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{{Use Indian English|date=February 2020}}

'''Kala azar''' ('''Visceral leishmaniasis''') in India refers to the special circumstances of the disease [[leishmaniasis|kala azar]] as it exists in India. Kala azar is a major health problem in India with an estimated 146,700 new cases per year as of 2012.<ref name="Alvar 2012">{{cite journal |last1=Alvar |first1=Jorge |last2=Vélez |first2=Iván D. |last3=Bern |first3=Caryn |last4=Herrero |first4=Mercé |last5=Desjeux |first5=Philippe |last6=Cano |first6=Jorge |last7=Jannin |first7=Jean |last8=Boer |first8=Margriet den |last9=Kirk |first9=Martyn |title=Leishmaniasis Worldwide and Global Estimates of Its Incidence |journal=PLOS ONE |date=31 May 2012 |volume=7 |issue=5 |article-number=e35671 |doi=10.1371/journal.pone.0035671|pmid=22693548 |pmc=3365071 |bibcode=2012PLoSO...735671A |doi-access=free }}</ref> In the disease a parasite causes sickness after migrating to internal organs such as the [[liver]], [[spleen]] and [[bone marrow]]. If left untreated the disease almost always results in the death. Signs and symptoms include [[fever]], [[Cachexia|weight loss]], [[fatigue (medical)|fatigue]], [[anemia]], and substantial [[Hepatosplenomegaly|swelling of the liver and spleen]].

People get the disease from the bites of sandflies which themselves got a parasite from drinking blood of another person infected with the parasite. Globally there are more than 20 different ''[[Leishmania]]'' parasites which cause the disease and 90 species of sandfly which spread those parasites.<ref name="WHO fact sheet 2019">{{cite web |author1=World Health Organization |title=Leishmaniasis Fact Sheet |url=https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis |website=www.who.int |publisher=World Health Organization |language=en |date=14 March 2019}}</ref> In the [[Indian subcontinent]], however, there is only one common species of parasite, ''[[Leishmania donovani]]'' and only one species of sandfly, ''[[Phlebotomus argentipes]]'', which spreads the disease.<ref name="Joshi 2009">{{cite journal |last1=Joshi |first1=AB |last2=Das |first2=ML |last3=Akhter |first3=S |last4=Chowdhury |first4=R |last5=Mondal |first5=D |last6=Kumar |first6=V |last7=Das |first7=P |last8=Kroeger |first8=A |last9=Boelaert |first9=M |last10=Petzold |first10=M |title=Chemical and environmental vector control as a contribution to the elimination of visceral leishmaniasis on the Indian subcontinent: cluster randomized controlled trials in Bangladesh, India and Nepal. |journal=BMC Medicine |date=5 October 2009 |volume=7 |page=54 |doi=10.1186/1741-7015-7-54 |pmid=19804620|pmc=2763005 |doi-access=free }}</ref> The form of the disease, the medicine for eliminating the parasite, and insecticide for preventing the insect bite varies by region, and there are recommendations in place for India.<ref name="regional office 2012">{{Citation |author=Regional Office for South-East Asia |year=2012 |title=Regional strategic framework for elimination of kala-azar from the South-East Asia Region (2011-2015) |publisher=[[World Health Organization]] |location=New Delhi |hdl=10665/205826 }}</ref>

Besides the personal cost, the disease has a great economic cost to the affected communities and India in general.<ref name="regional office 2012"/>

