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

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.