Planning of Health Education programme on kala-azar

1. Planning of Health Education
Programme on kala-azar

2. Contents Outline
• Rationale for presentation
• Introduction
• Global Scenario
• National Scenario
• Epidemiology
• Steps of planning on health education
programme
• References

3. Rationale for presentation
• To gain practical knowledge on how to plan a
health education program
• To overview the condition of Kala-azar
• It is the means of changing KAP of community
people

4. Introduction
• Leishmaniasis are group of protozoal diseases
caused by parasite Leishmania donovani, and
transmitted to humans by the bite of female
phlebotomine sandfly
• This diseases is also known as kala-azar, black
fever, sandfly disease, Dum-Dum fever
• There are mainly three form of the
leishmaniases : visceral (also known as kala-
azar, which is the most serious form of the
disease), cutaneous (the most common), and
mucocutaneous.

5. Contd
• The disease affects some of the poorest
people and is associated with malnutrition,
population displacement, poor housing, a
weak immune system and lack of financial
resources.
• Leishmaniasis is also linked to environmental
changes such as deforestation, building of
dams, irrigation schemes and urbanization.

6. Global scenario
• Leishmaniasis is found in 88 countries. 72 of
which are developing countries
• An estimated 50 000 to 90 000 new cases of
VL occur worldwide annually, with only
between 25 to 45% reported to WHO. It
remains one of the top parasitic diseases with
outbreak and mortality potential.
• In 2019, more than 90% of new cases
reported to WHO occurred in 10 countries:
Brazil, Ethiopia, Eritrea, India, Iraq, Kenya,
Nepal, Somalia, South Sudan and Sudan.

7. National scenario
• The first case of Kala-azar was reported in
Nepal as early as 1960s
• Assumed that it was imported from Bihar
• Twelve 12 districts are endemic in eastern and
central region (>8million people at risk)
• Since then reported > 1,000 cases every year
• A total of 24739 cases and 325 deaths
• New KA cases have been reported from 50
(out of 77) districts in the country

8. Figure : Spatial distribution of KA cases in
Nepal,
2017 (Source: National Guideline on KA
Elimination
Program, 2019)

9. Epidemiological Determinants
• Agents
Leishmania are intracellular parasites.
Human infection is caused by about 21 of 30
species
These includes
– L. donovani complex with 3 species (L. donovani, L. infantum, and L.
chagasi);
– L. mexicana complex with 3 main species (L. mexicana, L.
amazonensis, and L. venezuelensis);
– L. tropica;
– L. major;
– L. aethiopica

10. Reservoir : variety of animal (dogs, jackals,
foxes, rodents and other mammals)
The parasite has two stages in its life cycle:
– Amastigote form: occurring in humans and
mammals.
– Promastigote form: occurring in sandfly.

11. • Host factor
age- all age group including infants, peak age
Sex –males are affected twice as often as
females.
Population movement- movement of
population between endemic and non-
endemic areas can result in spread of
infection.
Socio-economic status- usually strikes the
poorest of the poor.

12. Contd
Immunity- recovery from kala-azar and
oriental sore give a lasting immunity.
Occupation- people working in farming
practices, forestry, mining and fishing have a
great risk of being bitten by sandflies.

13. • Environment factor
Altitude- the disease is mostly confined to the
plains, it does not occur over 2000ft
Season- the prevalance of disease is high
during and after rainfalls
Rural areas- more common in rural areas as
favorable conditions for breeding of sandflies
exists
Development Projects: Exposes people to
leishmaniasis

14. • Vectors
Phlebotomine argentipes is a proven vector of
kaka-azar.

15. Mode of transmission
• Kala-azar is transmitted from person to person
by the bite of the female Phlebotomine
sandfly
• Blood transfusion, congenitial infection,
accidental inoculation of cultured
promastigotes in the lab workers and sexual
intercourse
• Males are affected more due to increase
exposure through the occupation and leisure
activities

17. Incubation Period
• The incubation period in man is quite variable,
generally 1 to 4 months; range is 10 days to 2
years.

18. Clinical features
Visceral leishmaniasis
• Visceral lieshmaniasis, also known as kala-azar
is fatal if left untreated in over 95% of cases.
• It is characterized by irregular bouts of fever,
weight loss, enlargement of the spleen and
liver, and anaemia.
• Darkening of the skin of face, hands, feet and
abdomen is common.
• Lymphadenopathy may also occur.