==Etymology==
''Kala-azar'' ([[Hindustani language|Hindustani]]: काला आज़ार <small>([[Devanagari]])</small> کالا آزار <small>([[Nastaleeq]])</small> ''kālā āzār''), is derived from ''kala'' which means black in [[Sanskrit]], as well as in the [[Indo-Aryan languages|languages descended]] from it, including [[Hindi]] and [[Urdu]];<ref name="MWKA">{{cite web | author = Merriam-Webster's online dictionary | url = http://www.merriam-webster.com/dictionary/kala-azar | title = kala-azar | access-date = 2010-01-21 }}</ref> the word ''azar'' is a [[Persian language|Persian]] loanword in [[Hindustani language|Hindustani]] that means "fever";<ref name="Collins English Dictionary">{{cite web | author = HarperCollins Publishers, 1991, 1994, 1998, 2000, 2003. | url = http://www.thefreedictionary.com/kala-azar | title = kala-azar | access-date = 2010-01-21 }}</ref><ref>{{cite book|title=Framework for Industrialization in Africa|url=https://books.google.com/books?id=I7JNoIcUycQC&q=hindustani+azar+fever&pg=PA77|first=Thomas A.|last=Taku|publisher=Greenwood Publishing Group|page=77|quote=Locally, the disease was called kala-azar or black fever, which is the meaning in the Hindustani language.|isbn=978-0-275-96498-6|year=1999}}</ref> as such the disease is named for the darkening of the skin on the extremities and abdomen that occurs in the disease. It is also pronounced ''kālāzar'' (कालाज़ार کالا زار).<ref>{{cite web |title=kaalaa-zaar |url=https://www.rekhtadictionary.com/meaning-of-kaalaa-zaar?lang=hi |website=Rekhta Dictionary |access-date=30 September 2024 |language=en}}</ref>

==Types==
[[File:Parasites of the tropical diseases Kala-Azar and Oriental So Wellcome V0022616.jpg|thumb|right|Kala azar causes various changes in the body]]
A 2012 report based on 2004-8 data estimated that the number of new annual cases of kala azar was at least 146,000 in India, 12,000 in Bangladesh, and 3,000 in Nepal.<ref name="Alvar 2012"/> Among all the people the subcontinent carrying infection, 10% have kala azar, 10% have PKDL, and 80% are asymptomatic.<ref name="Le RutteCoffeng2016">{{cite journal|last1=Le Rutte|first1=Epke A.|last2=Coffeng|first2=Luc E.|last3=Bontje|first3=Daniel M.|last4=Hasker|first4=Epco C.|last5=Ruiz Postigo|first5=José A.|last6=Argaw|first6=Daniel|last7=Boelaert|first7=Marleen C.|last8=De Vlas|first8=Sake J.|title=Feasibility of eliminating visceral leishmaniasis from the Indian subcontinent: explorations with a set of deterministic age-structured transmission models|journal=Parasites & Vectors|volume=9|issue=1|page=24|year=2016|issn=1756-3305|doi=10.1186/s13071-016-1292-0|pmid=26787302|pmc=4717541 |doi-access=free }}</ref>

===Kala azar===
{{main|Visceral leishmaniasis}}
Kala azar, also called visceral leishmaniasis, is a disease in which a parasite migrates to the internal organs such as the [[liver]], [[spleen]] (hence "[[Viscus|visceral]]"), and [[bone marrow]]. If left untreated, will almost always result in the death of the host. Signs and symptoms include [[fever]], [[Cachexia|weight loss]], [[fatigue (medical)|fatigue]], [[anemia]], and substantial [[Hepatosplenomegaly|swelling of the liver and spleen]].{{citation needed|date=May 2021}}

Among people with kala azar, there is variation in the symptoms, and some people can have unusual symptoms.<ref>{{cite journal |last1=Thakur |first1=L |last2=Singh |first2=KK |last3=Shanker |first3=V |last4=Negi |first4=A |last5=Jain |first5=A |last6=Matlashewski |first6=G |last7=Jain |first7=M |title=Atypical leishmaniasis: A global perspective with emphasis on the Indian subcontinent. |journal=PLOS Neglected Tropical Diseases |date=September 2018 |volume=12 |issue=9 |article-number=e0006659 |doi=10.1371/journal.pntd.0006659 |pmid=30260957|pmc=6159859 |doi-access=free }}</ref>

