# Elimination of visceral leishmaniasis as a public health problem in Bangladesh: Lessons learned and questions remaining

## TL;DR

Bangladesh successfully eliminated visceral leishmaniasis as a public health problem by implementing strategies like early diagnosis, spraying, and digital surveillance.

## Contribution

Bangladesh became the first country validated by WHO for eliminating visceral leishmaniasis at the subdistrict level.

## Key findings

- All subdistricts in Bangladesh achieved and maintained the elimination threshold by 2017.
- Key strategies included rapid diagnostics, indoor residual spraying, and digital surveillance systems.

## Abstract

In 2023, Bangladesh became the first country to achieve World Health Organization (WHO) validation of elimination of visceral leishmaniasis as a public health problem, defined as maintenance of annual kala-azar incidence at <1 case per 10,000 population at the subdistrict (upazila) level. The pillars of the programme are early diagnosis and effective treatment, indoor residual insecticide spraying, improved case detection, social mobilization and operational research, and effective disease surveillance. The Bangladesh National Kala-azar Elimination Programme was established in 2008, with introduction of rapid diagnostics and newer treatment modalities in health complexes at sub-district level in the endemic area in 2012–2015, initiation of blanket IRS in affected communities in 2012–2013 and adoption of a digital surveillance system in 2015. All subdistricts achieved and maintained the elimination threshold from 2017 onward. We present documentation of the course of KA elimination in Bangladesh and provide a perspective on the components necessary to maintain current success into the future.

In 2023, Bangladesh became the first country validated by the WHO for eliminating visceral leishmaniasis (kala-azar) as a public health problem—defined as having less than 1 case per 10,000 population annually at the subdistrict (upazila) level. The National Kala-azar Elimination Programme, launched in 2008, implemented key strategies: early diagnosis and treatment, indoor residual spraying (IRS), improved case detection, social mobilization, operational research, and digital surveillance. Rapid diagnostics and updated treatment protocols were introduced in subdistrict health complexes from 2012–2015, alongside blanket IRS campaigns and digital surveillance adoption in 2015. By 2017, all subdistricts had achieved and sustained the elimination threshold. Bangladesh’s success reflects strong programmatic coordination and evidence-based interventions. This document outlines the elimination journey and highlights essential components to sustain progress and prevent resurgence.