Kala-azar or visceral leishmaniasis is endemic in Nepal along with Bangladesh and India in the south east region. Government of Nepal is a signatory to the memorandum of understanding on strengthening collaboration in the regional effort to eliminate kala-azar as a public health problem which was formalized during the World Health Assembly held in May 2005.
In 2005, Nepal formulated a national plan to eliminate kala-azar defined as < 1 case per 10,000 population at district level with a target of achieving elimination by 2015. However, the elimination target could not be achieved by the program. Although the program has seen a steady decline in number of kala-azar cases, sporadic cases are being consistently reported from other districts which are considered as non- endemic. Recently in 2017, a mountainous district, Dolpa, reported kala-azar cases above the elimination threshold. In 2018, 53% of the total kala azar cases reported were from districts considered as non- endemic for kala-azar.
The national kala-azar program was mainly focusing its elimination activities in endemic districts. Initially twelve districts out of 75 were considered endemic for kala-azar. However, later, six districts which were consistently reporting kala-azar cases were added to the list of endemic district after local transmission of the disease was verified. This geographical expansion of the disease to the hilly and mountainous district is alarming. Moreover, increasing number of other forms of the disease like cutaneous leishmaniasis and mucocutaneous leishmaniasis is posing a threat in country’s elimination effort.