===Asymptomatic kala azar===
[[Asymptomatic]] kala azar (also called asymptomatic ''Leishmania'' infection) occurs when someone has the infection but does not show symptoms.<ref name="Hirve 2016">{{cite journal |last1=Hirve |first1=S |last2=Boelaert |first2=M |last3=Matlashewski |first3=G |last4=Mondal |first4=D |last5=Arana |first5=B |last6=Kroeger |first6=A |last7=Olliaro |first7=P |title=Transmission Dynamics of Visceral Leishmaniasis in the Indian Subcontinent – A Systematic Literature Review. |journal=PLOS Neglected Tropical Diseases |date=August 2016 |volume=10 |issue=8 |article-number=e0004896 |doi=10.1371/journal.pntd.0004896 |pmid=27490264|pmc=4973965 |doi-access=free }}</ref>

For every 1 person with kala azar symptoms, 4–17 people may have asymptomatic kala azar.<ref name="Hirve 2016"/> Risk of asymptomatic kala azar is high for anyone in close contact with a person with kala azar.<ref name="Hirve 2016"/> Most people who would test positive for asymptomatic kala azar will clear the infection naturally.<ref name="Hirve 2016"/> Between 1–23% of asymptomatic people will develop kala azar within 1 year.<ref name="Hirve 2016"/>

===Post-kala-azar dermal leishmaniasis===
{{main|Post-kala-azar dermal leishmaniasis}}
Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL); it is characterised by a macular, maculopapular, and nodular rash in a patient who has recovered from VL and who is otherwise well. Despite being called "post kala azar", 29% of cases appear from people who never had kala azar, and who had an asymptomatic infection previously.<ref name="Hirve 2016"/>

==Vector==
[[File:Transmission dynamics of visceral leishmaniasis in the Indian subcontinent.png|thumb|400px|diagram of how kala azar spreads in India]]
In various places in the world different [[sandflies]] transmit different ''[[Leishmania]]'' parasites which cause different variations of kala azar. In the [[Indian subcontinent]] the particular sandfly is ''[[Phlebotomus argentipes]]'' and it transmits ''[[Leishmania donovani]]''. One part of preventing the disease in India is preventing the insect bite.<ref name="Joshi 2009"/>

A challenge with preventing the insect bite is lack of ecological data and lack of information about the life of the insect. Ecological information which would predict when and where sandflies live include [[temperature]], [[rain]], [[wind speed]], [[Relative humidity]], [[soil moisture]], [[pH]], and [[total organic carbon]].<ref name="Chowdhury 2016">{{cite journal |last1=Chowdhury |first1=R |last2=Kumar |first2=V |last3=Mondal |first3=D |last4=Das |first4=ML |last5=Das |first5=P |last6=Dash |first6=AP |last7=Kroeger |first7=A |title=Implication of vector characteristics of Phlebotomus argentipes in the kala-azar elimination programme in the Indian sub-continent. |journal=Pathogens and Global Health |date=May 2016 |volume=110 |issue=3 |pages=87–96 |doi=10.1080/20477724.2016.1180775 |pmid=27376500|pmc=4940889 }}</ref> If that information were available, then it would be easier to study when insects bite, how they choose to bite either animals or humans, and where they breed.<ref name="Chowdhury 2016"/> Knowing about insect life and behavior would increase efficiency and lower cost of public health programmes to prevent kala azar.<ref name="Chowdhury 2016"/>

Using [[insecticide treated nets]] in 90% of the households in districts with kala azar could be an effective part of controlling the spread of disease.<ref name="Joshi 2009"/>

There is no evidence that animals are a major concern for spread of kala azar.<ref name="Singh 2013">{{cite journal |last1=Singh |first1=Niti |last2=Mishra |first2=Jyotsna |last3=Singh |first3=Ram |last4=Singh |first4=Sarman |title=Animal Reservoirs of Visceral Leishmaniasis in India |journal=The Journal of Parasitology |date=2013 |volume=99 |issue=1 |pages=64–67 |issn=0022-3395|jstor=23355018 |doi=10.1645/GE-3085.1 |pmid=22765517 |s2cid=41464582 }}</ref> Tests of cattle, buffalo, chickens, wild rats, and dogs found little or no infection.<ref name="Singh 2013"/> There is some evidence that goats could be reservoirs of infection.<ref name="Singh 2013"/>

