Kala azar death in Jharkhand; state says cause comorbidities

Data regarding kala azar in the state is available since 2014. However, even in 2015, when Jharkhand reported a high of 1,358 cases, no deaths were seen.

Kala-Azar drive in Dumka district of Jharkhand.

4 min readRanchiJan 13, 2022 12:39 PM IST First published on: Jan 13, 2022 at 03:27 AM IST

For the first time in eight years, Jharkhand reported a death due to kala azar in the state, even as the total cases continue to decline. While 752 cases were identified as positive in 2015, the number of provisional cases last year till November was 242, as per data on the National Centre for Vector Borne Disease Control portal.

The Jharkhand government however said the eight listed on the central portal as deaths due to kala azar in 2021 were only suspected casualties due to the disease.

A parasitic disease spread by sandfly bites, kala azar (meaning black death) or Visceral leishmaniasis is almost always fatal if not treated. 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 population.

State Malaria Officer who also looks after kala azar prevention in the state, Dr Shesh Narayan Jha, said the eight deaths in 2021 of patients with kala azar were due to comorbidities.

Data regarding kala azar in the state is available since 2014. However, even in 2015, when Jharkhand reported a high of 1,358 cases, no deaths were seen.

State Malaria Officer who also looks after kala azar prevention in the state, Dr Shesh Narayan Jha, said the eight deaths in 2021 of patients with kala azar were due to comorbidities. “In one case the patient had renal failure and in another, the patient had tuberculosis.”

Jharkhand Additional Chief Secretary Arun Singh (Health) said: “As per the monitoring cell reports made available to me, in 2020, 17 suspected were reported, and in 2021, eight. A ‘verbal autopsy’ was conducted of 19 such cases, and there were zero confirmed kala azar deaths.” Verbal autopsy determines the cause of death through a set of questions.

The verbal autopsy in five of the eight cases recorded as kala azar deaths in the Central portal, as per data by the state’s National Health Mission (NHM), says their probable cause of death was pulmonary tuberculosis. The verbal autopsy is pending for two while one died during dialysis.

WHO’s State Coordinator (Neglected Tropical Diseases) Doctor Abhishek Paul said the deaths were a result of comorbidities.

The vector sandfly is known to live in cracks and crevices of muddy houses, especially in dark and humid corners. Dumka, where three of the suspected deaths happened last year, is particularly susceptible due to heavy rainfall and its large tribal population that lives in mud houses. Insecticide spraying can help tackle the vector.

Dumka DC Ravi Shankar Shukla, a former NHM Director, said a survey between December 13 and 23 had found 19 kala azar positive cases. Admitting the three suspect deaths, Shukla said: “The idea is to identify the positive cases so that there can be complete elimination of the disease. We conduct four-six active searches a year and have increased spraying of insecticides. We also show people the sandflies (so that they can identify them).”

WHO’s State Coordinator (Neglected Tropical Diseases) Doctor Abhishek Paul also said the deaths were a result of comorbidities.

On the efforts to counter kala azar, he said they had roped in 1,184 rural health practitioners, including traditional healers, for surveillance reporting while the state was the first to set up treatment centres for kala azar in all the affected blocks.

Jharkhand, in fact, has managed to ensure an uninterrupted decline in cases – 25% on an average annually – despite two waves of Covid-19. Noting this, Paul said: “Cases have declined, but the transmission cannot be reduced abruptly. Elimination is a time-bound process and it will happen.”