Kala-azar or visceral leishmaniasis is endemic in Nepal along with Bangladesh and India in the south east region. Government of Nepal is a signatory to the memorandum of understanding on strengthening collaboration in the regional effort to eliminate kala-azar as a public health problem which was formalized during the World Health Assembly held in May 2005.
In 2005, Nepal formulated a national plan to eliminate kala-azar defined as < 1 case per 10,000 population at district level with a target of achieving elimination by 2015. However, the elimination target could not be achieved by the program. Although the program has seen a steady decline in number of kala-azar cases, sporadic cases are being consistently reported from other districts which are considered as non- endemic. Recently in 2017, a mountainous district, Dolpa, reported kala-azar cases above the elimination threshold. In 2018, 53% of the total kala azar cases reported were from districts considered as non- endemic for kala-azar.
The national kala-azar program was mainly focusing its elimination activities in endemic districts. Initially twelve districts out of 75 were considered endemic for kala-azar. However, later, six districts which were consistently reporting kala-azar cases were added to the list of endemic district after local transmission of the disease was verified. This geographical expansion of the disease to the hilly and mountainous district is alarming. Moreover, increasing number of other forms of the disease like cutaneous leishmaniasis and mucocutaneous leishmaniasis is posing a threat in country’s elimination effort.
Jan 1
Flooding in the rural districts of Bagmati Province creates the classic postdisaster conditions for communicable disease transmission: contamination of drinking-water sources, destruction of latrines, displacement of populations into crowded temporary shelters, interruption of health services and cold chain, expansion of vector breeding habitat, and loss of livestock with associated zoonotic exposure. Floods do not import new pathogens; they amplify the pathogens already endemic in the area. Preparedness must therefore be built on what is known to circulate in Bagmati Province — including the enteric pathogens Vibrio cholerae O1, Salmonella Typhi and hepatitis A and E viruses, together with dengue virus, Orientia tsutsugamushi, Leptospira species, Japanese encephalitis virus, measles virus, and residual foci of malaria and visceral leishmaniasis. Two operational realities shape this plan. First, the interval between exposure and detectable clusters is short for enteric disease (2–14 days) and long for vector-borne and leptospiral disease (2–8 weeks), so surveillance intensity must be sustained well beyond the point at which media and political attention recede. Second, the routine surveillance system will be degraded exactly when it is most needed, because reporting health facilities may be damaged, staff displaced and connectivity lost. Apparent declines in reported cases in the first weeks after a flood are more often artefacts of reporting failure than evidence of control.
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Jan 1
Acute Gastro Enteritis was the highest reported condition, accounting for 721 cases.
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Jan 1
Acute Gastro Enteritis was the highest reported condition, accounting for 667 cases.
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