A total of 48 households (12/village) were recruited. Centers for Disease Control and Prevention light traps (CDC-LTs) were compared with Improved Prokopack (PKP) and mechanical vacuum aspirators (MVA) using standardised methods. Four 12x12 Latin squares, 576 collections, were attempted (12/house, 144/village,192/method). Molecular analyses of collections were conducted to confirm identification of P. argentipes and to detect human and Leishmania DNA. Operational factors, such as time burden, acceptance to householders and RNA preservation, were also considered. A total of 562 collections (97.7%) were completed with 6,809 sand flies captured. Females comprised 49.0% of captures, of which 1,934 (57.9%) were identified as P. argentipes. CDC-LTs collected 4.04 times more P. argentipes females than MVA and 3.62 times more than PKP (p<0.0001 for each). Of 21,735 mosquitoes in the same collections, no significant differences between collection methods were observed. CDC-LTs took less time to install and collect than to perform aspirations and their greater yield compensated for increased sorting time. No significant differences in Leishmania RNA detection and quantitation between methods were observed in experimentally infected sand flies maintained in conditions simulating field conditions. CDC-LTs were favoured by householders. CDC-LTs are the most useful collection tool of those tested for MX surveillance since they collected higher numbers of P. argentipes females without compromising mosquito captures or the preservation of RNA. However, capture rates are still low.

Moderate Accuracy of Survey Responses about Infant and Young Child Feeding Counseling Reported by Mothers with Children Less than 1 Year of Age in India

BackgroundCounseling on infant and young child feeding (IYCF) to support optimal breastfeeding and complementary feeding practices is an essential intervention, and accurate coverage data is needed to identify gaps and monitor progress. However, coverage information captured during household surveys has not yet been validated. ObjectivesWe examined the validity of maternal reports of IYCF counseling received during community-based contacts and factors associated with reporting accuracy. MethodsDirect observations of home visits conducted by community workers in 40 villages in Bihar, India served as the “gold standard” to maternal reports of IYCF counseling received during 2-wk follow-up surveys (n = 444 mothers with children less than 1 y of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and AUC. Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. ResultsPrevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 wk was moderate (AUC: 0.60; 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, the recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Child age, maternal age, maternal education, mental stress, and social desirability were associated with reporting accuracy of multiple indicators. ConclusionsValidity of IYCF counseling coverage was moderate for several key indicators. IYCF counseling is an information-based intervention that may be received from various sources, and it may be challenging to achieve higher reporting accuracy over a longer recall period. We consider the modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time.

COVID‐19 Induced Income Loss among Migrant Workers: Evidence from Eight Villages of Bihar

The COVID‐19 crisis re‐shaped many livelihood options and placed significant burdens on those with precarious incomes exacerbating persisting vulnerabilities, especially among a large section of the migrant population. This group faced a dual threat – both to their livelihood and health. To understand the consequences of this pandemic on the income of the migrant population, a household level survey was conducted in the state of Bihar, India, which is one of the highest migrant‐sending states. We examine the role of differences in the socio‐economic status of migrants and their households in determining the extent of vulnerability caused by the COVID‐19 crisis. Vulnerability is proxied by the income lost by migrants during the lockdown. The results suggest that households with diversified income portfolio, larger landholdings, and those receiving government benefits suffered significantly lower income loss whereas, larger household size and greater distance from town tended to escalate income loss. Additionally, private salaried workers faced higher income loss and an increment in years of education lowers the losses significantly. It is observed that individual‐level characteristics also played a significant role in determining economic loss due to the lockdown. Our findings suggest a binding necessity to actively shape policies considering the financial insecurity of vulnerable migrants at their destination and the household members at the origin.

Thyroid homeostasis in iodine deficient healthy pregnant women from 10 villages of bihar, india

Thyroid homeostasis in iodine deficient healthy pregnant women from 10 villages of bihar, india

Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India

People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in a cohort of PLHIV in Bihar, India. We hoped to evaluate optimal diagnostic algorithms to detect ALI in PLHIV. We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or post kala-azar dermal leishmaniasis (PKDL) at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and/or quantitative polymerase chain reaction (qPCR). Additionally, the urinary Leishmania antigen ELISA was evaluated. Determinants for ALI were established using logistic regression and agreement between diagnostic tests calculated using Cohen’s Kappa. A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (interquartile range 33–46), were included in the analysis. Baseline prevalence of ALI was 7.4% (n = 96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n = 6) and 0.4% (n = 5) were positive by qPCR and rK39 RDT, respectively. Negligible or weak agreement was seen between assays. Independent risk factors for ALI were CD4 counts <100 (OR 3.1; 95% CI 1.2–7.6) and CD4 counts 100–199 (OR = 2.1;95% CI:1.1–4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR = 1.9;95% CI:1.1–3.1). A total of 2.2% (n = 28) participants were positive by Leishmania antigen ELISA, detecting 20 additional participants to the asymptomatic cohort. Prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. Using the Leishmania antigen ELISA, prevalence increased to 9.0%. Patients with low CD4 counts and larger household size were found to have significantly higher risk of ALI.Trial Registration: Clinical Trial Registration CTRI/2017/03/008120.

