1. MSF Experience: Leishmaniasis control in Fulbaria Upazilla of Mymensing district Date: 1 st September, 2012

2. Kala-Azar & PKDL Parasitic disease (Leishmania donovani) Transmitted by- Sand fly Host- Human (South East Asia) and many in other parts of the world Appears as -Visceral leishmaniasis (Kala Azar) -Cutaneous and -Muco-cutaneous leishmaniasis.

3. Kala-Azar and MSF 1988: 1 st KA patient treated by MSF 1988-1994: >19000 KA patients treated in South Sudan 1994: MSF realized that it should consider KA as a disease of importance because of its nature 2002: Paromomycin + SSG Till 2011 (December): > 100,000 KA treated Patients

4. MSF Kala Azar Project in Bangladesh  Fulbaria Upazilla of Mymensing District  2004: 1st assessment by MSF  2009 (April) : 2 nd assessment by MSF (Resulted in a Project)  2009 (December): MoU signed between MoH and MSF  May/2010: 1 st KA Patient was treated by MSF in Fulbaria

6. Project Strategy Integrated case management  Active case finding 1) Blanket approach 2) Cluster approach (Index case based)  Treatment IRS (Indoor R. Spray) Ministry of Health

7. Patient Flow TreatedObservationReffd F/U KA: 1M, 3M, 6M and 12 M PKDL: 1M, 6M, 12M Index case 200 M.

8. Project description Clinic  20 bed clinic (10 M / 10 F)  07 Nurses  02 national Medical Doctors & 01 M. Assistant  02 Laboratory technicians  01 Data manger  01 Registrar  All supervised by 01 Expat Medical Doctor Out Reach  39 ORWs  16 OR Monitors  02 OR Supervisors  All supervised by 01 Expat Nurse

9. Case Definition Kala – Azar  Suspected: Fever > 2 weeks + Splenomegaly + Weight loss  Confirmed: Above features + rK-39 positive (Relapse- Spleen Aspiration) PKDL (Post Kala-Azar Dermal Leishmaniasis)  PKDL: H/O KA + Typical Lesions (Hypo pigmented, Not itchy usually)

10. Treatment of KA and PKDL Drug: Liposomal Amphotericin B (L. AmB) Route: Slow IV (over 02 hrs) mixed with 5% DA Dose:  PKA- 15 mg/ Kg divided into 03 doses, 05 mg/ Kg/ day for 03 days (D0, D1 and D5)  Relapse KA- 25 mg/ Kg divided into 05 doses  PKDL- 30 mg/ Kg; 05 mg/ kg /day for 06 days (twice/ week for three weeks)

23. Thank You