Active and passive case detection strategies for the control of VISCERAL leishmaniasis (KALA AZAR) in Bangladesh Prepared by: Manimoy Chakma MSF-OCA, Bangladesh Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Introduction Kala-azar is a parasitic disease that kills if it remains untreated More than 7,000 cases of kala-azar annually till 2007 IN BANGLADESH Post kala-azar dermal leishmaniasis (PKDL) develops in 10%-15% PKDL patients serve as source of infection PKDL patients do not usually seek care by themselves Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Context 32 (of 64) districts of Bangladesh are affected 70% reported from Mymensingh district Fulbaria and Trishal, which are hyper endemic for leishmaniasis in Bangladesh, contributed 50% case load Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Why did MSF intervene? conventional treatment of KA (30 days) and PKDL (120 days) was long and also not very safe. Passive case detection was missing a lot of patients in the community – especially PKDL If PKDL is not treated, Elimination of Kala-Azar will not be possible Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Project Location Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Objectives To determine the yield of ACTIVE CASE DETECTION (ACD) in terms of no. of cases of VL and PKDL diagnosed and to compare it with that of diagnosed by PASSIVE CASE DETECTION (PCD) Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Methods Study Design Descriptive study: retrospectively collected prog. data Study Population All VL and PKDL patients (self and outreach referral) diagnosed between April, 2010 to December, 2011 in MSF kala azar treatment centre and upazila health complex of Trishal Ethical Approval We obtained ethical approval from the MSF-ERB It was also approved by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease, Paris, France. Permission was obtained from the Director of Communicable Disease Control, Ministry of Health, Dhaka, Bangladesh. Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Results Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Conclusions Successful active case finding strategy based on cluster approach An ACD strategy at the sub-district level resulted in an increased yield of VL and a much higher yield of PKDL. Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Limitations Lesson learnt Way forward Crossing over of patients from one upazilla to another Inferior record keeping in PCD area and different Treatment regimen. Lesson learnt As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent Way forward Recommendation to Government of Bangladesh to adopt ACD for the diagnosis of leishmaniasis especially PKDL Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

Thank You Manimoy Chakma, MSF, Title: Active and passive case detection strategies for the control of leishmaniasis in Bangladesh Thanks to Jennifer Loscumbe for the photographs Active and passive case detection strategies for the control of leishmaniasis in Bangladesh