==Treatment==
Kala azar is a community problem and requires individual and community participation in treatment.<ref name="regional office 2012"/> Treatment starts with healthcare workers seeking people with the disease.<ref name="regional office 2012"/> There is testing in clinics but also in the field.<ref name="regional office 2012"/> Preferred treatment is a single injection of [[liposomal]] [[amphotericin B]] at a clinic on the same day as testing and diagnosis. By doing everything in one visit, people will be able to easily complete treatment.<ref name="regional office 2012"/> Even after treatment, people may require a follow up including some combination therapy. Some people may require an alternative therapy and other drugs are effective.{{citation needed|date=May 2021}}

[[Miltefosine]] is the only available [[Oral administration|oral]] medication available for VL and PKDL.<ref name="Pijpers 2019">{{cite journal |last1=Pijpers |first1=J |last2=den Boer |first2=ML |last3=Essink |first3=DR |last4=Ritmeijer |first4=K |title=The safety and efficacy of miltefosine in the long-term treatment of post-kala-azar dermal leishmaniasis in South Asia - A review and meta-analysis. |journal=PLOS Neglected Tropical Diseases |date=February 2019 |volume=13 |issue=2 |article-number=e0007173 |doi=10.1371/journal.pntd.0007173 |pmid=30742620|pmc=6386412 |doi-access=free }}</ref> While the drug works for short term treatment of VL, PKDL would require a longer treatment of more than 28 days with this drug.<ref name="Pijpers 2019"/> Miltefosine is not recommended for use as a monotherapy to treat PKDL.<ref name="Pijpers 2019"/>

==Elimination of disease==
The eradication of kala azar in India is achievable and there are favorable circumstances for doing so.<ref name="Joshi 2009"/> Humans are the only reservoir host in this region for the parasite causing the disease.<ref name="Joshi 2009"/> The only way the disease spreads from human to human is by one insect in the region, ''[[Phlebotomus argentipes]]''.<ref name="Joshi 2009"/> {{As of|2009|post=,}} the disease only existed in 109 districts in India, Bangladesh, and Nepal.<ref name="Joshi 2009"/> The disease is easy to diagnose, even in the field and outside of a clinic.<ref name="Joshi 2009"/> When testing identifies a patient with the condition, then available drugs are completely effective in removing the parasite.<ref name="Joshi 2009"/>

The current goal for eliminating the disease is to have its rate below 1 in 10,000 people by 2020.<ref>{{cite journal |last1=Sundar |first1=S |last2=Singh |first2=OP |last3=Chakravarty |first3=J |title=Visceral leishmaniasis elimination targets in India, strategies for preventing resurgence. |journal=Expert Review of Anti-infective Therapy |date=November 2018 |volume=16 |issue=11 |pages=805–812 |doi=10.1080/14787210.2018.1532790 |pmid=30289007|pmc=6345646 }}</ref>

One part of the elimination strategy was to reduce [[Phlebotomus argentipes|sandflies]] as a [[Vector (epidemiology)|vector]] by giving [[mosquito nets]] treated with [[DDT]] along with programs for early case detection and treatment.<ref name="Ostyn 2008">{{cite journal |last1=Ostyn |first1=B |last2=Vanlerberghe |first2=V |last3=Picado |first3=A |last4=Dinesh |first4=DS |last5=Sundar |first5=S |last6=Chappuis |first6=F |last7=Rijal |first7=S |last8=Dujardin |first8=JC |last9=Coosemans |first9=M |last10=Boelaert |first10=M |last11=Davies |first11=C |title=Vector control by insecticide-treated nets in the fight against visceral leishmaniasis in the Indian subcontinent, what is the evidence? |journal=Tropical Medicine & International Health |date=August 2008 |volume=13 |issue=8 |pages=1073–85 |doi=10.1111/j.1365-3156.2008.02110.x |pmid=18564350|s2cid=2471946 |doi-access=free }}</ref><ref>{{cite journal |last1=Rijal |first1=Suman |last2=Sundar |first2=Shyam |last3=Mondal |first3=Dinesh |last4=Das |first4=Pradeep |last5=Alvar |first5=Jorge |last6=Boelaert |first6=Marleen |title=Eliminating visceral leishmaniasis in South Asia: the road ahead |journal=BMJ |volume=364 |date=22 January 2019 |article-number=k5224 |doi=10.1136/bmj.k5224|pmid=30670453 |pmc=6340338 }}</ref>

