At least eight people from Kalikot district have tested positive for kala-azar (visceral leishmaniasis or black fever) since the start of the current fiscal year. Of the total infected patients, around 50 percent are children, according to officials at the Health Office Kakikot.

“In 2024, we recorded 16 cases of kala-azar infection in the district,” said Hem Raj Bom, a kala-azar control focal person at the Health Office, Kalikot. “In one year in the past, we had as many as 43 cases of kala-azar, and the number has been declining gradually due to mitigation measures taken against the spread of infection.”

Kala-azar, also known as visceral leishmaniasis or black fever, is transmitted through the bite of the infected female phlebotomine sandfly. Loss of appetite, weight loss, weakness, cough, continuous fever and enlargement of the spleen and stomach are common symptoms of the disease. If not treated on time, the disease has a fatality rate of up to 95 percent.

Health officials say that the spread of kala-azar cases in districts like Kalikot, whose elevation is up to 4,000 meters, and infection in children pose new challenges to the country’s disease elimination goal.

In the past, it was believed that female phlebotomine sandflies, which spread the disease, could not survive at altitudes higher than 650 meters above sea level. But the Health Ministry’s data show that the vector has been found in places located at altitudes of up to 2,000 metres such as Bajura, Dailekh, Pyuthan and Kalikot.

Of the two types of sandflies—phlebotomus adlerious and phlebotomus major—experts attributed phlebotomus adlerious as responsible for the surge in infections among children. This sandfly species is also causing infections in children in other countries.

“Children do not wear full-sleeve clothes and play in the open, and this makes them become more vulnerable to kala-azar infection,” said Bam. “We have been carrying out active case surveillance to contain the disease’s spread.”

Nepal has committed to eliminating kala-azar by 2026, but the rise in cases in the area considered non-endemic in the past poses a serious challenge to meeting the target, officials concede.

Over 200 new cases of kala-azar infection were reported last year.

Health officials, however, are still optimistic that the country could achieve the Kala-azar elimination target of 2026, as the number of infections has declined significantly.

“To achieve the elimination target, we must reduce the case number to one per 10,000 population,” said Dr Gokarna Dahal, the Vector-borne Disease Control Section chief at the Epidemiology and Disease Control Division. “None of the districts crossed that number this year. We are confident in achieving the kala-azar elimination target. Our efforts are ongoing.”

In 2005, Nepal, along with Bangladesh and India, committed to eliminating the Kala-azar as a public health problem from the Indian subcontinent by 2015. By 2021, the number of reported kala-azar cases dropped by over 95 percent compared to 2007. The target is to reduce the annual incidence of kala-azar to less than 1 per 10,000 population at the district level.