Kala-azar (Visceral Leishmaniasis) Elimination in Bangladesh: Successes and Challenges

Abstract

Visceral leishmaniasis (VL) also known as kalaazar is a major public health problem in Bangladesh. A national VL elimination program was initiated in 2008 in Bangladesh after the signing of a memorandum of understanding between the Government of Bangladesh, India, and Nepal in 2005 for the elimination of VL from these three countries by 2015. Following the strategic plan of the VL elimination program of the three countries, the national program in Bangladesh was established in 2008. Based on information in the directorate general of health services, expert opinions in a recently held advocacy meeting in Dhaka and on available scientific literature, we report here the successes and challenges of the national VL elimination program in Bangladesh. The program prepared the national kala-azar elimination guidelines and strategic plan for VL elimination in consultation with the technical working group for VL elimination and VL experts in Bangladesh and abroad, including the World Health Organization-The Special Programme for Research and Training in Tropical Diseases (TDR). The program trained health staff from all VL endemic hospitals in proper diagnosis and treatment, stratified the country according to VL burden, and introduced the rapid diagnostic test and oral treatment with miltefosine at no cost for patients. Integrated vector control management with indoor residual spraying and the distribution of commercial, long-lasting, insecticidetreated bed-nets were also studied and then implemented. VL burden has declined, but is still far from the target of VL elimination. Thus, the program must continue to maintain these activities and also introduce new activities to involve community participation in the program. The program is facing challenges regarding the shortage of human resources and logistics because of a scarcity of resources. To maintain the success of the program, support from national and international donor agencies and policy makers will be necessary. Other options for the treatment of VL patients as well as for vector control must also be considered.

Mobile suitcase laboratory for rapid detection of Leishmania donovani using recombinase polymerase amplification assay

“…Total of 48 archived DNA samples from VL patients, asymptomatic individuals and PKDL patients were tested by both RPA and real-time PCR assays [ 22 ]. All VL patients ( N = 23) were either parasitologically confirmed or diagnosed with VL in accordance with Bangladeshi national guidelines [ 23 ]. Likewise, all asymptomatic individuals ( N = 5) were habitants of VL endemic areas and clinically healthy but positive in Leishmaniasis DAT and rK39 dipstick test.…”

Evaluation of diagnostic performance of rK28 ELISA using urine for diagnosis of visceral leishmaniasis

“…Since the kala-azar elimination programme is on target to reduce the rate of VL to 1 per 10,000 in endemic areas in the Indian sub-continent by 2015, a strategy of active case detection is going to be deployed to maintain the targeted case rate standstill by the programme which has extended its activity till 2017 [ 5 , 7 , 30 ]. According to the current strategy, rK39 RDT is the sole serodiagnostic tool while this method has several limitations [ 30 , 31 ]. Our data indicate that rK28 urine ELISA has shown sensitivity and specificity consistent with the criteria that has been defined by Boelaert et al [ 9 ] for use of diagnostic tools in active case detection.…”

Entomological efficacy of durable wall lining with reduced wall surface coverage for strengthening visceral leishmaniasis vector control in Bangladesh, India and Nepal

“…Fortunately the burden of VL is now going down in the Indian sub-continent [ 5 , 6 ]. In 2005 the Governments of India, Bangladesh and Nepal committed to a VL elimination program to sustainably bring down the number of cases to less that 1 per 10,000 people at the district/upazila (sub-district) level by 2015 [ 7 ].…”

“…Nepal achieved the elimination target and Bangladesh is very close to the achievement [ 8 ]. Early case detection and proper management and indoor residual spraying with insecticides (IRS) for sand fly control were the pillars of success in the attack phase of the elimination program [ 5 , 6 , 8 ]. In the subsequent consolidation and maintenance phases of the program the Government of these countries may be reluctant to use IRS for controlling sand fly because of its cost and in a situation when VL burden has substantially went down to few hundreds.…”