World Health Organization, Data and Statistics
Regional Situation of Kala Azar
The disease is endemic in three countries of WHO’s SEA Region –Bangladesh, India and
Nepal. Approximately 200 million people in the Region are “at risk” from the disease.
The disease is now being reported in 45 districts in Bangladesh, 52 in India and 12 in
Nepal. The total number of districts reporting kala‐azar exceeds 109. Bhutan has also
reported sporadic cases from 10 districts. with a total of 22 cases was reported between
1999 and March 2011, while it was officially documented for the first time in 2007.
Of the estimated 500,000 people in the world infected each year, nearly 100,000 are
estimated to occur in the Region. In the endemic countries, kala azar affects the poorest
of the poor with little knowledge about the disease and limited access to diagnosis and
treatment. The health expenditure and economic loss are fuelling their cycle of poverty.
Trend of Reported Cases of Kala‐azar in SEA Region 1994‐2011
10000 20000 30000 40000 50000 60000
Bhutan
India
Bangladesh
Nepal
0
Number of cases
Reported Kala-azar Cases in SEA Region, 1994-2011
1994
1996
1998
2000
2002
Year
2004
2006
2008
2010
Trend of Reported Cases of Kala‐azar in India 1990‐2011
Trends of Reported Kala-azar Cases and Deaths in India, 1990-2011
1600
90000
80000
1400
70000
1200
60000
50000
800
40000
Number of Deaths
Number of Cases
1000
Cases
Deaths
600
30000
400
20000
200
10000
0
0
1990
1995
2000
2005
2010
Year
INDIA
VL by L. donovani was known in India for a long time. It has virtually disappear during
the DDT spraying campaign of the national Malaria Eradication Programme. When
extensive DDT spraying stopped in the 1960s,VL re‐emerged in the form of large
epidemic outbreaks (100,000 cases in 1977 and 40,000 in 1978), which have continued
to occur until today. Currently, the endemic area covers the largest part of Bihar and
extends to West Bengal, Jharkhand and Uttar Pradesh (NVBDCP, Delhi).
Bihar is the most affected state; the case load in Bihar, where 90% of the population
lives in extreme poverty, currently represents half of the worldwide burden of VL.
The number of reported cases is a gross underestimation of the real number of cases.
Trend of Reported Kala azar Cases and Deaths in Nepal,
1994-2011
2500
14
12
10
1500
8
6
1000
4
Number of deaths
Number of cases
2000
Cases
Death
500
2
0
19
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
0
20 6
0
20 7
0
20 8
0
20 9
1
20 0
11
0
Year
NEPAL
Similar like India, in Nepal VL prevalence was reduced during 1950s and 1960s Malaria
Eradication Program with the DDT spraying, and then re‐emerged. From 1980 to 1989, the
incidence rate per 100,000 person‐years remained below 10. Since then, the incidence has
grown steadily and in the last few years it increased from 43 to 55 per 100,000 person‐years
Most of the cases are reported from the regions bordering the endemic districts of Bihar, India.
A sharp decline in the number of cases has been observed since the launch of National Kala‐azar
Elimination program, but between 2007 and 2010, VL was notified from an increasing number of
districts (from 14 in 2007 to 26 in 2010). In 9 districts, the elimination target has been reached.
Trend of Reported Kala-azar Cases and Death in Bangladesh,
1999-2011
10000
40
9000
35
30
7000
6000
25
5000
20
4000
15
3000
10
Number of deaths
Number of cases
8000
Cases
Death
2000
5
0
0
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
1000
Year
BANGLADESH
The country has VL cases since before the independence, and while it was thought to be
eliminated in 1970s, there has been a resurgence of VL with more than 5000 cases since
1999. VL is now endemic in many Bangladeshi areas, with the Mymensingh district
representing over 50% of the cases.
