Newer Strategies for the Kala-Azar Elimination Programme in India (Correspondence) (Report)
Sir, Three attempts made in independent India to eliminate kala-azar (visceral leishmaniasis) have failed. The massive DDT spray programme under National Malaria Control Programme (1953-68) resulted in cases of post kala-azar dermal leishmaniasis (PKDL) (1) and chronic kala-azar cases from rural area (2) that were ignored. A 6-10 day course of 6 ml intramuscular injection daily of sodium antimony gluconate (SAG) was used for treatment of cases. After discontinuance of this programme sandlflies returned, fed on chronic cases of kala-azar and PKDL (3) and an epidemic of kalaazar with 100, 000 cases occurred in 1977 (4). During this epidemic, 30 per cent of cases were found unresponsive to SAG (5), and control programme continued for three years only. In 1991-1992 another epidemic with 250,000 cases (6) occurred. Again control programme with DDT spray and treatment of cases with SAG was continued for three years only. By that time in some areas of Bihar 85 per cent of cases were found unresponsive to SAG (7) and the drug was responsible for many deaths caused by its cardiac toxicity. The number of cases started increasing again after 2002. The Government of India in its Health Policy 2002 (8) undertook a decision to eliminate kala-azar by 2010. In this programme two new drugs, amphotericin B and miltefosine have been included for treatment and rk-39 test for field diagnosis. To assess the implementation of this programme and to examine the deficiencies if any, we carried out this study in five randomly selected villages of Bihar State, India.