Kala-azar, a vector-borne disease generally found in Tarai districts, has also been taking its toll in Okhaldhunga, a hill district of Koshi Province, over the past few years. Manebhanjyang Rural Municipality is the hardest hit local unit in Okhaldhunga by kala-azar, also known as visceral leishmaniasis or black fever.

According to the Department of Health Services (DHS), Okhaldhunga district in Koshi Province and Kalikot district in Karnali Province are hugely affected by the black fever.

As many as 75 people were diagnosed with kala-azar in Okhaldungha over the past five years.

According to the District Health Office, 10 people were diagnosed with kala-azar in the fiscal year 2019-20; 37 in 2020-21; 24 in 2021-22; four in 2022-23; and three people have been infected with the disease so far in the current fiscal year. All four infected people except one are from Manebhanjyang.

In Okhaldhunga district, kala-azar was first detected in Manebhanjyang in 2016. The DHS in coordination with the World Health Oganisation (WHO) launched various health campaigns in the district.

Four days ago, a DHS team reached Manebhanjyang and conducted a public awareness event, conducting tests on suspects and their family members and immediate neighbours.

“We have come here with the aim of eradicating kala-azar from Manebhanjyang. In the first step, we will run tests on the samples collected from the recently infected patients and their families and neighbours. We will follow that up with full-fledged public awareness and control programmes to prevent further infection,” said Uttam Koirala, senior public health officer of the DHS.

According to the DHS, out of the seven provinces in the country, Karnali province, at 100, had the highest number of kala-azar patients in 2022. In the same year, in Koshi province, 38 cases of kala-azar were confirmed; 49 people in Sudurpaschim, 32 in Lumbini, six in Gandaki, 14 in Bagmati and 18 in Madhesh province.

The federal, provincial and local governments have also made collective efforts to control the spread of the disease such as sanitising the environment and distributing mosquito nets, among other things.

Ashrachan Rai, deputy chairman of Manebhanjyang, said that the rural municipality has allocated a budget of Rs200,000 in the current fiscal year for prevention and control of kala-azar. “People don’t use sleeping nets here. Since it’s a hilly area, people don’t feel the need for it. So we are now conducting awareness campaigns to inform people of the importance of taking precautions like using sleeping nets,” said Rai.

So far, there has been no detailed research to determine the presence of kala-azar infection in Manebhanjyang. According to Koirala from the DHS, kala-azar was limited to the 12 districts of Tarai and gradually spread to the hilly region.

Kala-azar is transmitted through the bite of infected female phlebotomine sandflies.

“So far, no studies have been conducted, but the gradual spread of the disease indicates that the climate in hilly areas is getting warmer and the mosquitoes and sandflies are moving to higher altitudes,” he said.

According to the Epidemiology and Disease Control Division (EDCD), kala-azar was first seen in Nepal in 1980 in the 12 districts of Tarai, from Jhapa to Parsa. Earlier, the government had announced plans to eliminate the disease by the fiscal year 2018-19, but kala-azar was seen in Bhojpur, Okhaldhunga, Makawanpur, Palpa, Surkhet, and Kailali taking the total number of districts to 18. By 2020, the infection had reached 23 districts, including the hilly districts such as Bajura, Dailekh, Dang, Pyuthan, and Kalikot. According to the DHS, the disease was also seen in Lamjung in 2022. Nepal had now committed to eliminating kala-azar by 2025, but rise in cases in the area considered non-endemic in the past poses a serious challenge to meeting the target.

Weight loss, weakness, cough and fever that lasts from a few weeks to months are common symptoms of kala-azar. Delay in treatment can also lead to death, say experts.

The government provides rK39 kits at the primary health centres and other health facilities for free for kala-azar tests.

After kala-azar started infecting underprivileged communities such as the Musahar community in 2021, the government started providing Rs7,000 per patient—Rs5,000 for treatment and Rs2,000 for transportation.

According to DHS, 104 people are infected by kala-azar currently.