===Challenges===
Major challenges in eliminating kala azar is lack of access to health care, planning for drug resistance, the absence of a [[kala azar vaccine]], and the difficulty in controlling the insect spreading the infection.<ref name="Singh 2016">{{cite journal |last1=Singh |first1=OP |last2=Hasker |first2=E |last3=Boelaert |first3=M |last4=Sundar |first4=S |title=Elimination of visceral leishmaniasis on the Indian subcontinent. |journal=The Lancet. Infectious Diseases |date=December 2016 |volume=16 |issue=12 |pages=e304–e309 |doi=10.1016/S1473-3099(16)30140-2 |pmid=27692643|pmc=5177523 }}</ref> Progress in diagnosis, treatment, and the development of a vaccine is significant and is guiding the elimination planning.<ref name="Singh 2016"/> A program to eliminate kala azar would only work with strong support from local communities.<ref name="Singh 2016"/> [[Public health surveillance]] is necessary for years to identify cases as soon as possible for treatment and to prevent spread.<ref name="Singh 2016"/>

Humans with the parasite are reservoirs of infection which could revive the disease even if it seems eliminated.<ref name="Hirve 2016"/> People with asymptomatic kala azar can still spread the disease and so can people who seem cured of kala azar, but who later development PKDL.<ref name="Hirve 2016"/>

Potential great dangers to elimination are [[drug resistance]] and [[pesticide resistance]] and a need for [[pharmacovigilance]] to ensure drug safety for using the medications.<ref name="Elimination of Kala-Azar from the S">{{cite journal |last1=Bhattacharya |first1=SK |last2=Dash |first2=AP |title=Elimination of Kala-Azar from the Southeast Asia Region. |journal=The American Journal of Tropical Medicine and Hygiene |date=April 2017 |volume=96 |issue=4 |pages=802–804 |doi=10.4269/ajtmh.16-0279 |pmid=28115678|pmc=5392624 }}</ref>

===Public health programs===
The India National Health Policy, 2002 set a goal to eliminate kala azar by 2010.<ref name="Thakur 2016">{{cite journal |last1=Thakur |first1=C. P. |title=Is elimination of kala-azar feasible by 2017? |journal=Indian Journal of Medical Research |date=1 December 2016 |volume=144 |issue=6 |pages=799–802 |doi=10.4103/ijmr.IJMR_335_16 |pmid=28474615 |pmc=5433271 |language=en |issn=0971-5916 |doi-access=free }}</ref> The Central Government of India started supporting states with case registration in 2003.<ref>{{cite journal |last1=Dhillon |first1=GP |last2=Sharma |first2=SN |last3=Nair |first3=B |title=Kala-azar elimination programme in India. |journal=Journal of the Indian Medical Association |date=October 2008 |volume=106 |issue=10 |pages=664, 666–8 |pmid=19552101}}</ref> In 2005 the governments of India, Nepal, and Bangladesh started an initiative with the [[World Health Organization]] to collaborate in eliminating kala azar in the region.<ref>{{Citation |author=Regional Office for South-East Asia |year=2005 |title=Regional strategic framework for elimination of kala azar from the South-East Asia Region (2005–2015) |publisher=[[World Health Organization]] |location=New Delhi |hdl=10665/205825 }}</ref>

