MSF calls for a spotlight on kala azar

Bihar state, in the northeast of India, is an epicentre of kala azar (visceral leishmaniasis), a neglected tropical disease responsible for 50,000 deaths every year worldwide. Bihar’s Ministry of Health has declared 15 March ‘Kala Azar Day’ to increase awareness of the disease which, if left untreated, is almost always fatal. On the occasion of Bihar’s first Kala Azar Day, the international medical humanitarian organisation Médecins Sans Frontières (MSF) calls on all countries where the disease is endemic to increase access to proper diagnosis and treatment for kala azar sufferers.

Kala azar generally affects the world’s poorest and most vulnerable people, though the challenges presented by the disease vary according to the context. In East Africa, the disease is exacerbated by epidemic outbreaks with high mortality, by the HIV pandemic and by weak healthcare systems. In South Asia, the most widely available drug, pentavalent antimonials, is of limited effectiveness. This is partly due to resistance having developed when patients failed to finish their full course of treatment.

“In our project in Bihar, we often receive patients who have been sick for a long time. Most of them have visited traditional healers or private clinics, but none have been correctly diagnosed or treated. Their search for a cure can lead them into catastrophic debt. By the time they reach us, they are often in a very bad condition,” says Bjorn NISSEN, MSF’s head of mission in India.

MSF has been successfully running a free kala azar diagnosis and treatment project in Vaishali district, Bihar, since 2007. Since then MSF has treated more than 9,000 patients with an initial cure rate of 98 percent.

In India, as in all MSF’s kala azar projects worldwide, the organisation has proved that it is possible to diagnose and treat kala azar patients with a high cure rate even in remote settings. All ministries of health in endemic countries need to implement proper strategies to scale up access to diagnosis and treatment for kala azar sufferers.

In South Asia, this means access to other treatments which may include safe and highly effective drugs such as liposomal amphotericin B (L-AmB) or combination therapies as recommended by the Leishmaniasis Expert Committee of the World Health Organization in its Blue Book published in 2010. Miltefosine, the first-line treatment in India and one of the WHO recommended drugs, is currently experiencing a shortage in some endemic areas of the country. MSF is concerned about kala azar patients lacking effective lifesaving treatment and hopes a solution can be found as soon as possible.

In East Africa, more attention needs to be given to people co-infected with HIV and kala azar. At present, most kala azar drugs are unregistered in East Africa, which limits people’s access to better treatment.  

International funding is needed to strengthen the capacity of national control programmes so that patients have access to the best available treatments. More funding is also essential for research and development so as to improve and simplify the diagnostic tools and to develop better drugs.

“We hope that Kala Azar Day in Bihar will help to highlight the needs of the most vulnerable patients in their fight for better diagnosis and treatment, both nationally and globally,” says Nines Lima, MSF’s medical referent for kala azar. “Today, most of the world’s kala azar sufferers don’t have easy access to treatment; this is an unacceptable situation that must be changed.”

Kala azar (visceral leishmaniasis) is spread by the bite of the sandfly, and is endemic in 76 countries. Its annual incidence is estimated at 250-300,000 cases, with over 90 percent of those cases occurring in India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. As with all neglected diseases, kala azar affects mainly the poorest people who have little or no political power. Without treatment, almost all patients will die. However, with timely diagnosis and treatment, nearly all patients can be cured, even in resource-limited and remote settings.

Since 1988, MSF has treated more than 100,000 kala azar patients, mainly in Sudan, South Sudan, Ethiopia, Kenya, Somalia, Uganda, India and Bangladesh. In Bihar, India, MSF is treating kala azar patients with liposomal amphotericin B, a safe and very effective drug.