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My Fellowship Project: India Kala-Azar Elimination Program

I have recently learned some details about my primary fellowship project: I will be based in New Delhi, helping CARE India to set up a new program to eradicate Kala-Azar, or visceral leishmaniasis (VL). VL is a disease caused by a protozoan called Leishmania donovani, and it is transmitted by Phlebotomus, a small sand fly, which bites human hosts much like a mosquito. According to the World Health Organization (WHO), it is endemic in the province of Bihar in India (where I'll be working in the field) and 60%+ of VL cases occur in the Indian subcontinent (including Bangladesh, and Nepal). VL is also prevalent in Brazil and Sudan. In 2010, in Bihar alone, over 20,000 cases of VL were reported (with likely many more unreported), and nearly 100 reported deaths due to the disease.

The disease usually first results in fever, weight loss, and enlargement of the spleen and/or the liver. The name Kala-Azar means literally "Black disease," and the form of VL found in India often results in darkening of the skin. VL is considered to be fatal if untreated, though it is actually the weakening of the immune system, leading to other (secondary) infections, that usually results in death. Because the sand fly and the protozoan are found in rural, poverty-stricken areas of the world, where the inhabitants are typically undernourished and subject to many other diseases (tuberculosis, malaria, and many others) - as well as a lack of treatment - it is easy to see the need for intervention. There have been efforts in the past to eliminate VL in India, through what is called Residual Indoor Spraying (with insecticides like DDT) coupled with efforts to educate villagers about how to better prevent or limit sand fly bites (bed netting or some kind of screening can be very effective); these efforts have been able to reduce the incidence of the disease for some years, but a renewed effort is needed to finish the job. My project will be working with CARE (and likely other stakeholders) to establish a new eradication program, establish goals, and determine how best to monitor and evaluate progress over time. I will be making several visits to Bihar, and by the end of my Fellowship will have started a pilot program to put everything into practice. The eradication effort will likely span many years, so key to this is setting up a sustainable system to continue monitoring progress over time. For more information about Kala-Azar and past attempts to eradicate it in India, click here, here and here.

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