Knowledge hub

Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study

Author summary

"Ethiopia bears a high burden of visceral leishmaniasis (VL)—a neglected tropical  disease transmitted through the bite of a sand fly that  disproportionately affects vulnerable populations. Without treatment, VL  progresses, causing increasingly severe symptoms and ultimately death  within two years, in most cases. Early access to VL diagnosis and care  improves clinical prognosis and reduces transmission from infected  humans; however, significant obstacles exist. To our knowledge, our  study is the first in Ethiopia to use qualitative methods to assess  barriers to VL diagnosis and care among seasonal mobile workers.  Strikingly, we found that contrary to what health policy for VL dictates  in this endemic setting, study participants reported very poor access  to diagnosis and, consequently, significantly delayed access to  treatment. Our findings have important public health and policy  implications. Specifically, our results offer strategies that may  increase access to VL diagnosis and care, allowing for earlier treatment  and better prognoses for VL patients, and reducing the potential health  disparities and the overall burden of VL."

Coulborn RM, Gebrehiwot TG, Schneider M, Gerstl S, Adera C, et al. (2018) Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study. PLOS Neglected Tropical Diseases 12(11): e0006778. https://doi.org/10.1371/journal.pntd.0006778
12 Nov 2018
Publication
Case management, Operational research
Ethiopia

Kala-azar Outbreak Management Guidelines, Bangladesh, 2016.

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in August of 2016.

5 Nov 2018
Policy paper
Improving surveillance
Bangladesh

National Guideline For Kala-azar Case Management, Bangladesh, 2016

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in 2016. Third edition.

5 Nov 2018
Policy paper
Case management
Bangladesh

Monitoring and Evaluation Guideline, National Kala-azar Control Program, Bangladesh, 2018

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in 2018.

5 Nov 2018
Policy paper
Improving surveillance, Health education, Training health workers, Case management
Bangladesh

Quantifying the infectiousness of post-kala-azar dermal leishmaniasis towards sandflies

A xenodiagnosis study on PKDL and VL patients using laboratory-reared Phlebotomus argentipes was conducted to determine whether PKDL patients can act as an infection reservoir. The study concludes that nodular and macular PKDL, and VL, can be infectious to sand flies. The authors therefore advise that "active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs".

29 Oct 2018
Academic paper
Case management, Improving surveillance
Bangladesh

The role of case proximity in transmission of visceral leishmaniasis in a highly endemic village in Bangladesh

"Author summary

Visceral leishmaniasis (VL), a fatal parasitic disease transmitted by sandflies, has been targeted for elimination as a public health problem in the Indian subcontinent by 2020. The goal has been reached in the majority of endemic regions in Bangladesh, India and Nepal, but the disease persists in several hotspots. Better understanding of spatial clustering of VL cases and the role of asymptomatically infected individuals in transmission is required to improve control interventions and sustain the elimination target. To address this issue, we have fitted an individual-level spatiotemporal model of VL transmission to geo-located incidence data from Bangladesh to estimate the rate at which VL risk decreases with distance from a case and the potential contribution of asymptomatic individuals to transmission. Our results suggest that VL risk decreases quickly with distance and that symptomatic individuals are the main drivers of transmission, highlighting the potential for spatially-targeted control interventions to reduce transmission".

12 Oct 2018
Academic paper
Improving surveillance
Bangladesh

Visceral Leishmaniasis in the Muzaffapur Demographic Surveillance Site: A Spatiotemporal Analysis

Abstract

"In the Indian subcontinent, visceral leishmaniasis (VL) has a strongly clustered distribution. The “index case approach” is promoted both for active case finding and indoor residual spraying (IRS). Uncertainty exists about the optimal radius. Buffer zones of 50–75 m around incident cases have been suggested for active case finding, for IRS the recommendation is to cover a radius of 500 m. Our aim was to establish optimal target areas both for IRS and for (re)active case finding. We plotted incident VL cases on a map per 6-month period (January–June or July–December) and drew buffers of 0 (same household), 50, 75, 100, 200, 300, 400, and 500 m around these cases. We then recorded total population and numbers of VL cases diagnosed over the next 6-month period in each of these buffers and beyond. We calculated incidence rate ratios (IRRs) using the population at more than 500 m from any case as reference category. There was a very strong degree of spatial clustering of VL with IRRs ranging from 45.2 (23.8–85.6) for those living in the same households to 14.6 (10.1–21.2) for those living within 75 m of a case diagnosed, during the previous period. Up to 500 m the IRR was still five times higher than that of the reference category. Our findings corroborate the rationale of screening not just household contacts but also those living within a perimeter of 50–75 m from an index case. For IRS, covering a perimeter of 500 m, appears to be a rational choice."

 

11 Oct 2018
Academic paper
Improving surveillance
India

Indoor residual spraying for kala-azar vector control in Bangladesh: A continuing challenge

Author summary

"The visceral leishmaniasis (VL) elimination programme was launched in the Indian subcontinent (Bangladesh, India and Nepal) in 2005. Although the integrated vector management (IVM) system is one of the important elements highlighted in the Regional VL elimination strategy, indoor residual spraying (IRS) is the sole intervention practice that has been implemented. In fact, in Bangladesh from 1999 to early 2012, no VL vector control was used at all and pre-monsoon IRS was only re-introduced by the national programme in eight high endemic upazilas (sub-districts) in 2012. The present study monitored IRS operation in five upazilas (Fulbaria, Trishal, Mukthagacha, Gaforgaon and Bhaluka). Monitoring took place with the help of using observation check lists and questionnaires included in the WHO/TDR monitoring and evaluation tool kit. The study identified that training of spraymen was insufficient and a supervisor was not always present during spraying. The spraying techniques by all the sprayers were sub-standard. It was also found that all the required personal protective equipment was not provided by the national programme. It is recommended that the national programme should conduct monitoring and evaluation activities to ensure high quality of IRS operations in order to achieve maximum benefit.

"

8 Oct 2018
Academic paper
Training health workers, Operational research
Bangladesh

Open-access Seminar on Leishmaniasis by The Lancet

Abstract

"Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7–1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled."
5 Oct 2018
Health education material
Health education, Training health workers

Open-access Seminar on Leishmaniasis by The Lancet

Abstract

"Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7–1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled."
5 Oct 2018
Academic paper
Health education, Training health workers

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