Hajipur (Bihar), March 15, 2014: On the third annual Kala Azar Day, international medical humanitarian organisation Doctors Without Borders/ Médecins Sans Frontières (MSF) has emphasised on the need for scaling up awareness about kala azar (Leishmaniasis), its diagnosis and treatment in Bihar for the poorest, most vulnerable communities who make up the majority of people who become infected by the disease. The state government has been observing March 15 as ‘Kala Azar Day’ to bring attention to this public health challenge.
“In our project, most patients come to our facilities when the disease is already at an advanced stage because people are still not familiar with the signs and symptoms or do not know where they can find adequate diagnosis and medication,” says Dr Prince Mathew, Deputy Medical Coordinator, India. “Many communities with high prevalence lack access to diagnostics, and treatment in the private sector is not only expensive but also often irrational, which in turn poses serious risks of outbreaks and increasing drug resistance,” he adds.
If left untreated, kala azar is almost always fatal. “The government of Bihar is making efforts to increase access to kala azar diagnosis and correct line of treatment,” says Dr Ramashis Kumar, Civil Surgeon, Vaishali District.“It is critical to increase treatment literacy and awareness in the community so that patients avoid quacks and seek effective treatment at the nearest Primary Health Centre (PHC),” he adds.
PHCs have a major role to play as they take treatment closer to the patients’ homes and thereby increase access to medical care. “We at MSF are creating awareness among people about the symptoms of kala azar and we want them to realise that there is medical care available free-of-charge and which can be accessed easily and immediately,” says Joao Antunes, Field Coordinator, Hajipur.
However, it is important to note that Bihar, one of the most endemic areas in the country with 10,000 cases annually, is now showing a positive trend with a decrease in the number of cases. MSF will continue to work hand in hand with the National Vector Borne Disease Control Programme (NVBDCP), the Bihar State Health Society and other partners including Drugs for Neglected Diseases Initiatives (DNDi) and Rajendra Memorial Research Institute (RMRI) in the fight against kala azar and work towards the elimination of this disease by 2015 by strengthening existing health structures, scaling up prevention efforts and finding effective treatment.
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Notes to editor:
• MSF is an international, independent, medical humanitarian organisation which has been working in India since 1999. Since July 2007, MSF has treated over 12,000 kala azar patients in Bihar. Currently MSF supports a kala azar ward inside the Sadar District Hospital in Hajipur, and five primary health centres (PHCs) in Goraul, Vaishali, Mahua, Mahnar and Raghapour in neighbouring blocks.
• Kala azar disproportionately affects the poorest, most vulnerable communities in Bihar, and is transmitted by the bite of the sand fly. The disease usually occurs in villages where houses have mud walls and earthen floors, and cattle and other livestock are kept close to human dwellings.
• Creating awareness about the disease along with an insecticide spraying campaign and encouraging patients who have symptoms like prolonged fever, weakness, loss of appetite and swollen abdomen to seek free treatment at the nearest PHC, are needed to attain the goal of elimination of this disease by 2015.
• Co-infection of kala azar and HIV is a major challenge in Bihar as both diseases influence each other by creating a vicious downward spiral as they attack and weaken the immune system. In 2013, MSF decided to start focusing on this deadly co-infection by counselling and screening kala azar patients for HIV in Sadar Hospital. If patients test HIV-positive then MSF works with the ART centre of Hajipur to immediately start antiretroviral treatment.
• Post Kala azar Dermal Leishmaniasis (PKDL) is a recurrence of kala azar that may appear on the skin of affected individuals even many years after treatment. The symptoms of PKDL include rashes or boils on the skin. Effective treatment of PKDL therefore must also be prioritised.
