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Bangladesh Eliminates Public Health Problem Kala-Azar – BORGEN – Borgen Project


SAN MARCOS, Texas — Visceral Leishmaniasis (VL), also known as Kala-Azar or “Poor Man’s Disease,” strives among the world’s poorest populations, with transmission occurring through the bite of infected female phlebotomine sandflies. As of January 2023, 50,000 to 90,000 VL cases occurred worldwide annually. This disease is connected with malnutrition, population displacement, poor housing, a weak immune system and a lack of financial resources. However, in October 2023, Bangladesh became the first country in the world to eradicate Kala-Azar, thus exterminating it as a public health problem.

Bangladesh Before Eradicating VL

The upsurge of VL found its bearing in “modern-day” Bangladesh, marking the site of the first documented VL outbreak. This outbreak led to 75,000 deaths in only three years, from 1824 to 1827. While the country’s Kala-Azar cases dropped by 1980 to only 59 cases reported in 12 years, Bangladesh saw a resurgence with 109,266 cases from 1993 to 2013. The increase in this “Poor Man’s Disease” did not come as a shock, considering that, as of 2019, 20.5% of the Bangladesh population lived below the national poverty line.

This public health problem affects the people who are most malnourished and living in poverty-stricken households. In 2008, Bangladesh planned to improve VL diagnosis, which it did with the emergence of the rK-39 rapid diagnostic test. However, disadvantaged groups, specifically women and children, continued to struggle to have the means to get their hands on such innovations. Consequently, these groups experienced ongoing incidences of the disease and had to bear the accompanying symptoms.

How Bangladesh Eliminated VL

While the complete eradication of Kala-Azar did not happen till 2023, elimination efforts were well underway in 2005 with a Regional Kala-Aazar Elimination Initiative from Bangladesh, Nepal and India. This initiative’s priority was early diagnosis, treatment and disease monitoring. The rK-39, a diagnostic tool developed through collaboration between Tropical Disease Research (TDR) and the World Health Organization (WHO), demonstrated its effectiveness as a crucial step in the early detection of VL in Bangladesh. Collaborative efforts between TDR and WHO in 2008 led to the discovery of improved treatment options such as Miltefosine and Liposomal Amphotericin B (AmBisome).

AmbiSome, which Gilead Sciences Inc. created, was the first-ever Kala-Azar treatment. It proved effective in more than 95% of its cases, pushing forth the disease’s eradication in South-East Asia. This led to a record of only 47 cases of VL in Bangladesh in 2022. Moreover, the number of reported cases has consistently remained below one per 100,000 population for at least three consecutive years. To upkeep the eradication of Kala-Azar, Bangladesh is focusing its efforts on surveillance of VL cases, treatment effectiveness and symptoms.

Bangladeshi Patient’s Life Saved From Treatment

Antifungal drug AmbiSome was proven effective in Bangladesh when a man in his 30s was struggling in the hospital, diagnosed with Kala-Azar and suffering its symptoms with a swollen spleen and failed liver. The man was not even able to access the thirty pain injections with a failed drug, which was the country’s only means of treatment at the time and he was left to die. Dr. Dinesh Mondal of the Dhaka-based research institute icddr,b offered AmbiSome, a new treatment that medical professionals had previously used for cancer and AIDS. After three days of AmbiSome treatment, the man, who was close to death, was feeling much better with a decrease in symptoms. Today, he is fully cured and healthy. This is one story of many where this new antifungal treatment proved effective in the eradication of VL as a public health problem in Bangladesh.

Conclusion

In October 2023, Bangladesh became the first country in the world afflicted with Kala-Azar, which eradicated it as a public health problem. Earlier in May 2023, Bangladesh also succeeded in eliminating another health problem, Lymphatic Filariasis (LF), a painful disease acquired in childhood through filarial parasites in mosquito bites and its symptoms manifesting later in life. Bangladesh continues to make positive strides in the health department by eliminating two major health problems and making history in 2023.

– Lucciana Choueiry
Photo: Flickr



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Ellis Wilder

Hey there! My name is Ellis Wilder, and I'm a student at the University of Calgary. When I'm not hitting the books, you can usually find me writing articles for sports and travel blogs. I've always had a passion for exploring new places and experiencing different cultures, so I love sharing my travel stories with others. Whether I'm hiking in the Rocky Mountains or exploring a new city, I always try to capture the essence of the places I visit in my writing. Thanks for stopping by, and I hope you enjoy reading my articles as much as I enjoy writing them!

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