India changed the target year to 2015.<ref name="Thakur 2016"/> When the year came there was uncertainty that the goal would be met.<ref>{{cite journal |last1=Cousins |first1=Sophie |title=India unlikely to meet goal of eliminating kala-azar by 2015, say experts |journal=BMJ |volume=351 |date=28 July 2015 |article-number=h4117 |doi=10.1136/bmj.h4117|pmid=26220177 |s2cid=39380201 }}</ref> In February 2015 the health ministers of India, Bangladesh, and Nepal joined with the health ministers of Thailand and Bhutan to set a new target date to eliminate kala azar by 2017.<ref>{{Citation |author=World Health Organization |date=14 July 2015 |title=Kala-Azar elimination programme – Report of a WHO consultation of partners, Geneva, Switzerland, 10–11 February 2015 |editor-last=Postigo |editor-first=J. Ruiz |isbn=978-92-4-150949-7 |publisher=World Health Organization |location=Geneva |url=https://www.who.int/leishmaniasis/resources/9789241509497/en/ |archive-url=https://web.archive.org/web/20170329010216/http://www.who.int/leishmaniasis/resources/9789241509497/en/ |archive-date=March 29, 2017 }}</ref>

==History==
[[File:Scientist Sir Upendra Nath Brahmachari.png|thumb|left|150px|[[Upendranath Brahmachari]] researched kala-azar in Kolkata]]
[[File:Number of Deaths from Kala-Azar in Assam.svg|thumb|right|The miracle of urea stibamine, drawn by [[Upendranath Brahmachari]] himself. The death rate is drastically declined from nearly 6300 to 750 within ten years in Assam.]]
India has long been involved in drug development for kala azar.<ref>{{cite journal |last1=Alves |first1=F |last2=Bilbe |first2=G |last3=Blesson |first3=S |last4=Goyal |first4=V |last5=Monnerat |first5=S |last6=Mowbray |first6=C |last7=Muthoni Ouattara |first7=G |last8=Pécoul |first8=B |last9=Rijal |first9=S |last10=Rode |first10=J |last11=Solomos |first11=A |last12=Strub-Wourgaft |first12=N |last13=Wasunna |first13=M |last14=Wells |first14=S |last15=Zijlstra |first15=EE |last16=Arana |first16=B |last17=Alvar |first17=J |title=Recent Development of Visceral Leishmaniasis Treatments: Successes, Pitfalls, and Perspectives. |journal=Clinical Microbiology Reviews |date=October 2018 |volume=31 |issue=4 |doi=10.1128/CMR.00048-18 |pmid=30158301|pmc=6148188 }}</ref>

[[William Twining (military physician)|William Twining]], an [[East India Company]] military physician, wrote a modern medical description of kala azar in 1835.<ref>{{cite journal |last1=Gupta |first1=PCS |title=History of Kala-Azar in India. |journal=The Indian Medical Gazette |date=May 1947 |volume=82 |issue=5 |pages=281–286 |pmid=29015274|pmc=5196405 }}</ref>

In 1903 [[William Boog Leishman]], a British Army medical officer, reported from [[Dum Dum]] near [[Calcutta]] identifying parasites which cause kala azar.<ref>{{cite journal |last1=Leishman |first1=WB |author-link1=William Boog Leishman |title=On the possibility of the occurrence of trypanosomiasis in India. 1903. |journal=The Indian Journal of Medical Research |date=1903 |volume=123 |issue=3 |pages=1252–4; discussion 79 |pmid=16789342}}</ref><ref name="Steverding 2017">{{cite journal |last1=Steverding |first1=D |title=The history of leishmaniasis. |journal=Parasites & Vectors |date=15 February 2017 |volume=10 |issue=1 |page=82 |doi=10.1186/s13071-017-2028-5 |pmid=28202044|pmc=5312593 |doi-access=free }}</ref> His report was correct, and scientists gave his name to the parasite ''[[Leishmania]]'' and to the Western name of the disease, [[leishmaniasis]].<ref name="Steverding 2017"/>

Bengali physician and scientist [[Upendranath Brahmachari]] treated, researched, and published about kala-azar until his death in 1946.<ref>{{cite journal |last1=Singh |first1=Rajinder |last2=Roy |first2=Syamal |title=U N Brahmachari: Scientific Achievements and Nomination for the Nobel Prize and the Fellowship of the Royal Society of London |journal=Indian Journal of History of Science |date=1 March 2019 |volume=54 |issue=1 |doi=10.16943/ijhs/2019/v54i1/49596|doi-access= }}</ref>

