KATMANDU -- Nepal, the "country of a thousand gods," presents a sad paradox. Endowed with exquisite beauty, it is at the same time home to a series of infectious diseases that take a heavy toll on its population. Perhaps the less known among them, and the most neglected, is kala azar. The name literally means "black sickness" because of the darkened skin of some patients.
Kala azar is the Mogul vernacular name of visceral leishmaniasis, a disease fatal if not treated, which affects annually 500,000 people in 69 countries, putting at risk a population of 350 million. Ninety percent of the cases occur in Bangladesh, India, Nepal and Sudan, and it has also been reported in 12 veterans of the Persian Gulf War, who apparently contracted the disease while in Saudi Arabia.
Kala azar, characterized by an enlarged liver, irregular fever and anemia, results from infection with a parasite transmitted by a sand fly that uses humans as a reservoir. Kala azar is not uniformly distributed in affected areas. It normally exists in areas of drought, famine and densely populated villages with poor or no sanitation. Among those most commonly affected are older children and young adults of both sexes, especially males.