Background

Kala-azar is one of the clinical forms of Leishmaniasis and is caused by the protozoa Leishmania donovani. In Bangladesh it is transmitted by the sand fly named Phlebotomus argentipes. The disease presents as prolonged fever with splenomegaly, anemia, weight loss and darkening of complexion. In endemic areas, children and young adults are its principal victims. Kala-azar is fatal if not treated timely. Kala-azar HIV or TB co-infection has emerged as a health problem in recent years. The disease is seen in several countries of the world with about 500,000 cases annually. India, Sudan, Nepal, Bangladesh and Brazil account for 90% of the total global cases. It affects largely the socially marginalized and the poorest communities.

Kala-azar situation in Bangladesh

Kala-azar is one of the major public health problems in Bangladesh and the disease is endemic for many decades. During the ‘Malaria Eradication Program’ blanket DDT spraying controlled Kala-azar transmission. In the late 1970s Kala-azar re-emerged sporadically. During 1981-85 only 8 upazilas (Sub-district) reported Kala-azar, which increased to 105 upazilas in 2004. During the last few years the Kala-azar situations has assumed epidemic proportion with the number of reported cases increasing from 3978 in 1993 to 8505 in 2005. But for the last few years the incidence declined to some extent and reach to (2534+842) = 3376 cases are reported in 2011.

Under the current surveillance system the Upazila Health Complexes (UHCs), District Hospitals and other specialized hospitals report cases to Civil Surgeon Office and the Civil Surgeon Office after compilation report to the Kala-azar Elimination Program, Communicable Disease Control (CDC) Unit in DGHS. This is however is a gross under reporting because the private sector clinics and hospitals, and the cases treated by private practitioners are not included.