Abstract
BackgroundOne of the major challenges for management of visceral leishmaniasis (VL) is early diagnosis of cases to improve treatment outcome and reduce transmission. We have therefore investigated active case detection of VL with the help of accredited social health activists (ASHA). ASHAs are women who live in the community and receive performance-based incentives for overseeing maternal and other health-related issues in their village.Methods and Principal FindingThrough conducting interviews with 400 randomly selected ASHAs from four primary health care centers (PHCs), it was observed that their level of knowledge about visceral leishmaniasis (VL) regarding transmission, diagnosis, and treatment was limited. The baseline data indicated that less than 10% of VL cases seeking treatment at the PHCs were referred by ASHAs. To increase the knowledge and the referral rate of VL cases by ASHAs, training sessions were carried out during the monthly ASHA meetings at their respective PHCs. Following a single training session, the referral rate increased from less than 10% to over 27% and the overall knowledge about VL substantially improved. It was not possible, however, to demonstrate that ASHA training reduced the time that individuals had fever before treatment at the PHC.ConclusionsTraining ASHAs to identify VL cases in villages for early diagnosis and treatment at the local PHC is feasible and should be undertaken routinely to improve knowledge about VL.
Highlights
There are estimated 200,000 to 400,000 new cases of visceral leishmaniasis (VL), known as kala-azar [1] every year worldwide
We have investigated the possibility of training accredited social health activists (ASHA) to identify potential VL cases and to send them for treatment at the local primary health care centers (PHCs)
We determined which PHCs had the highest number of VL cases in 2009 and 2010 in Muzaffarpur and Saran districts of Bihar State so that these could be selected for this study
Summary
There are estimated 200,000 to 400,000 new cases of visceral leishmaniasis (VL), known as kala-azar [1] every year worldwide. Awareness remains a major challenge in the most endemic districts of Bihar when considering the scale of the problem which involves thousands of villages [10,11]. Conducting one day fever camps is an effective approach to identify VL cases in highly endemic villages but requires significant resources when performed on large scale [11,12]. We have considered a different approach for case detection including enlisting the involvement of community health care workers, known as accredited social health activists (ASHA) to help identify potential VL cases in the endemic villages. One of the major challenges for management of visceral leishmaniasis (VL) is early diagnosis of cases to improve treatment outcome and reduce transmission. ASHAs are women who live in the community and receive performancebased incentives for overseeing maternal and other health-related issues in their village
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