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Why is it important to control VL?

Visceral leishmaniasis affects people at an individual level and at a population or national level. Watch this video with Dr Vikas Aggarwal.
VIKAS AGGARWAL: Hello. I am Doctor Vikas Aggarwal. I’m a medical doctor, but more of a public health practitioner. I have been working in South Asia region for the last 15 years and my role has been to manage programmes which are working with communities, especially with the most marginalised communities such as out of school youth, most marginalised communities as such, tribal populations. And the focus of my work has been, largely, to provide improved access to the communities and health care services. Another reason we need to focus on diseases like kala-azar, which are neglected diseases– I would say that as a health practitioner, these diseases are of primary importance because of three factors. First of all, why it’s important?
Because it affects the most marginalised communities– the poorest of the poor. Second, they are important because the return of investment on these diseases is quite high. And thirdly, because of the fact that these diseases can cause fatality– very high fatality. Now, when I talk about most marginalised communities, people would say that we have very less number of such cases even in a country like India. India though, has the highest number of real cases in the world. And especially, a state like Bihar, which bears the burden, as high as 70% of Indian caseload.
Many people still argue that number of real cases are coming down and we have other diseases like malaria, or maternal health related issues, which affects communities in large numbers. Then why do we have to focus on diseases like kala-azar? I would say that we need to focus on these diseases and we really need to learn about these diseases more, because of the fact that the burden which is borne by the most marginalised communities, because of these diseases, is quite high.
As per a survey which was done across various patients in four countries, including India and Bangladesh, what we have found that 40% to 50% of communities, or the patients, which we interviewed, they said that they have expended more than 20% of their household income or household expenditure, on a single episode of VL. And it’s not that they have made this expenditure on the treatment and on diagnostic, which are free and which are provided free by the government. It was mainly to go through various providers before they reached the health centre where they got the diagnosis and the treatment. And the opportunity cost which they have expended in terms of loss of employment, wage loss, or transport cost was quite high.
Now, all this can be prevented if health care workers are aware, and are trained, and if they know what is kala-azar, and if they know how to diagnose, what kind of diagnostic tests need to be done, what kind of signs and symptoms need to be taken care of or we have to be mindful of. And it’s just a simple training, you know. It’s not a very complex disease. There are simple set of algorithm, which you need to be aware of. And that’s what this course will tell you about.
I think it would be a good investment of time to go through this course and to know about how to identify a case of kala-azar, how to suspect a case of kala-azar, what kind of diagnostic test we should do, and what kind of treatment options are available, which is quite simple and which is quite effective. So I would say that the return of investment, not only in terms of the time, which we are spending in this course, but overall, the benefit which communities and society would achieve by us knowing more about this disease, would be far more and it would be very long-term benefit which we will achieve.

Visceral leishmaniasis affects people at an individual level but also has a range of impacts at a population or national level[1].

In the following interview, Dr Vikas Aggarwal discusses some of the direct and indirect effects VL has on people in the Indian subcontinent. VL is not only burdensome in terms of clinical symptoms and the number of days lost, it can also place a direct financial burden on patients and their carers. A recent KalaCORE study (see figure below) aimed to uncover these costs by surveying VL patients. One finding was that many people need to borrow money in order to access treatment, although treatment is free at the point of care.

For East Africa, the burden of VL will be different although it is still the poorest of the poor that are affected the most. The number of VL cases in the region has increased significantly over the past 15 years with an expected material impact on the population. A recent study has looked at how people access VL care in an endemic region in Sudan[2]– it is clear that economic constraints as well as cultural barriers play their part.

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Control and Elimination of Visceral Leishmaniasis

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