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A state of Kala-azar
Botched figures: Indian authorities think Bihar needs special measures to tackle the Kala-azar menace

Nearly three-fourths of the population of Bihar — 36 of whose 38 districts have recently seen a severe outbreak of Kala-azar — does not know what causes the disease. Fewer than 40 per cent of the population is aware of its infectious nature.

Researchers at the Kala-azar Medical Research Centre of the Banaras Hindu University have more such shocking revelations to make in the September issue of The American Journal of Tropical Medicine and Hygiene. Incidentally, the Indian government plans to eliminate the disease by 2010 and has launched a special awareness programme to help people and health workers fight the disease.

The survey was carried out among 26,444 respondents in Bihar and reveals that though 97.4 per cent know about Kala-azar, only 39.9 per cent know that the disease is infectious. About 72.8 per cent believe that Kala-azar spreads by mosquito bite (it is actually spread by the sandfly) and 63.6 per cent think the disease carrier breeds in garbage.

Kala-azar or Visceral Leishmaniasis is caused by a parasite — Leishmania. Sandflies, its carriers, actually breed in loose soil and love the warm and moist climate of Bihar. About half of 5,00,000 Kala-azar cases reported globally are from the Indian sub-continent. Bihar accounts for 70-75 per cent of the Indian cases.

“Poor knowledge of the disease and breeding sites of the vector (sandfly) underscores the need for health educational campaigns for the elimination programme to succeed,” believes Dr Shri Pra-kash Singh who led the research.

Dr Swapan Jana, secretary of the Society for Social Pharmacology, a West Bengal-based non governmental organisation working in the area, seconds him. “If you visit Sitamarhi or Muzaffarpur districts, you’ll find a large number of people who’re really poor and pay little attention to health. Many of them know the name of Kala-azar but have no idea how to fight the disease. Naturally they become the worst sufferers,” said Dr Jana.

The other reason that control measures are ineffective in Bihar is the rampant underreporting of cases, say experts. According to a study published in the journal Tropical Medicine & International Health in June 2006, “Visceral leishmaniasis (VL) is a major public health problem in Bihar, India. Unfortunately, accurate data on the incidence or prevalence of the disease are not available.” The study, which was also led by Dr Singh, was carried out from January 2001 to December 2003 in 14 villages in Kanti block of Muzaffarpur district in Bihar. It identified 202 cases of Kala-azar in three years, giving an average annual incidence rate of 2.49 per 1000.

Since identification data on patients for 2001 and 2002 were not available with the official reporting, the study could only assess the extent of underreporting of cases in 2003. In the population studies, 65 cases of Kala-azar were detected in 2003 but only eight (12.30 per cent) cases were reported officially. So the official rate of incidence for Kanti block was 0.31 per 1000 when the actual rate was 2.36 per 1000, resulting in underreporting by a factor of 8.13.

“Bihar has everything for Kala-azar,” says Dr Jana, “a favourable atmosphere for the sandfly, improper understanding of the disease among the common people and underreporting of Kala-azar cases by the authorities. When the incidences are underreported, the disease control programme cannot yield optimum results.”

According to a recent newsletter by the National Institute of Communicable Diseases, Union Directorate General of Health Services, “(Kala-azar) is a worldwide disease affecting 88 countries, and 90 per cent cases of VL occur in 5 countries: India, Bangladesh, Nepal, Sudan and Brazil. As per World Health Organisation estimates, Visceral Leishmaniasis (Kala-azar) affects 5,00,000 people globally, of which 50 per cent cases are from the Indian subcontinent.” It adds, “Bihar alone contributes about 70 to 75 per cent of the cases and majority of deaths recently reported.”

The Indian government aims to eliminate Kala-azar from the country by 2010. To achieve this goal, several initiatives have been adopted, such as early diagnosis and complete treatment of cases by utilising the primary health care system, proper control of vectors, awareness programmes, training to upgrade the technical skills of the functionaries and regular programme monitoring. However, experts believe that it’s essential to take up special measures for Bihar.

“Bihar is the most important region in terms of Kala-azar. It not only has the major load of the disease, but cases are transported from this state to other states as well.

If Kala-azar is eliminated from Bihar, the situation will soon be under control,” says Dr Jana. “So meticulous efforts should be taken to eliminate the disease from this state first and efforts in all the levels should be doubled.”

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