19. Post kala-azar dermal leishmaniasis
• Is a sequel of visceral leishmaniasis that
appears as macular, papular or nodular rash
usually on face, upper arms, trunks and other
parts of the body.
• It usually appears 6 months to 1 more years
after kaka-azar has apparently been cured, but
can occur earlier.

20. Cutaneous Leishmaniasis
 Occurs in dry, semi desert rural areas of
central Asia, middle east north and west
Africa, esp. in Ethiopia and Kenya.
 90% of cases occurs in Afghanistan, Brazil,
Iran, Peru and Saudi Arabia.
 Cutaneous leishmaniasis causes skin lesions,
mainly ulcers, on exposed parts of the body,
leaving life-long and serious disability.

21. Diagnosis
• Clinical
Most infections are diagnosed clinically.
The patient has an irregular fever , anaemia,
and leukopenia; hepatosplenomegaly and
bone marrow suppression and characteristic.
• Lab invest
Haematological findings viz anaemia,
leucopenia, thrombocytopenia and
hypergammaglobulinemia.
WBC: RBC ratio is 1:1500 or even 1:1200
Raised ESR

22. • Parasitological
• Aldehyde (Napier) test
• Serological test
• Leishmanin (Montenegro) test

23. Preventive and Control measures
• Reservoir control
• Active and passive case detection
• Treatment of those found infected including
PKDL
• Killing of infected dogs in case of zoonotic
kala-azar
• Vector control
• Reduction of sand fly population by
insecticides mainly DDT, dieldrin, malathion.

24. Contd
• Concomitantly prevent VL and other vector
borne disease, such as malaria and JE
• Health education to community about cause,
MOT of leishmaniasis
• Using insect repellent, bed nets and window
mess
• Keeping environment clean

25. Treatment
• Penta-valent antimonials:
– Meglumine antimonate
– Sodium stibogluconate solution
– MOA: interfere metabolism of the parasite.
– Dose: 20 mg antimony base/kg/day to 850 mg for
at least 20 days for adults and 30 days for infants.
• Others drugs : Pentamidine, Amphoterisin B,
Miltefosine, Interferon

26. Planning of Health Education Program
Steps of Planning:
1.Collection of baseline data and
information
2.Identification of health and health
education needs on priority basis
3.Setting goals and objectives
4.Deciding target group
5.Deciding on content to be taught
6.Methods and media

27. 7. Identification of resources
8. Developing plan of action
–Calendar of operation
–Detail plan of action
9. Implementation
10. Evaluation
11. Follow Up

28. Collection of baseline data and
Information
 District: Bara
 Palika (Ward): Nijgadh
 Municipality: 4
 Total population: 7554
 Male: 4510
 Female: 3044
 Major ethnic group: Brahmin,
Tharu, Teli
 Literacy rate: 62%
 Male: 57%
 Female: 43%
 Available Health Service:
 Government: 1 PHC
 Private: 3 clinics
• Schools:
• Government: 2 Primary, 3
lower secondary 1 higher
secondary school and 1
college
• Private: 1 Higher
Secondary School

29. • Most human cases are reported during rainy
seasons.
• It is most common in rural areas due to
favourable condition for breeding.
• EDCD formulated National Plan for Kala Azar
elimination in Kala azar endemic
districts. Indoor residual spraying was made
priority in the affected districts.
• On revised guideline from 2014 in 2019,
single dose of liposomal amphotericin B has
been recommended as first line treatment
of primary kala azar.

30. KAP on Kala azar
• Nearly 60% people have the idea about how
to prevent Kala azar
• About 25% people believe that Kala azar
occurs due to supernatural process.
• Only 55% people know that the kala azar
can be diagnosed and can be treated.
• Only 55% people know the integrated vector
management process to control the vector
borne diseases.

31. Need Prioritization
• Health education on kala azar prevention is
prioritized because of the following reasons:
• High case fatality rate: 40% among those
with diseases symptoms
• Among survivors, people gets long lasting
immunity but among them 20-25% suffered
from post kala azar dermal
leishmaniasis that is characterized by,
macular, maculopapular and nodular rash.

