- Health education
KalaCORE has worked with the WHO to help raise awareness about VL in communities. An Integrated Health Promotion and Communication Guide for Leishmaniasis Prevention was developed in 2016. Media slots, brochures, posters and banners/billboards were produced. Training was also given to a range of media professionals and public relation officers in Amhara and Tigray. By April 2017 media campaigns to raise public awareness on prevention of leishmaniasis were undertaken through local radio and regional television.
After a pause in activities in 2017, educational activities resumed in 2018 using targeted prevention messages to raise awareness, encourage behaviour change and improve health seeking behaviour in relation to VL. Some of these activities have included:
House to house education, peer education in schools, at health facilities and in farm areas, health extension workers, teachers and land managers have been reaching their target groups with educational messages, alongside relevant ‘sign posting’ - brochures, posters and billboards with prevention messages.
By October 2018 over 1.4 million people were estimated to have been reached by KalaCORE supported health education; around half of these represent the seasonal worker population who are most at risk group of people in Ethiopia of being infected and developing VL.
- Operational research
Together with partners at the Foundation for Research in Health Systems, Epicentre and Mekelle University, KalaCORE conducted research in India and Ethiopia to understand how to improve access to VL diagnostics and treatment for vulnerable groups. As a first step the research aimed to describe real or perceived barriers of access to VL diagnostic services and treatment by vulnerable groups, from the perspective of community and health care providers; followed by investigating the reasons that create such barriers. Outcomes of this research aim at providing recommendations to improve access, with an emphasis on migrants and displaced populations in Ethiopia and female patients in India.
- The study looking at gender barriers to care-seeking for visceral leishmaniasis in highly endemic districts in India is awaiting publication in spring 2019.
- The study in Ethiopia has been published and can be accessed as following:
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
- Operational research
KalaCORE teamed up with researchers from the University of Khartoum, Gedarif University and the Blue Nile Health Institute (Sudan) and University of Gondar (Ethiopia) to investigate multiple aspects of vector control in East Africa:
- Efficacy of different control measures on the vector of VL, Phlebotomus orientalis, and on transmission of visceral leishmaniasis in East Africa
- Vector bionomics and behaviour of the vector that influence the impact of these
- Acceptability of vector control tools under different cultural and socioeconomic contexts (migrant populations from Ethiopia and resident populations in Sudan).
Publications from these studies are expected after the end of the KalaCORE programme.
- Improving surveillance
To address gaps in knowledge about the epidemiology of VL in Ethiopia KalaCORE, together with the Armauer Hansen Research Institute (AHRI) conducted a ‘mapping of mapping’ exercise in 2015. This was published on the open access journal, Parasites and Vectors:
- Gadisa, E., Tsegaw, T., Abera, A., Elnaiem, D., Boer, M, Aseffa. A., Alvar, J. (2015). Eco-epidemiology of visceral leishmaniasis in Ethiopia. Parasites & Vectors, 381. https://doi.org/10.1186/s13071-015-0987-y
KalaCORE has also supported the retrospective data collection over the period from 2005 to 2016 to improve understanding on VL cases and mortality rates in the country and to guide needs for improved reporting and access to diagnosis and treatment of VL.
From 2016 two KalaCORE surveillance officers have been operating in Amhara and Tigray Regional Health Bureaus to strengthen surveillance supervision and outbreak response capacity. Joint assessments of hotspot areas for VL in these regions have been carried out in collaboration with VL focal persons within the Regional Health Bureaus (RHBs). Reporting has largely improved in Ethiopia, with all facilities in Amhara and Tigray region, which have the highest VL caseload, reporting within 3 months, at the end of the programme.
KalaCORE has also supported the identification and response to VL outbreaks or suspected cases by facilitating coordination and communication amongst partners. In collaboration with teams from the Ministry of Health and the WHO, KalaCORE has participated in outbreak assessments in endemic and non-endemic areas from the start and been involved in responses to potential outbreaks such as referring suspected VL patients and facilitating training to health workers at health facilities
- Training health workers
Three clinical mentoring teams (CMT) were deployed from June 2016, one in Tigray, one in Amhara and one covering the Southern SNNP, Oromia and Somali regions. These teams provide on-site training and coaching to staff involved in VL case management to ensure quality of case management of VL patients. Health workers include medical staff like nurses and doctors, laboratory staff and health officers.
A range of additional training of health staff has been organised and co-facilitated by KalaCORE, CM teams and run by the WHO. By October 2017, over 1800 health workers have received training by WHO and KalaCORE.
- Case management
In the first instance, KalaCORE conducted Health Facility Assessments in 17 health facilities where the vast majority of VL patients are diagnosed and treated (Amhara, Tigray, Oromia and SNNPR). Results showed that some of the facilities needed support for improving the standard of care in the following critical areas:
- Stock management
- Strengthening laboratory and diagnostic capacity
- Upgrading services for high numbers of VL patients during the peak season
- Minor infrastructure work and provision of equipment to ensure quality care while MoH finishes upgrading health facilities.
Mid-term health facility assessment were also carried out half-way into the programme to further guide health facility strengthening.
Following assessments, KalaCORE has been undertaking rehabilitation or refurbishment of treatment centres and supported health facilities to meet quality criteria in a number of ways: from overseeing the roll-out and respective supply of drug treatments (SSG, PM, AmBisome) and diagnostics (e.g. DAT) and making basic equipment available in wards and laboratories, to ensuring the training of at least one member of medical and laboratory staff in the national standardized VL guidelines and SOPs, among others.
In 2017 KalaCORE started the instalment of two new VL wards in order to increase bed capacity and provision of VL treatment at the endemic states of Amhara and Tigray. The wards at the St Mary hospital in Axum and Addis Zemen hospital were launched in 2018.
At programmatic closure, KalaCORE has been supporting 22 VL treatment centres and 13 facilities diagnosis only centres. Coordination with the Ethiopian government and the World Health Organization (WHO) to form and execute plans has been instrumental to service provision in new and/or improved facilities.
- Case management
Initially, KalaCORE procured the VL treatment drugs, sodium stibogluconate (SSG) and paromomycin, as well as rapid diagnostic tests and donated these to the Ethiopian Government. Supplies were then transferred to the Ethiopian Government’s Pharmaceutical Fund and Supply Agency (PFSA) who distribute them via established channels. KalaCORE has been providing technical assistance to forecasting supply needs.
Procurement of drugs and diagnostics and forecasting were gradually handed over to WHO from 2017. KalaCORE continued following up in the field with the clinical mentoring teams to ensure stock ruptures were averted.
Treatment: access and advocacy
In 2017, partly as a result of lobbying by KalaCORE, the Regional Health Bureaus of Amhara and Oromia committed to the provision of completely free hospital services and treatment of VL and co-morbidities for all VL patients. In 2018 this was also implemented by the Afar region.