For the first time in eight years, Jharkhand has reported one death from kala azar in the state, even as the total number of cases continues to fall. While 752 cases were identified as positive in 2015, the number of provisional cases last year through November was 242, according to data from the National Center for Vector Borne Disease Control portal.
The Jharkhand government, however, said that the eight people listed on the central portal as kala-azar deaths in 2021 were only suspected victims of the disease.
A parasitic disease spread by the bites of sandflies, kala azar (meaning black death) or visceral leishmaniasis is almost always fatal if left untreated. In Jharkhand, it is endemic to four districts, especially their rural areas: Sahebganj, Godda, Dumka and Pakur, covering 33 blocks. The disease is considered endemic if there is more than one case per 10,000 inhabitants.
Data for kala-azar in the state is available from 2014. However, even in 2015 when Jharkhand reported a peak of 1,358 cases, no deaths were recorded.
The state malaria control officer who also deals with kala-azar prevention in the state, Dr. Shesh Narayan Jha, said that the eight deaths in 2021 of kala-azar patients were due to comorbidities. “In one case the patient had kidney failure and in another the patient had tuberculosis.”
Jharkhand’s Additional Chief Secretary Arun Singh (Health) said: “According to the monitoring cell reports made available to me, in 2020, 17 suspects were reported and in 2021, eight. A “verbal autopsy” was conducted on 19 of these cases, and there were no confirmed deaths from kala-azar. The verbal autopsy determines the cause of death through a series of questions.
Verbal autopsies of five of the eight cases recorded as kala-azar deaths in the central portal, according to data from the state’s National Health Mission (NHM), indicate that their probable cause of death was pulmonary tuberculosis. Verbal autopsy is pending for two while one died during dialysis.
The sandfly vector is known to live in the cracks and crevices of muddy houses, especially in dark, damp corners. Dumka, where three of the alleged deaths occurred last year, is particularly vulnerable due to heavy rains and its large tribal population who live in mud houses. Insecticide spraying can help control the vector.
Dumka DC Ravi Shankar Shukla, a former NHM director, said a survey between December 13 and December 23 found 19 positive kala azar cases. Admitting the three suspicious deaths, Shukla said: ‘The idea is to identify positive cases so that there can be complete elimination of the disease. We do four to six active searches a year and have increased the spraying of insecticides. We also show people the sandflies (so they can identify them). “
WHO State Coordinator (Neglected Tropical Diseases), Dr Abhishek Paul, also said the deaths were the result of co-morbidities.
On the kala-azar control efforts, he said they had used 1,184 rural health practitioners, including traditional healers, for monitoring reports, while the state was the first to put establishment of kala-azar treatment centers in all affected blocks.
Jharkhand has indeed managed to ensure an uninterrupted decline in cases – 25% on average annually – despite two waves of Covid-19. Noting this, Paul said: “Cases have gone down, but transmission cannot be reduced abruptly. Elimination is a time-limited process and it will happen.
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