Introduction of KA (VL) and PKDL in Bangladesh.

1. Dr Shahjada Selim
Registrar
ShSMCH, Dhaka
1

2. 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
2

3. 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

4. Question: Researchers expect the area susceptible to Leishmaniasis to
increase over time, why?
4

5.  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
5

6. 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
6

7. 2013 Reporting
Hyperendemic
Upazilas:
Trishal
Fulbaria
Muktagachha
Moderately endemic
upazillas:
Madhupur, Sokhipur
Chouhali,Faridpur,
Vangura, Terokhada,
Valuka, Gafargaon
7

8. 8

9. 9

10. 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

11. Early diagnosis and complete
treatment
Integrated vector management
Effective disease surveillance
Social mobilization and partnerships
Operational research
11

12.  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
12

13. o Most effective but costly injectable drug
o Bangladesh 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. Miltefosine
13

14. Patient is treating
with Inj. AmBisome in
Fulbaria Upazila
Health Complex
14
Inj. AmBisome

15. 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.15

16. IRSAT DHANIKHOLAVILLAGE OFTRISHAL UPAZILLA
Dr.Shah
Golam Nabi,
DPM,KEP,
CDC,DGHS
with the IRS
Team ( Spray
man,Team
leader & 1st
Line
Supervisor) at
Dhanikhola
Village,Trishal
Upazilla.
Indoor Residual Spray
16

17. LLIN Distribution
17

18. New implementation- Larvicide Spray in Cow
and chicken shade
18

19.  WHO supported staffs for
strengthening Surveillance
System
National Consultant
Surveillance Medical Officer
Data Manager
 Regular collection of Data
from all Kala-azar Endemic
Upazila Health Complexes
 Active case search for
detection of Kala-azar in HH
level
19

20.  Partnership with- WHO, MSF & icddr,b
20

22. Spleen puncture Slide preparation

23. Thanks to All
23