1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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