A complication of VL, known as PKDL or Post Kala‐azar Demal Leishmaniasis, could be a
factor in VL transmission in Bangladesh
The disease is endemic in three countries of WHO’s SEA Region –Bangladesh, India and
Nepal. Approximately 200 million people in the Region are “at risk” from the disease.
The disease is now being reported in 45 districts in Bangladesh, 52 in India and 12 in
Nepal. The total number of districts reporting kala‐azar exceeds 109. Bhutan has also
reported sporadic cases from 10 districts. with a total of 22 cases was reported between
1999 and March 2011, while it was officially documented for the first time in 2007.
Of the estimated 500,000 people in the world infected each year, nearly 100,000 are
estimated to occur in the Region. In the endemic countries, kala azar affects the poorest
of the poor with little knowledge about the disease and limited access to diagnosis and
treatment. The health expenditure and economic loss are fuelling their cycle of poverty.
Trend of Reported Cases of Kala‐azar in SEA Region 1994‐2011
10000 20000 30000 40000 50000 60000
Bhutan
India
Bangladesh
Nepal
0
Number of cases
Reported Kala-azar Cases in SEA Region, 1994-2011
1994
1996
1998
2000
2002
Year
2004
2006
2008
2010
Trend of Reported Cases of Kala‐azar in India 1990‐2011
Trends of Reported Kala-azar Cases and Deaths in India, 1990-2011
1600
90000
80000
1400
70000
1200
60000
50000
800
40000
Number of Deaths
Number of Cases
1000
Cases
Deaths
600
30000
400
20000
200
10000
0
0
1990
1995
2000
2005
2010
Year
INDIA
VL by L. donovani was known in India for a long time. It has virtually disappear during
the DDT spraying campaign of the national Malaria Eradication Programme. When
extensive DDT spraying stopped in the 1960s,VL re‐emerged in the form of large
epidemic outbreaks (100,000 cases in 1977 and 40,000 in 1978), which have continued
to occur until today. Currently, the endemic area covers the largest part of Bihar and
extends to West Bengal, Jharkhand and Uttar Pradesh (NVBDCP, Delhi).
Bihar is the most affected state; the case load in Bihar, where 90% of the population
lives in extreme poverty, currently represents half of the worldwide burden of VL.
The number of reported cases is a gross underestimation of the real number of cases.
Trend of Reported Kala azar Cases and Deaths in Nepal,
1994-2011
2500
14
12
10
1500
8
6
1000
4
Number of deaths
Number of cases
2000
Cases
Death
500
2
0
19
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
0
20 6
0
20 7
0
20 8
0
20 9
1
20 0
11
0
Year
NEPAL
Similar like India, in Nepal VL prevalence was reduced during 1950s and 1960s Malaria
Eradication Program with the DDT spraying, and then re‐emerged. From 1980 to 1989, the
incidence rate per 100,000 person‐years remained below 10. Since then, the incidence has
grown steadily and in the last few years it increased from 43 to 55 per 100,000 person‐years
Most of the cases are reported from the regions bordering the endemic districts of Bihar, India.
A sharp decline in the number of cases has been observed since the launch of National Kala‐azar
Elimination program, but between 2007 and 2010, VL was notified from an increasing number of
districts (from 14 in 2007 to 26 in 2010). In 9 districts, the elimination target has been reached.
Trend of Reported Kala-azar Cases and Death in Bangladesh,
1999-2011
10000
40
9000
35
30
7000
6000
25
5000
20
4000
15
3000
10
Number of deaths
Number of cases
8000
Cases
Death
2000
5
0
0
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
1000
Year
BANGLADESH
The country has VL cases since before the independence, and while it was thought to be
eliminated in 1970s, there has been a resurgence of VL with more than 5000 cases since
1999. VL is now endemic in many Bangladeshi areas, with the Mymensingh district
representing over 50% of the cases.
A complication of VL, known as PKDL or Post Kala‐azar Demal Leishmaniasis, could be a
factor in VL transmission in Bangladesh