Agriculture and New Farm Laws in India: A Study of Probable Impacts on Marginal and Small Farmers

The insistent push towards privatisation of the agrarian sector is epitomised in the now repealed farm laws, and field data from thirteen Bhojpuri villages in Bihar, reveals that they would have further weakened the vulnerable position of marginal and small farmers. These laws would have enabled private traders and the corporate sector to manipulate the agriculture market in their favour. This article states that the new farm laws, rather than bringing about positive changes in agriculture, as proclaimed by the government, would aggravate rural conditions further and enhance the process of de-peasantisation.

Validation of Survey Questions on Counseling About Infant and Young Child Feeding Received by Mothers in Bihar, India

ObjectivesScarce data exists on coverage of infant and young child feeding (IYCF) counseling, which includes counseling about breastfeeding and complementary feeding, because few large-scale surveys have included questions to capture the coverage of these essential nutrition interventions. Consequently, maternal report of this information during household surveys has not been validated. We examined the validity of maternal report of IYCF counseling received during home visits and factors associated with response accuracy. MethodsDirect observations of home visits conducted by community workers in 40 villages in Bihar, India, served as the “gold standard” to maternal report of IYCF counseling received during 2-week follow-up surveys (n = 444 mothers with children less than 1 year of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and area under ROC curve (AUC). Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. ResultsActual prevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 weeks had moderate validity (AUC = 0.60, 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Maternal characteristics associated with response accuracy varied by indicator, but accuracy on reporting of any IYCF counseling received was associated with higher education level and lower mental stress scores. ConclusionsValidity of IYCF counseling coverage varied by indicator but was moderate for several key indicators and performed comparably to other health counseling coverage indicators. Given that counseling is an intervention involving intangible inputs, we consider these modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time. Funding SourcesBill & Melinda Gates Foundation, through IMPROVE-Coverage and DataDENT, managed by Johns Hopkins University.

Analyzing Women’s Exploitation in Agrarian Society: A Case of Musahar Community in Bihar

The exploitation of Musahars women has been closely linked with the question of land and it exposes three different systems of women's exploitation within the agrarian economy – The wage system, the loan system, and the working hour monopoly. This paper analyzes these three systems of women's exploitation, the semi-feudal and the semi-capitalist social structure in reference to the case of Kuria village of Bihar. Using a case study as a method, the paper has a key objective to find out the pattern of Musahars exploitation by looking at different aspects of existing social conditions. The caste system, in this, will be treated as the primary force of exploitation in the agrarian community.

Will to ‘enlighten’: The politics of forging and fracturing alignments in energy projects in India

There is a growing turn towards the involvement of non-state actors in the provision of basic services in developing countries. Focusing on this turn, this paper advances the knowledge of the politics of assembling energy for development projects by non-state actors. Building on Tania Murray Li’s ideas on trusteeship, and drawing on assemblage theory, this paper argues that meanings of electricity are central to forging and fracturing alignments within energy assemblages. Trustees mobilise particular meanings of electricity to forge alignments with other actors and assemble projects. They connect electricity to development through the provision of electric lights and evoke the metaphor of enlightenment. People’s alternate meanings of electricity result in fractures in the assemblage. Actors that agree on meanings, converge, and those that disagree, diverge. Meanings play an important role in assembling and reassembling energy assemblages.The paper is based on an ethnographic study of two community-based energy projects in India. This ethnographic research was done in 2012–13 in five villages in Bihar, an eastern province of India. Participant observations, interviews and group discussions were used to collect data, in addition to data collected from project websites and reports.

Assessment of arsenic exposure and its mitigation intervention in severely exposed population of Buxar district of Bihar, India

The present study aims to carry out the assessment of arsenic contamination in groundwater samples along with the health status of the exposed population of Buxar district of Bihar. In the present study, randomly 80 groundwater samples were collected from the handpumps across the village households. For the health assessment, blood samples from human subjects were collected from the same household to know the status of the arsenic contamination in their body and were analysed. The study showed significantly very high arsenic contamination in their handpumps as well as in the blood samples of the exposed subjects. The maximum arsenic concentration observed in the handpump water sample was 1908 μg/L, while in blood sample of an individual was 462.1 μg/L. Cancer in 12 subjects was also observed within 2 years. The mitigation intervention was carried out by installing an arsenic filter plant for this arsenic exposed village population. After one year of the usage of the installed arsenic filter, there was significant reduction in the disease symptoms in the exposed population. The present study deciphers the groundwater status as well as the health status of the arsenic exposed population of a village of Bihar along with an mitigation approach to overcome the disease burden.

