Nepal’s success is largely credited to a multi-pronged strategy combining surveillance, treatment and vector control.

Nepal is poised to eliminate kala-azar – a once-deadly neglected tropical disease – as a public health problem this year after decades of control efforts sharply reduced infections and deaths.

Health authorities say the country has already achieved the key benchmark required for elimination: fewer than one case per 10,000 people at the district level, while deaths have remained under one percent for the past two years.

“If we maintain the threshold this year, we will be eligible to achieve elimination status,” a senior vector-borne disease official said, pointing to strengthened surveillance and targeted control programmes across affected districts.

Kala-azar – also known as visceral leishmaniasis – is transmitted through the bite of infected female sandflies and attacks internal organs such as the liver and spleen. Without treatment, the disease can be fatal in up to 95 percent of cases.

The milestone would mark a major public-health success for the Himalayan nation, which once carried a significant disease burden in South Asia.

Regional Commitment and Long Struggle

Nepal’s progress stems from a regional campaign launched in 2005, when Nepal, India and Bangladesh agreed to eliminate kala-azar across the Indian subcontinent.

The goal was initially set for 2015 but repeatedly delayed due to sporadic outbreaks and spread into new areas.

Over time, however, aggressive interventions dramatically reduced infections:

• Cases fell by more than 95 percent by 2021 compared to 2007 levels
• New infections dropped to below one per 10,000 population
• Death rates remained under one percent

The World Health Organization defines elimination of kala-azar as reducing annual incidence below that threshold at district level.

Bangladesh has already achieved this milestone, showing elimination is feasible in the region.

How Nepal has Fought the Disease

Nepal’s success is largely credited to a multi-pronged strategy combining surveillance, treatment and vector control.

Active surveillance and early detection

Health workers actively track fever cases in villages, particularly in vulnerable communities, enabling early diagnosis and treatment.

Rapid diagnostic tests and improved medicines have shortened treatment time and reduced mortality.

Vector control measures

Authorities have targeted sandflies through:

• Indoor residual spraying
• Environmental sanitation
• Public awareness campaigns

Vector control is considered essential because the insect thrives in mud walls, cracks and damp soil common in poor housing.

Community mobilisation

Community health volunteers play a key role by identifying symptoms early and referring patients to health facilities, helping prevent severe disease and transmission.

Cross-border cooperation

Because endemic areas lie along the India-Nepal border, authorities also coordinate surveillance and investigation of cases across borders to prevent re-introduction.

Challenges in the Last Mile

Despite remarkable progress, officials say the fight is not over.

The disease has appeared in unexpected places – including mountain districts – challenging earlier assumptions that sandflies cannot survive at high altitude.

Vectors have been detected up to about 2,000 metres above sea level, and infections have occurred in districts once considered non-endemic.

Children remain particularly vulnerable, partly because of outdoor exposure and limited protective clothing.

Key remaining challenges include:

• Sporadic cases in new districts
• Post-treatment skin infections that can sustain transmission
• Cross-border movement
• Climate-related vector expansion

Health authorities warn that elimination does not mean eradication – surveillance must continue to prevent resurgence.

Beyond Elimination: Sustaining Success

Experts say maintaining elimination status will require long-term vigilance.

The WHO recommends countries strengthen reporting systems, improve diagnostic services and engage communities to prevent re-establishment of transmission.

South Asia has already recorded a 95 percent decline in cases over the past decade, but remaining hotspots could reverse gains if surveillance weakens.

For Nepal, sustaining success may depend on integrating kala-azar monitoring with broader neglected tropical disease programmes that also target dengue, filariasis and leprosy.

A Public-Health Turning Point

Kala-azar has historically affected the poorest communities, trapping families in cycles of illness and poverty.

Eliminating it would therefore represent not only a medical achievement but also a major socio-economic milestone.

If the country maintains low infection levels through the year, Nepal will join the small group of nations that have defeated one of the world’s deadliest parasitic diseases as a public-health threat.

Health officials say the goal now is simple: ensure the disease never returns.