India's National Malaria Eradication Programme was using [[DDT]] between 1953 and 1964 as the insecticide to prevent malaria.<ref name="Rao 2016">{{cite web |last1=Rao |first1=Menaka |title=India has been talking about defeating kala azar since 1947 – and now has a good chance of doing so |url=https://scroll.in/pulse/819854/india-has-been-talking-about-defeating-kala-azar-since-1947-and-now-has-a-good-chance-of-doing-so |website=[[Scroll.in]] |date=27 October 2016}}</ref> DDT is highly effective was banned for also being toxic to humans and the environment.<ref name="Rao 2016"/> When India was using DDT, that effort to reduce malaria also killed sandflies and prevented kala azar.<ref name="Rao 2016"/><ref>{{cite journal |last1=Bublitz |first1=DC |last2=Poché |first2=RM |last3=Garlapati |first3=R |title=Measures to Control Phlebotomus argentipes and Visceral Leishmaniasis in India. |journal=Journal of Arthropod-borne Diseases |date=June 2016 |volume=10 |issue=2 |pages=113–26 |pmid=27308270|pmc=4906751 }}</ref> After 1964 and the halt of DDT use, kala azar returned, but physicians no longer recognized the disease after its absence.<ref name="Rao 2016"/>

From about 1960–1975, there were no records of kala azar in the subcontinent.<ref name="Joshi 2006">{{cite journal |last1=Joshi |first1=AB |last2=Banjara |first2=MR |last3=Pokhrel |first3=S |last4=Jimba |first4=M |last5=Singhasivanon |first5=P |last6=Ashford |first6=RW |title=Elimination of visceral leishmaniasis in Nepal: pipe-dreams and possibilities. |journal=Kathmandu University Medical Journal |date=2006 |volume=4 |issue=4 |pages=488–96 |pmid=18603960}}</ref> In 1978 in Nepal, people reported the disease.<ref name="Joshi 2006"/> From 1980 the disease spread among many people.<ref name="Joshi 2006"/>

==Special populations==
[[Quackery]] is common enough to be a significant problem in treating the disease. The government seeks to make official clinics accessible, but many people take services from unlicensed medical practitioners.<ref name="Elimination of Kala-Azar from the S"/><ref>{{cite journal |last1=Boettcher |first1=Jan P |last2=Siwakoti |first2=Yubaraj |last3=Milojkovic |first3=Ana |last4=Siddiqui |first4=Niyamat A |last5=Gurung |first5=Chitra K |last6=Rijal |first6=Suman |last7=Das |first7=Pradeep |last8=Kroeger |first8=Axel |last9=Banjara |first9=Megha R |title=Visceral leishmaniasis diagnosis and reporting delays as an obstacle to timely response actions in Nepal and India |journal=BMC Infectious Diseases |date=6 February 2015 |volume=15 |issue=1 |page=43 |doi=10.1186/s12879-015-0767-5|pmid=25656298 |pmc=4335691 |doi-access=free }}</ref>

Men are more likely than women to get kala azar.<ref name="Cloots Jan 2020">{{cite journal |last1=Cloots |first1=K |last2=Burza |first2=S |last3=Malaviya |first3=P |last4=Hasker |first4=E |last5=Kansal |first5=S |last6=Mollett |first6=G |last7=Chakravarty |first7=J |last8=Roy |first8=N |last9=Lal |first9=BK |last10=Rijal |first10=S |last11=Sundar |first11=S |last12=Boelaert |first12=M |title=Male predominance in reported Visceral Leishmaniasis cases: Nature or nurture? A comparison of population-based with health facility-reported data. |journal=PLOS Neglected Tropical Diseases |date=29 January 2020 |volume=14 |issue=1 |article-number=e0007995 |doi=10.1371/journal.pntd.0007995 |pmid=31995564|pmc=7010295 |doi-access=free }}</ref>

