Published Date: 1998-04-25 23:50:00
Subject: PRO/AH/EDR> Kala-azar - Nepal
Archive Number: 19980425.0781
KALA-AZAR - NEPAL
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A ProMED-mail post
Date: Fri, 24 Apr 1998 08:38:57 -0500
From: Clyde Markon <docmarkon@worldnet.att.net>
Source: Kathmandu Post, April 23
A large population from Terai have come under the threat of kala-azar, a
disease spread by sand-flies. About 5.5 million people, most of them from
the Terai districts sharing border with the Bihar state of India, have been
affected from kala-ajar, according to the director of Epidemiology and
Disease Control Division (EDCD).
The disease appears in April, reaches epidemic proportions in July and
begins declining from September. Siraha and Sarlahi have the highest
recorded cases of kala-azar. Other Terai districts affected with the
disease are Morang, Sunsari, Saptari, Dhanusha, Rautahat, Bara, Udayapur
and Jhapa. Siraha recorded 441 cases in fiscal year 1997/98 and Sarlahi
recorded 421 in the 1996/97.
The government health agencies are losing their battle against kala-azar
and malaria. The incidence rate has increased sharply over 18 years from
1.5 per 100,000 cases in 1980 to 49.03 cases in 1994, according to Dr
Mahendra Bahadur Bista, director of EDC D. Malaria is making a comeback in
Nepal with alarming proportions. A recent survey found out that 64
districts, not all of them in Terai, have already fallen into the killer
diseases domain. Explaining the reasons behind the increase in the
disease, Dr Bista says that the disease had been controlled after the
government started spraying DDT and malathion in 1953 and resurfaced after
1980. The sand-fly developed resistance, open border with Bihar also made
easy to transmit the disease, and unhealthy and poor condition of Terai
dwellers aggravated the problem. Though District Public Health Offices
spray insecticide twice a year the disease does not show the sign of
defeat. Hundreds of people are hospitalized in the terai region with the
symptoms of kala-azar- such as high fever, swelling of liver and spleen and
weakness.
Many of the 105 patients who visited Rajbiraj hospital in February/March
this year were found to be suffering from kala-azar. Even if the government
provides free medical treatment and medicines to kala-azar patients, each
year people are dying from this disease. The government data show that 23
persons died of kala-azar in 1996/97 fiscal year, which considering very
poor reporting and inefficient recording system may be grossly misleading.
Though the district health offices observe the yearly ritual of spraying
insecticides, the whole affected population has not been covered. As a
result, kala-azar outbreaks in Terai have become routine. Likewise, many
of the insects including malaria-spreading _Anopheles_ [sp. mosquitoes]
have developed resistance [to insecticide]. Sandflies, considered weak
[meaning?] vectors may also [be developing insecticide resistance]. "But
there has never been a research about transmission of kala-azar in our
country," said Dr Bista.
--
ProMED-mail
e-mail: promed@usa.healthnet.org
[Kala-azar, also known as visceral leishmaniasis and other epithets, is
caused by a viscerotropic flagellate protozoan, _Leishmania donovani_. It
occurs focally in Central and South Americas, Africa, the Middle East,
India, and some countries near to India. In the Americas, domestic and
wild canid species are reservoir hosts and the parasite is transmitted by
the phlebotomine fly (sand fly) _Lutzomyia longipalpis_. In the
Mediterranean region dogs are reservoir hosts and _Phlebotomus_ sp. sand
flies serve as vectors. In India, and likely in Nepal, humans are the
principal reservoir and dogs and other animals have not been implicated in
the natural cycle. Some years ago, when malaria control programs in larger
cities were interrupted, kala-azar reached epidemic proportions in Bihar,
northern India.
Nepal sits on the northern border of India. The Terai district, in the
south of Nepal, is a flat fertile strip of land where about 30% of the
Nepalese population lives. Many diseases, such as Japanese encephalitis,
occur in the Terai district. Although research on kala-azar has not been
carried out in Nepal, epidemiologic studies suggest its presence there. -
Mod.CHC]
...................................chc/es
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