Dear Editor,
I am writing to draw your attention to the remarkable progress Bangladesh has made in the battle against kala-azar, also known as visceral leishmaniasis. Kala-azar, a deadly disease that primarily affects the poorest communities in Bangladesh, India, and Nepal, poses a significant public health challenge. It is transmitted through sandflies and is characterized by symptoms such as fever, weight loss, and enlargement of the spleen and liver (1).
Bangladesh, one of the countries most severely affected by kala-azar, initiated the National Kala-azar Elimination Program (NKEP) in 2005, with the ambitious aim of eradicating the disease by 2020. The NKEP's implementation of various strategies, including indoor residual spraying, insecticide-treated bed nets, and active case detection, has been instrumental in reducing the prevalence of kala-azar. However, challenges persist in terms of early diagnosis and treatment, particularly in remote areas. The complexity of managing the disease has further increased with the emergence of post-kala-azar dermal leishmaniasis (PKDL), a cutaneous complication of visceral leishmaniasis. Data from 2018 indicated that PKDL cases were concentrated in six countries, including Bangladesh, with vulnerable populations, especially young individuals, bearing the brunt of the disease (2).
The success of Bangladesh's fight against kala-azar can be attributed to several factors. A key factor is the cooperation of various parties, including the World Health Organization (WHO), the International Center for diarrhoeal disease research, Bangladesh, the United Kingdom, Gilead Sciences, Inc., the Bill & Melinda Gates Foundation, the Special Program for Research and Training in Tropical Diseases (TDR), the Government of Bangladesh, and others in the WHO Southeast Asia Region (3). Through the Regional Kala-azar Elimination Initiative, Bangladesh, India, and Nepal launched a coordinated effort in 2005, focusing on social mobilization, operational research, integrated vector control, early diagnosis, comprehensive case management, and efficient disease surveillance (4).
Thanks to these collaborative efforts, Bangladesh has historically become the first country worldwide to eliminate visceral leishmaniasis as a public health concern. Additionally, Bangladesh achieved another remarkable feat by becoming the first country to eliminate two neglected tropical diseases in the same year, following the validation of lymphatic filariasis elimination in May 2023. The remarkable results achieved over the last decade testify to the power of collective action (4). With the NKEP targeting zero transmission of kala-azar by 2025, vector control has become a central strategy. Bangladesh has been implementing vector control activities since 2012, and comprehensive guidelines have been developed and aligned with national guidelines (5).
This achievement is globally significant because kala-azar affects millions of people worldwide, particularly in impoverished regions. Bangladesh's accomplishments demonstrate that with dedicated efforts, strategic planning, and international collaboration, even the most challenging public health problems can be conquered (4). The successful elimination of kala-azar in Bangladesh represents a significant milestone in the fight against neglected tropical diseases. This underscores the importance of international cooperation, research, and targeted strategies. However, it is essential to remain vigilant in maintaining this achievement, particularly in regions facing last-mile challenges. Strong political commitments, effective drugs, improved insecticides, and rigorous monitoring and evaluation are vital for sustaining kala-azar elimination. We hope that this success story from Bangladesh will inspire and inform the ongoing efforts of the global community to combat kala-azar and other neglected tropical diseases.