Modified Biosand Filter for Provisioning of Potable Water to Rural Households Affected by Chronic Arsenic Pollution in Groundwater

Chronic arsenic (As) pollution in aquifers is one of the major challenges faced by economically and socially marginalized sections of the world, which often depend heavily on groundwater for their sustenance. To safeguard these sections against As poisoning, an easy-to-use and sustainable water-treatment solution is warranted. This study was undertaken to systematically evaluate the performance and feasibility of a low-cost modified biosand filter (JalKalp) in providing potable water to affected rural households in India. JalKalp removes As by sorption on rusted-iron nails and pathogens by an additional copper layer. Initially, As-removal efficiencies of this filter were evaluated under laboratory conditions using (1) unpolluted groundwater spiked with variable concentrations (50–500 μg/L) of total dissolved arsenic (AsT), either as As(V), or As(III), or both; and (2) real As-polluted groundwater (∼150 μg/L). Results indicated that the JalKalp filter removed AsT with an efficiency of 95–99% and passed all water quality tests, except hardness and alkalinity. An ∼3-year long “JalKalp” program was then initiated to provide clean drinking water in selected villages of Bihar, India with the support of local agents, nongovernmental and governmental organizations. Filters were installed in select households (n = 22), and the community was involved in the program through training and workshops. The performance of these filters was evaluated through the testing of water and sludge generated, and the conduct of socioeconomic and health surveys. The filter was equally effective under field conditions and removed AsT (<10 μg/L), total iron (<1 mg/L), and fecal coliforms at all locations, at a cost of ∼INR 0.28 (US$ ∼0.004)/L of treated water. JalKalp requires replacement of iron nails after an estimated ∼1.7 years of treatment of ∼6,000 L of water containing 100 μg/L of AsT. Toxicity characteristic leaching procedure on As-containing sludge after filtration indicated that the sludge was not hazardous and could be disposed safely in landfills along with regular municipal waste. Findings from this study could be replicated elsewhere in providing immediate solutions to As-affected water pollution by enabling independent construction and sustainable use of this potentially long-lasting filter.

'Why People Move Away from Their Places': An Empirical Study of Immigrants Working as Street Food Venders in Noida

“I shall not return; I have seen the worst. Although I do not own anything at my place yet I will find a way to feed my family. But I swear in the name of my child, I am not returning to this city at any cost.” Those were the words of Nandan, a worried Pani-Puri seller, earning Rs. 10000-12000 per month, who had been living in Sector 134 NOIDA for last 4 years, while he was on his way back to his village in Bihar due to the infamous lockdown imposed in view of COVID-19 pandemic. It has just been three months and it seems he has chosen to forget the hardships that he underwent at that time and now he is back, disremembering the vow that he made to himself barely three-four months ago. The objective of this paper, based on the information provided by 20 such migrants, who went back to their places during the COVID-19 Lockdown crisis and vowed never to return but have now returned to NOIDA, is to understand, analyse and explain the reasons through different angles and perspectives for such ‘migrations, reverse migrations and re-migrations’ among those hawkers, street venders and stall owners and to find answers to the following questions: One, who are these people and what is their socio-economic status?Two, why did they go back to their native places? and Three, why have they come back to the place where they had to face extreme hardships? This paper is divided into the following four chapters: Chapter I introduce those Migrant hawkers; street venders and stall owners who have now returned to NOIDA; chapter II describes the reasons as to why did they go back to their native places during the infamous COVID-19 lockdown; chapter III presents the main findings of my analysis as to why have they now come back; and in Chapter IV, I have presented the concluding observations of this study.

The Clarion: A Social Enterprise Disrupting School Stationary Industry for Sustainability

Clarion Education and Skills Private Limited Patna, is a start-up promoted to address the school stationery demand–supply gap in the rural elementary education delivery system and cater to the needs of the rural school children in the states of Bihar, Jharkhand and West Bengal. This case documents the way Clarion pursued disrupting the school notebooks market, with a goal of making a notebook affordable at one-sixth the existing cost of a notebook in the marketplace in 2016. Clarion was promoted by The Better World Foundation (BWF), Patna, a social enterprise working in the area of rural elementary education in Bihar. BWF was of the view that the challenges of school stationery supply chain need to be addressed through a commercial enterprise only, so as to drive changes in the sector, so that BWF could focus on its core objective of creating and developing meaningful elementary educational institutions in the remote rural villages in Bihar, India. This case study details the strategy of Clarion in developing a business model to break the shackles of high-priced branded notebooks by linking the advertising of social marketing campaigns with insertions in the notebook covers, and thus converting the notebook into an advertising medium, and meticulously campaigning for supply of affordable notebooks through various governmental and non-governmental institutions. Clarion challenged the competitive forces on one side and pursued building a cost leadership position for itself through cost-value trade-off initiatives on the other.

