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Huda, M Mamun; Hirve, Siddhivinayak; Siddiqui, Niyamat Ali; Malaviya, Paritosh; Banjara, Megha Raj; Das, Pradeep; Kansal, Sangeeta; Gurung, Chitra Kumar; Naznin, Eva; Rijal, Suman; Arana, Byron; Kroeger, Axel; Mondal, Dinesh (2012)
Publisher: BioMed Central
Journal: BMC Public Health
Languages: English
Types: Article
Subjects: Elimination progamme, Research Article, Post kala-azar dermal leishmaniasis, wc_715, wa_30, wa_395, wr_350, Active case detection, India, wc_765, RA1-1270, Public aspects of medicine, Kala-azar, Nepal, Bangladesh, Visceral leishmaniasis, Public Health, Environmental and Occupational Health

Abstract

Background

Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal.

Methods

The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method.

Results

Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing.

Conclusion

National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.

  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Bhattacharya SK, Sur D, Sinha PK, Karbwang J: Elimination of leishmaniasis (kala-azar) from the Indian subcontinent is technically feasible & operationally achievable. Indian J Med Res 2006, 123(3):195-196.
    • 2. Stauch A, Sarkar RR, Picado A, Ostyn B, Sundar S, Rijal S, Boelaert M, Dujardin JC, Duerr HP: Visceral leishmaniasis in the Indian subcontinent: modelling epidemiology and control. PLoS Negl Trop Dis 2011, 5(11):e1405.
    • 3. Bern C, Chowdhury R: The epidemiology of visceral leishmaniasis in Bangladesh: prospects for improved control. Indian J Med Res 2006, 123(3):275-288.
    • 4. Joshi A, Narain JP, Prasittisuk C, Bhatia R, Hashim G, Jorge A, Banjara M, Kroeger A: Can visceral leishmaniasis be eliminated from Asia? J Vector Borne Dis 2008, 45(2):105-111.
    • 5. Rahman R, Bangali M, Kabir H, Naher FB, Mahboob S: Kala-azar situation in Bangladesh. In Natinal Guideline and Training Module for Kala-azar Elimination in Bangladesh. 1st edition. Edited by Hossain M. Dhaka: CDC, DGHS, Ministry of Health and Family Welfare, Government of the Peoples Republic of Bangladesh; 2008.
    • 6. World Health Organization S: Regional Strategic Framework for Elimination of Kala-azar from the South-East Asia Region (2005-2015). New Delhi: Regional Office for South-East Asia; 2004.
    • 7. World Health Organization S: Regional Technical Advisory Group on Kala-azar Elimination. Report of the first meeting, Manesar, Haryana, 20-23 December 2004. New Delhi: Regional Office for South-East Asia; 2005.
    • 8. Mondal D, Singh SP, Kumar N, Joshi A, Sundar S, Das P, Siddhivinayak H, Kroeger A, Boelaert M: Visceral leishmaniasis elimination programme in India, Bangladesh, and Nepal: reshaping the case finding/case management strategy. PLoS Negl Trop Dis 2009, 3(1):e355.
    • 9. Hirve S, Singh SP, Kumar N, Banjara MR, Das P, Sundar S, Rijal S, Joshi A, Kroeger A, Varghese B, et al: Effectiveness and feasibility of active and passive case detection in the visceral leishmaniasis elimination initiative in India, Bangladesh, and Nepal. AmJTrop Med Hyg 2010, 83(3):507-511.
    • 10. Matlashewski G, Arana B, Kroeger A, Battacharya S, Sundar S, Das P, Sinha PK, Rijal S, Mondal D, Zilberstein D, et al: Visceral leishmaniasis: elimination with existing interventions. Lancet Infect Dis 2011, 11(4):322-325.
    • 11. Singh SP, Hirve S, Huda MM, Banjara MR, Kumar N, Mondal D, Sundar S, Das P, Gurung CK, Rijal S, et al: Options for active case detection of visceral leishmaniasis in endemic districts of India, Nepal and Bangladesh, comparing yield, feasibility and costs. PLoS Negl Trop Dis 2011, 5(2):e960.
    • 12. World Health Organization S: Regional Technical Advisory Group on Kala Azar Elimination. Report of the third meeting, Dhaka, Bangladesh. Dhaka, Bangladesh: World Health Organization, SEARO; 2009.
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