introduction, kala azar situation and outline of kala-azar in bangladesh dr shahjada selim

Dr Shahjada SelimRegistrarShSMCH, Dhaka

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Global situation Leishmaniasis threatens 350 million people

in 88 countries of the world

Burden: Estimated cases: 2.5 million, Incidence 500,000/year, 59,000 deaths/year

Over 90% of VL cases occur in Indian sub-continent (Bangladesh, India and Nepal: 66%),

Kala-azar affects largely the socially marginalized and the poorest communities

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According to the RTAG, 2004 VL burden of

21 cases/10,000 among sampled

population in Indian sub-continent was

found.

Accordingly, a total of 420,000 Kala-azar

cases out of 200 million population at risk.

But only 25,000-40,000 cases and 200-

300 deaths due to VL are reported.

So the disease is highly under-reported

and neglected 3

Question: Researchers expect the area susceptible to Leishmaniasis to increase over time, why?

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In late 1970s Kala-azar re-emerged sporadically

During 1981-85 only 8 upazilas reported Kala-azar, which increased to 105 upazilas in 2004.

Number of reported cases increased from 3978 in 1993 to 8505 in 2005.

In 2013 : 1428 cases and 02 deaths were reported

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By 2015 Bangladesh, India, and Nepal committed to eliminate Kala-azar

In May 2005 Three countries signed a Memorandum of Understanding (MOU), in Geneva during the World Health Assembly

Countries agreed to adopt and implement Elimination program

Kala-azar Elimination Program was launched in 9th May, 2008

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2013 ReportingHyperendemic Upazilas:

Trishal Fulbaria

Muktagachha

Moderately endemic upazillas: Madhupur, Sokhipur

Chouhali,Faridpur, Vangura, Terokhada,

Valuka, Gafargaon

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The impact objective is to reduce the incidence of Kala-azar to less than 1 case of Kala-azar and Post Kala-azar Dermal Leishmaniasis per 10,000 population upazila level by:

Reducing the incidence of Kala-azar in the endemic communities including the poor, vulnerable and un-reached populations.

Reducing case fatality rates from Kala-azar.

Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) to reduce the parasite reservoir.

Prevention and treatment of Kala-azar-HIV-TB co-infections. 10

Early diagnosis and complete

treatment

Integrated vector management

Effective disease surveillance

Social mobilization and

partnerships

Operational research 11

According to updated National Kala-azar treatment Guideline recommended drugs are

Inj. Liposomal Amphotericin B (AmBisome)

Cap. Miltefosine Now all PKA and PKDL Cases are treated

in Endemic Upazila Health Complexes. In all endemic Upazilas Rapid Diagnostic

test (rk39) and Cap. Miltefosine are kept available

Training and refresher training on Kala-azar management for doctors and Nurses are going on every year

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o Most effective but costly injectable drug

oBangladesh government received 14500

Inj. AmBisome from WHO

o Now 10 Upazilas are using Inj,

AmBisome for treating Primary Kala-azar.

o In 2013 about 554 cases of PKA were

treated with Inj. AmBisome and 730 cases

of PKDL with Cap. Miltefosine13

Patient is treating with Inj. AmBisome in Fulbaria Upazila Health Complex

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Inj. AmBisome

Indoor Residual Spray (IRS):

Used insectiside is Deltamethrin

Provision of 6 round of IRS

Piloting was done at Fulbaria in 2011

Al ready 4 rounds of IRS were done

Among them 4 rounds were done in 8 hyper-

endemic areas.

1 round in moderate and low endemic areas.

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IRS AT DHANIKHOLA VILLAGE OF TRISHAL UPAZILLA

Dr. Shah GolamNabi, DPM, KEP, CDC, DGHS with the IRS Team ( Spray man, Team leader & 1st

Line Supervisor) at Dhanikhola Village, Trishal Upazilla.

Indoor Residual Spray16

LLIN Distribution

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New implementation- Larvicide Spray in Cow and chicken shade

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WHO supported staffs for strengthening Surveillance SystemNational ConsultantSurveillance Medical OfficerData Manager Regular collection of Data from all Kala-azar Endemic Upazila Health Complexes Active case search for detection of Kala-azar in HH level

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Partnership with- WHO, MSF & icddr,b

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Spleen puncture

Slide preparation

Thanks to All

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