Open Access Highly Accessed Research article

Active case detection in national visceral leishmaniasis elimination programs in Bangladesh, India, and Nepal: feasibility, performance and costs

M Mamun Huda1*, Siddhivinayak Hirve23, Niyamat Ali Siddiqui4, Paritosh Malaviya5, Megha Raj Banjara6, Pradeep Das4, Sangeeta Kansal5, Chitra Kumar Gurung6, Eva Naznin7, Suman Rijal8, Byron Arana9, Axel Kroeger109 and Dinesh Mondal11

Author Affiliations

1 Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh

2 KEM Hospital Research Center, Pune, India

3 Umea Center for Global Health Research, Umea University, Umea, Sweden

4 Rajendra Memorial Research Institute of Medical Sciences, Patna, India

5 Institute of Medical Sciences, Benares Hindu University, Varanasi, India

6 Tribhuvan University, Kathmandu, Nepal

7 Consultant, World Health Organization, Geneva, Switzerland

8 BP Koirala Institute of Health Sciences, Dharan, Nepal

9 World Health Organization, Special Program for Research and Training in Tropical Diseases, Geneva, Switzerland

10 Liverpool School of Tropical Medicine, Liverpool, UK

11 Centre for Nutrition and Food Security, icddr,b, Dhaka, Bangladesh

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BMC Public Health 2012, 12:1001  doi:10.1186/1471-2458-12-1001

Published: 20 November 2012

Abstract

Background

Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal.

Methods

The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method.

Results

Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing.

Conclusion

National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.

Keywords:
Visceral leishmaniasis; Kala-azar; Post kala-azar dermal leishmaniasis; Active case detection; Elimination progamme; Bangladesh; India; Nepal