VL elimination and post-elimination management in Bangladesh

The film in this step shows Dr Mondal, a Senior Scientist at Bangladesh’s International Centre for Diarrhoeal Disease Research, talking about the National Kala-azar Elimination Programme and how best proceed once the elimination target has been reached.

Among the endemic regions for VL globally, countries in the Indian Sub-continent (ISC) have made phenomenal progress in approaching elimination of the disease. Since the early 2000s, several ongoing efforts to control VL in the region have contributed to this achievement. In 2005, the governments of Bangladesh, India and Nepal signed a Memorandum of Understanding (MoU) to eliminate VL by 2015^[1]. In 2014, the elimination target was extended to 2017 at a regional meeting in Dhaka, where a new MoU was signed by the health ministers of Bangladesh, India, Nepal and also Bhutan and Thailand^[2].

Meanwhile, global commitment for NTD elimination has also increased. In 2012, the WHO NTDs Roadmap set out the target to eliminate a range of different NTDs including VL by 2020s^[3]. This together with the 2012 London Declaration^[4] have encouraged NTD elimination activities, not only by providing technical guidance but also by securing funds and resources and supporting key partnerships.

At present (2018), the goal of elimination of VL or kala-azar as a public health problem in the ISC is defined as less than 1 cases per 10,000 per year – at the sub-district in India and Bangladesh and at the district level in Nepal. Nepal has achieved this goal unofficially; despite a significant decrease VL cases, India has yet to achieve the target, and Bangladesh officially achieved the target at the end of 2017.

Bangladesh first launched its National Kala-azar Elimination Programme (NKEP) in 2008. The VL elimination programme consists of three separate phases^[5]:

1. attack (achieving the target by 2017)
2. consolidation (sustain target for three years i.e. from 2017–2019)
3. maintenance (sustain target beyond 2020)

Dr Dinesh Mondal, Senior Scientist at the icddr,b a research and implementation institute in Bangladesh working closely on VL control and elimination, spoke to us in the spring of 2017, just before elimination was announced. Some of the (national) guidelines, on case management, outbreak response and monitoring and evaluation that Dr. Mondal refers to can be found in the references section below^[6].