Presentation On National Kala-azar Elimination Program Nepal 2020

  • Kala-azar situation Nepal
    • Slated for elimination as a public health problem (achieving annual incidence of < 1 case/10,000 population at the district level.
    • GoN is committed to the WHO regional strategy to eliminate kala azar.
    • Nepal is also signatory to the MOU on strengthening collaboration in the regional elimination efforts along with Bangladesh and India during WHA 2005 which was renewed in 2014 with inclusion of Bhutan and Thailand.
    • In Nepal parasite species for Kala azar is Leishmania donovani and P. argentipes is the main vector.
    • First cases of kala azar were reported as early as 1960s
      in Nepal.
    • National program initially identified 12 districts as kala azar endemic districts.
    • 6 other districts were included in the list in 2016 because sporadic cases were consistently being reported by these 6 districts.
    • Currently 18 districts are considered endemic
    • Increasing number of cases are being reported by districts not included in the endemic list.
    • In 2018, 32 districts considered as non endemic have reported at least 1 kala azar case.
    • All the endemic districts achieved annual incidence to < 1 case/10,000 population by 2013, however in 2017 one district Dolpa
    • considered non endemic, crossed the elimination threshold.
    • In 2018, all districts reported annual incidence of <1/10,000 population.
  • National KA Elimination Program
    • 2005 EDCD formulated a National Plan for the Elimination of Kala azar (KA) in Nepal
    • 2010 National Plan revised as National Strategic Guideline on Kala azar Elimination in Nepal rK39 recommended as rapid diagnostic test kit and Miltefosine as the first line treatment for KA
    • 2014 National Strategic Guideline updated to introduce Liposomal Amphotericin B and  combination therapy in the national treatment  protocol.
    • 2019 National Guideline on KA elimination revised, single dose L AmB , 10mg/kg as 1 st line therapy and surveillance system strengthening (KA Tracker)
  • GOAL
    • To contribute to mitigation of poverty in kala azar
      endemic districts of Nepal by

      • reducing the morbidity and mortality of the disease and
      • assisting in the development of equitable health systems
  • OBJECTIVES
    • Reduce incidence of kala azar in endemic communities with special emphasis on poor, vulnerable and unreached population
    • Reduce case fatality rates from primary Kala azar to ZERO;
    • Detect and treat PKDL to reduce the parasite reservoir
    • Prevent and manage kala azar HIV TB co infections