Status of Labour households and Marginal Farmers in Bihar: A Comparative Analysis

This study is based on the longitudinal information collected in the selected villages of Bihar. The data collected during 2010-11 and 2014-15 were analyzed using descriptive and econometric techniques. An attempt was made to analyze employment generation, income of different marginal farmers and labour households and the extent of indebtedness and earning prevalent among rural labour and marginal farm households in rural Bihar. The result indicated that the average size of landholding of labour and marginal farmers increased in villages under study because some of these households purchased land from other categories of households through their meagre savings possible due to increase in employment opportunity and wages, particularly in non- farm sector in Bihar. The levels of livelihood parameter are low on labour households, but they performed impressively during the recent past. The total values of assets of labour and marginal farms’ households under study has considerably enhanced during five years due to either possession of new assets, rejuvenation, and/ or value appreciation of the existing assets. Labour households earned a higher income than marginal household in 2014- 15 due to availability of non - farm employment and grants under social security schemes. There has been significant improvement in education level, asset possession and availability of facilities. However, social security programmes seem to be more robust than economic development programmes including agricultural development. The investment in human capital or skill development in rural area will be equally important in the endeavour for alleviating poverty and improving livelihood status. The complementarities among various types of infrastructures, institutions and development programmes need to be ensured to accelerate the process of poverty alleviation and improving livelihood in rural Bihar.

Normative development in rural India: ‘school readiness’ and early childhood care and education

ABSTRACT Global education agendas frequently draw on the construct of ‘school readiness’, indexing the developmental trajectories of children to the expectations of school systems. Through in-depth ethnographic research in a village in Bihar, India, this paper examines how normative discourses of ‘school readiness’ govern family strategies for early childhood care and education (ECCE). To navigate the demandsof a competitive and socially stratified school system, marginalised families saw it as crucial for their young children to access multiple forms of educational capital: written literacy, discipline, and dominant caste-class codes. In the absence of functioning provision of ECCE by the state, the low-fee and low-quality private market of early childhood education was seen as a key site through which ‘school readiness’ could be secured. The paper illustrates how normative developmentalism in education, and the ‘hegemonic aspirations’ it enshrines, has entrenched the marketisation of ECCE and reinscribed forms of caste-class domination.

Intensely clustered outbreak of visceral leishmaniasis (kala-azar) in a setting of seasonal migration in a village of Bihar, India

BackgroundA visceral leishmaniasis outbreak was reported from a village in a low-endemic district of Bihar, India.MethodsOutbreak investigation with house-to-house search and rapid test of kala-azar suspects and contacts was carried out. Sandfly collection and cone bio-assay was done as part of entomological study.ResultsA spatially and temporally clustered kala-azar outbreak was found at Kosra village in Sheikhpura district with 70 cases reported till December 2018. Delay of more than a year was found between diagnosis and treatment of the index case. The southern hamlet with socio-economically disadvantaged migrant population was several times more affected than rest of the village (attack rate of 19.0% vs 0.5% respectively, ORMH = 39.2, 95% CI 18.2–84.4). The median durations between onset of fever to first contact with any health services, onset to kala-azar diagnosis, diagnosis to treatment were 10 days (IQR 4–18), 30 days (IQR 17–73) and 1 day (IQR 0.5 to 3), respectively, for 50 kala-azar cases assessed till June 2017. Three-fourths of these kala-azar cases had out-of-pocket medical expenditure for their condition. Known risk factors for kala-azar such as illiteracy, poverty, belonging to socially disadvantaged community, migration, residing in kutcha houses, sleeping in rooms with unplastered walls and non-use of mosquito nets were present in majority of these cases. Only half the dwellings of the kala-azar cases were fully sprayed. Fully gravid female P. argentipes collected post indoor residual spraying (IRS) and low sandfly mortality on cone-bioassay indicated poor effectiveness of vector control.ConclusionsThere is need to focus on low-endemic areas of kala-azar. The elimination programme should implement a routine framework for kala-azar outbreak response. Complete case-finding, use of quality-compliant insecticide and coverage of all sprayable surfaces in IRS could help interrupt transmission during outbreaks.