MSF Experience: Leishmaniasis control in Fulbaria Upazilla of

Mymensing districtDate: 1st September, 2012

Kala-Azar & PKDL

• Parasitic disease (Leishmania donovani)• Transmitted by- Sand fly • Host- Human (South East Asia) and many in other

parts of the world• Appears as- Visceral leishmaniasis (Kala Azar)- Cutaneous and - Muco-cutaneous leishmaniasis.

Kala-Azar and MSF

• 1988: 1st KA patient treated by MSF• 1988-1994: >19000 KA patients treated in

South Sudan• 1994: MSF realized that it should consider KA

as a disease of importance because of its nature

• 2002: Paromomycin + SSG• Till 2011 (December): > 100,000 KA treated

Patients

MSF Kala Azar Project in Bangladesh

Fulbaria Upazilla of Mymensing District2004: 1st assessment by MSF2009 (April) : 2nd assessment by MSF

(Resulted in a Project)2009 (December): MoU signed between MoH

and MSFMay/2010: 1st KA Patient was treated by MSF

in Fulbaria

Project Strategy

Integrated case managementActive case finding1) Blanket approach2) Cluster approach (Index

case based)

Treatment

IRS (Indoor R. Spray)Ministry of Health

Patient Flow

ORWSSelfMoHOthers

KATC

Treated Observation Reffd

F/U KA: 1M, 3M, 6M and 12 M

PKDL: 1M, 6M , 12MIndex case200 M.

Project description

Clinic 20 bed clinic (10 M / 10 F) 07 Nurses 02 national Medical

Doctors & 01 M. Assistant 02 Laboratory technicians 01 Data manger 01 Registrar All supervised by 01 Expat

Medical Doctor

Out Reach 39 ORWs 16 OR Monitors 02 OR Supervisors All supervised by 01 Expat

Nurse

Case Definition

Kala – AzarSuspected: Fever > 2 weeks + Splenomegaly +

Weight loss Confirmed: Above features + rK-39 positive

(Relapse- Spleen Aspiration)

PKDL (Post Kala-Azar Dermal Leishmaniasis)PKDL: H/O KA + Typical Lesions (Hypo pigmented,

Not itchy usually)

Treatment of KA and PKDL

Drug: Liposomal Amphotericin B (L. AmB)Route: Slow IV (over 02 hrs) mixed with 5% DADose: PKA- 15 mg/ Kg divided into 03 doses, 05 mg/ Kg/

day for 03 days (D0, D1 and D5)

Relapse KA- 25 mg/ Kg divided into 05 doses

PKDL- 30 mg/ Kg; 05 mg/ kg /day for 06 days (twice/ week for three weeks)

Fulbaria

Muktagach

a

Trishal

Others

Mymensh

ingh

Madhupur

Gafargaon

Phulpur

Ghatail

Shokhipur

Bhaluka

Dhubaura

Ishwarig

anj

1158

169 119 47 43 42 11 11 10 9 5 4 2

No. of KA patients treated by MSF at KATC (n=1634) (May, 2010 – July, 2012)

Jan Feb Mar AprMay Jun Jul Aug Sep Oct Nov Dec0

10

20

30

40

50

60

70

80

90

Number of PKA cases from Fulbaria only

2010Linear (2010)2011Linear (2011)2012Linear (2012)

Num

ber o

f cas

es

020406080

100120140160180200

KA Patients from Fulbaria only

PKARelapse

Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

2010 2011 2012

0

2

4

6

8

10

12

14

16

18

Fulbaria Sadar Union KA (n=208)

Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

2010 2011 2012

0

2

4

6

8

10

12

14

16

18

Kushmail (KA=186)

Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

2010 2011 2012

0

2

4

6

8

10

12

14

Balian (KA=117)

Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

2010 2011 2012

0

2

4

6

8

10

12

Radhakanai (KA=116)

Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

pO

ctN

ov Dec Jan

Feb

Mar

Apr

May Jun Jul

2010 2011 2012

0

1

2

3

4

5

6

7

8

9

10

PutijanaLinear (Putijana)NaogaoLinear (Naogao)

Fulbaria Trishal Muktagacha Others Total0

200

400

600

800

1000

1200

1400

1600

1215

78 75 79

1447

No. PKDL treated in MSF KATC

Putijana

Radhak

anai

Achim

patuli

Naoga

on

Fulbari

a

Bhaban

ipur

Kushmail

Kaladah

aBak

taBali

an

Enay

etpur

Ranga

matia

Deokhola

0

20

40

60

80

100

120

140

Union-wise PKDL treated at KATC (May, 2010 - July, 2012)

0

50

100

150

200

250

Union-wise PKDL & KA (May, 2010- July-2012)

PKDLKA

Y-1999

Y-2000

Y-2001

Y-2002

Y-2003

Y-2004

Y-2005

Y-2006

Y-2007

Y-2008

Y-2009

Y-2010

Y-20110

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

KA load Comparison

CountryMymenOutside Mym

No.

of K

A ca

ses

repo

rted

Thank You