32. Contd...
• Living in high risk area: around 1.5 million
people
• Around about 3000 people are at risk every
year, among them 2.4% people die every
year (2003)
• The incidence per 10,000 population at
district level in 2016/2017 is 0.01 in Bara
district.
• Age group (5-15) are at high risk. They
nearly account 22% among the people with
kala azar alone in Bara district.

33. Setting Goals and Objectives
• Goal:
To decrease the incidence of mortality and
morbidity among the people of Nijgadh
municipality Ward 4 by reducing the
number of Kala azar infection through
improvement in knowledge, practice about
Kala-azar prevention and treatment.

34.  General Objectives:
To change the KAP on Kala Azar among the people
of Nijgadh Municipality Ward 4 for the prevention
of Kala azar.
 Specific Objectives:
– About 80% of the participants will be able to
explain about Kala Azar and its transmission
– About 90% of the participants will be able to
appreciate the importance of the kala azar and
its post effect.
– About 75% will be able to describe the
importance of treatment of kala azar.

35. Behavioural Objectives:
• About 70% will be able to use the vector
management techniques as insect repellent
measures.
• About 90% of the people will use the personal
protective measures.
• About 80% will be able to control the sandfly
breeding.
• About 90% will use permethrin treated uniforms
while working in the field.
• About 90% will use the permethrin treated bed
nets.

36. Target Group
 Students of class 5-10 and their parents.

37. Content to be taught
 Introduction to Kala Azar
 Transmission of Kala Azar
 Sign and symptoms of Kala azar
 Prevention of Kala azar
 Importance of integrated vector
management

38. Methods and Media
Methods
• Discussion
• Mini lecture
• Story Telling
Media
• Posters
• Pamphlets
• Flip Chart

39. Identify Resources
 External resources:
• Human: BPH 5th semester students
• Money: fund available from DPHO
• Materials: IEC materials available
from NHEICC, DPHO, District hospital

40.  Internal resources:
• Human: School teachers, FCHVs
• Money: fund available from ward office
• Materials: school hall, white board, marker,
duster, stationary materials including pen,
copies, etc

41. Calendar of operation
S.N
.
Action Day 1 Day 2 Day 3 Day 4 Day 5
1 Planning of
Program
2 Implementation
of program
3 Evaluation of
program

42. Implementation
Implementation is the process of putting the plan
of action into operation.
Strategies:
• Building commitment
– People involved will be made committed to the
success of the programme by explaining the
purpose and usefulness of the programme.
• Training manpower
– BPH 5th semester students will train the school
teachers and FCHV to conduct the programme.

43. Contd..
• Utilizing resources
–Teachers, FCHVs and local leaders will be
oriented and given responsibility;
–Financial support will be received from
DPHO and Rural Municipality. Other
necessary materials will be managed by
DPHO and transportation by ACAS.

44. Contd..
• Organizing community
–Required for the sustainability of
the program.
–Community will be organized by
• Meeting with key persons
• Establishing coordination with local
agencies
• Forming health education committee by
involving the influential and interested
person

45. Contd..
• Monitoring
–Information about program
implementation will be collected and
analysed in regular interval to see
whether program activities are carried
out as planned or not.
• Supervision
–The programme implementers will be
supervised to enable them to learn
according to their needs, to make the
best use of their knowledge and skills.

46. Evaluation
• Evaluation is the process of determining the
amount of success in achieving the
predetermined objectives
• The health education programme on Kala
azar prevention will be evaluated in three
steps
– Short term: Change in knowledge and attitude
of the participants will be assessed at the end
of the session through question answer.

47. Contd..
• Mid term: Knowledge and attitude on
preventive measures of Kala azar would be
evaluated.
• Long term: Reported cases of Kala azar in PHC
and district hospital would be assessed.

48. Follow Up
• Essential for the continuity of the
programme and to see how the programme
is running.
• Will be done periodically to encourage the
community and see their progress

49. Refrences
• K. park- 25th edition,
• Ministry of Population and ministry
• Class notes
• Report obtain from:
National Guideline on Kala-azar Elimination Program
- EDCD
• http://www.edcd.gov.np
• https://www.onlinebiologynotes.com

50. THANK YOU!!!!!!!