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124 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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A review of progress of the elimination programme in Bangladesh, India and Nepal indicated
a declining trend in the incidence of the disease and a significant increase in the number of
subdistricts that have achieved the elimination target (< 1 case per 10 000 population) (9).
The Government of Bangladesh has adapted a new treatment policy guideline applying the
use of single-dose AmBisome and has started rolling out its implementation in various health
facilities.
The incidence of reported cases in Bangladesh, India and Nepal decreased respectively in
2013 by around 37%, 33% and 50% from 2012 (Fig. 4.9.3). Coverage with indoor residual
insecticides in villages endemic for visceral leishmaniasis has improved, but its quality has
many gaps. Implementation of active case searches has also improved in the endemic areas
using community structures. Capacity-building activities have been intensified by training a
large number of health professionals.
Fig. 4.9.3
Top six high-burden countries for visceral leishmaniasis,
2003–2012
Number of cases reported
Thousands
70
60
50
40
30
20
10
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Top six high-burden countries (HBC)
Bangladesh India Nepal
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Bangladesh 6 113 5 920 6 892 9 379 4 932 4 840 4 293 3 800 3 376 1 902
Brazil 2 971 3 580 3 597 3 651 3 604 3 852 3 693 3 716 3 840 3 118
Ethiopia NA 1 403 2 585 2 375 1 579 1 356 1 083 1 936 2 032 2 500
India 18 214 24 479 32 803 39 173 44 533 33 598 24 213 28 382 33 155 20 571
South Sudan 7 722 3 777 3 141 1 117 758 582 1 907 9 166 11 862 5 012
Sudan 704 2 619 3 713 1 827 2 788 3 310 4 880 6 957 5 226 3 165
Top 6 HBC 42 324 41 778 52 731 57 522 58 194 47 538 40 069 53 957 59 491 36 268
Most endemic countries in East Africa have revised their national guidelines and initiated
combination treatment for visceral leishmaniasis (sodium stibogluconate and paromomycin).
Combination therapy has reduced the duration and cost of treatment, improved compliance
with treatment and is expected to delay or even prevent drug resistance.