Kala-Azar: How Visceral Leishmaniasis And Malnutrition Are Linked, And Ways To Eliminate The Disease From India

The link between nutrition and kala-azar is a crucial aspect of disease management and prevention. Malnutrition exacerbates susceptibility to kala-azar and worsens its severity.

Visceral leishmaniasis, commonly known as kala-azar, is prevalent in 75 countries across Asia, Africa, and the Americas. Adequate nutrition strengthens the body's immune defenses, enhancing resistance against Leishmania parasites.

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By Dr Rajan Sankar

Visceral leishmaniasis, commonly known as kala-azar, is prevalent in 75 countries across Asia, Africa, and the Americas. According to the World Health Organization (WHO), India accounted for 18 per cent of the global kala-azar burden in 2020. Key government interventions, such as rigorous indoor residual spraying to curb sandfly breeding, application of special soil to seal mud wall crevices to prevent sandfly nesting, and mobilisation of the ASHA network to ensure completion of treatment for patients with post-kala-azar dermal leishmaniasis (PKDL), a complication of visceral leishmaniasis, have contributed to meeting elimination targets. 

Elimination for kala-azar is defined as a reduction in annual Kala-azar case incidence to less than one case per 10,000 individuals at block level in the country. According to data from the National Centre for Vector Borne Diseases Control, as many as 595 cases of kala-azar were reported in 2023 across Bihar, Jharkhand, West Bengal, and Uttar Pradesh. 

By December 2023, all endemic blocks had achieved the target of reporting less than one case per 10,000 population. While the target numbers have been met, sustaining this progress is crucial for India to be declared kala-azar-free.

How kala-azar and malnutrition are linked

The link between nutrition and kala-azar is a crucial aspect of disease management and prevention. Malnutrition exacerbates susceptibility to kala-azar and worsens its severity, particularly among vulnerable populations such as children. Malnourished individuals often exhibit weakened immune responses, increasing susceptibility to Leishmania infection and impeding treatment effectiveness, leading to prolonged recovery times and higher risks of disease relapse.

Conversely, addressing malnutrition is a promising approach to prevent kala-azar. Adequate nutrition strengthens the body's immune defenses, enhancing resistance against Leishmania parasites.

Ways to eliminate kala-azar from the country

Nutritional interventions can improve treatment efficacy, speeding up recovery and reducing disease recurrence. For instance, in West Bengal, the state program provides nutrition kits to visceral leishmaniasis and PKDL patients. These kits contain essential supplements like pulses, sweet potatoes, corn, amla, soybeans, multivitamins, dates, and dry fruits. Each kit costs Rs 1000. The kits are provided for six months to supplement the patient’s nutritional needs.

Integrating nutrition-sensitive approaches into kala-azar control programs is crucial, ensuring access to nutritious food, promoting dietary diversity, and micronutrient supplementation, especially in endemic regions with high malnutrition rates. 

Collaborative efforts between public health authorities, nutrition experts, and local communities are essential for implementing comprehensive strategies addressing both nutritional determinants and health consequences of kala-azar.

Recognising and addressing the intricate relationship between nutrition and kala-azar is paramount in developing effective and sustainable solutions to combat the disease. By prioritising nutrition as a core component of intervention strategies, the burden of kala-azar can be mitigated, moving closer to its eventual elimination.

(The author is the director of The India Nutrition Initiative (TINI), and a senior advisor for nutrition at Tata Trust).

[Disclaimer: Information provided in this article is for general guidance only. Individual results may vary. It is important to consult a healthcare professional, who knows your body type and medical history, before implementing the suggestions and information provided herein].