1. Potentiality of GPS Approach to Leishmaniasis in Hyper- endemic area of Bangladesh Bumpei Tojo 1, Makoto Ito 2, Mohammad Sohel Samad 2, Emi Ogasawara 1 1.University of Tokyo, Japan (Long term (2013-2015) project expert of JICA) 2.Aichi Medical Univ., Japan

2. Background of this study Part of JICA (/SATREPS) Kala-Azar Project http://www.satreps-kalaazar.com/en/index.html

3. Framework of Kala-azar Project Develop Diagnostic tools Actual status and mechanisms of Kala-azar and PKDL Vector control

4. Content of this presentation Introduction of our mass screening activity targeting school children which perform the measurement of urinary antibody and the position information collecting using GPS (Global Positioning System) in Mymensingh district. KEY WORDS: Kala-azar, Epidemiology, Surveillance system, Global Positioning System (GPS), GIS Analysis

5. Mymensingh Number of patients (2011) persons/year 426737 262 Kala-azar endemic area (2011)* * Information based patient number registered at government hospital ・ It is said number of kala-azar patients decline from year to year in Bangladesh. ・ Southern part of Mymensingh (Fulbaria, Trishal, Gafargaon Upazila) is still relatively high endemic area of kala-azar according to the government data. ・ Annual patients number of these three upazila is 737, 426, 262. They are 14.8, 9.1, 5.1 person of patients per population of 10,000. It is still more than elimination goal (less than 1.0). ・ These data source is hospital base patient number. We guess another result will come by active survey… 49 36

6. Actual Mass screening Activity (2013-2014) in Mymensingh, Trishal Upazila

7. Establishment the efficient and costless active survey “system” for kala-azar. 1. Measurement of urinary antibody : To find out infection of kala-azar by quick and easy operation.. 3. Distribution of GPS logger : It is possible to collect mass of the position information effectively. 2. Paperless registration “system” : Using tablet device with data-entry program instead of Questionnaire paper. It drastically saves time and labor of whole process of activity. Mass screening “system” targeting school children =

8. Workflow of Mass screening activity at primary school in trishal Using tablet device with data-entry program for student registration, hand over a cup and GPS logger After registration, each student is back with urine specimen, specimen is stored inside tube.

9. This is a movie of actual mass screening at trishal. Using tablet device and bar-cord system, it becomes possible to manage data linkage fast and easily between student registration information, urinalysis result, collected position data using GPS logger. After introducing this Paperless “system”, very few staff can handle around 300-400 student mass screening within 1 day.

10. Measurement of urinary antibody of collected specimen using ELISA at SK KRC From last survey (Mar 2014), we success to start measurement of urinary antibody using SK KRC laboratory facility ↑ Detected ELISA positives are shown green color

11. Total number of school children examined Urine ELISA positivesNumber of Primary School (PS) 2013 Aug (8/25 - 9/9) 1,3526 (0.4%)6 (In the west part of Trishal Upazila) 2014 Mar (3/4 - 3/16) 1,17178 (6.6%)4* (In the east part of Trishal Upazila) Sub total*2,52384 (3.3%)10 * (East Part) PS1 = 7 / 208 (3.3%) PS2 = 30 / 305 (9.8%) PS3 = 15 / 309 (4.8%) PS4 = 26 / 349 (7.4%) Result of mass screening conducted 2013 August and 2014 March in Trishal Upazila 1. Number of ELISA positives between two survey duration was very different (16.5 times differ). 2. Between 4 PS of survey in March in the east part of the upazila, its positives differs from 3.3% to 9.8 % (about 3 times).

12. 010 km 5 West Part (6 PS): 0.4% East Part (4 PS): 6.6% Trishal Upazila Legend Primary School (PS) Upazila boundary Area coverage of mass screening Image: ALOS-AVNIR-2 (False Color) ← Spatial inequality of ELISA positive has clearly observed in this result. PS1 (3.3%) PS2 (9.8%) PS3 (4.8%) PS4 (7.4%)

13. 【 【 Time series tracking log data of GPS 】 Analyzing the position information (extracted from GPS logger) of each registered student on GIS. Finding “more” micro hot spot of kala-azar endemic using GPS data logging and Tracking Analysis on GIS Before Tracking After Tracking

14. 05 km 2.5 2014 March Total screening=1171 GPS data collection success=1008 Total Positive=78 GPS data collection success=66 Urine Antibody Unit (Negative) (Positive) PS1 (3.3%) PS4 (7.4%) PS2 (9.8%) PS3 (4.8%)

15. 01 km 0.5 Urine Antibody Unit (Negative) (Positive) Endemic Foci PS2 (9.8%) PS3 (4.8%)

16. 01 km 0.5 Urine Antibody Unit (Negative) (Positive) Endemic Foci PS1 (3.3%) PS4 (7.4%)

17. Conclusion - Developing the mass screening surveillance system targeting school children were achieved until now. This system consist of measure urinary antibody and collect the position information using GPS (Global Positioning System). Assist by e-registration system is essential from viewpoint of labor saving in this system(huge field data can handle within few days by few staff). -From previous 2 times surveillance results, there is a possibility that can be constructed monitoring system to identify the micro-scale hot spot of kala-azar endemic using GIS, helpful for evaluation of kala-azar elimination situation. -Find possibility of application of this system for another neglected tropical infectious disease surveillance (malaria, filaria, etc).