Children with kala azar have the same symptoms as adults.<ref name="Bhattacharya 2006">{{cite journal |last1=Bhattacharya |first1=S.K. |last2=Sur |first2=Dipika |last3=Karbwang |first3=Juntra |title=Childhood visceral leishmaniasis |journal=Indian Journal of Medical Research |date=March 2006 |volume=123 |issue=123 |pages=353–356 |pmid=16778316 |url=http://medind.nic.in/iby/t06/i3/ibyt06i3p353.pdf |archive-date=2018-11-23 |access-date=2020-02-10 |archive-url=https://web.archive.org/web/20181123130845/http://medind.nic.in/iby/t06/i3/ibyt06i3p353.pdf }}</ref> Miltefosine is as effective and well tolerated as a treatment in children as adults and can be a first line treatment.<ref>{{cite journal |last1=Bhattacharya |first1=SK |last2=Jha |first2=TK |last3=Sundar |first3=S |last4=Thakur |first4=CP |last5=Engel |first5=J |last6=Sindermann |first6=H |last7=Junge |first7=K |last8=Karbwang |first8=J |last9=Bryceson |first9=AD |last10=Berman |first10=JD |title=Efficacy and tolerability of miltefosine for childhood visceral leishmaniasis in India. |journal=Clinical Infectious Diseases |date=15 January 2004 |volume=38 |issue=2 |pages=217–21 |doi=10.1086/380638 |pmid=14699453|doi-access=free }}</ref> 90% of the cases of kala azar are in Bihar, and children there have the burden of 50% of the loss of [[disability adjusted life years]].<ref name="Bhattacharya 2006"/>

[[HIV-positive people]] have a greater risk of reinfection of kala azar.<ref>{{cite journal |last1=Cota |first1=Gláucia F. |last2=de Sousa |first2=Marcos R. |last3=Rabello |first3=Ana |last4=Jaffe |first4=Charles L. |title=Predictors of Visceral Leishmaniasis Relapse in HIV-Infected Patients: A Systematic Review |journal=PLOS Neglected Tropical Diseases |date=7 June 2011 |volume=5 |issue=6 |article-number=e1153 |doi=10.1371/journal.pntd.0001153|pmid=21666786 |pmc=3110161 |doi-access=free }}</ref><ref>{{cite journal |last1=Singh |first1=Sarman |title=Changing trends in the epidemiology, clinical presentation, and diagnosis of Leishmania–HIV co-infection in India |journal=International Journal of Infectious Diseases |date=December 2014 |volume=29 |pages=103–112 |doi=10.1016/j.ijid.2014.07.011|pmid=25449244 |doi-access=free }}</ref>

==References==
{{reflist}}

==Further consideration==
* {{cite web |author1=National Vector Borne Disease Control Programme |title=National Kala-azar Elimination Programme |url=https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=469&lid=3752 |website=nvbdcp.gov.in |publisher=[[Ministry of Health and Family Welfare]]}}
* {{Citation |author=Regional Office for South-East Asia |year=2012 |title=Regional strategic framework for elimination of kala-azar from the South-East Asia Region (2011–2015) |publisher=[[World Health Organization]] |location=New Delhi |hdl=10665/205826 }}
* {{Citation |author=National Vector Bourne Disease Control Programme |date=February 2017 |title=Accelerated Plan for Kala-azar Elimination 2017 |publisher=[[Ministry of Health and Family Welfare]] |url=https://www.who.int/leishmaniasis/resources/Accelerated-Plan-Kala-azar1-Feb2017_light.pdf}}

==External links==
* [https://web.archive.org/web/20180422134840/http://www.who.int/leishmaniasis/burden/Leishmaniasis_India/en/ Leishmaniasis in India] – a World Health Organization profile (archived 22 April 2018)

[[Category:Leishmaniasis]]
[[Category:Diseases and disorders in India]]

Kala azar in India - Revision history

CatharineJorgens at 16:16, 19 April 2026