Abstract
.Nepal has completed the attack phase of visceral leishmaniasis (VL) elimination and now needs active case detection (ACD) and vector control methods that are suitable to the consolidation and maintenance phases. We evaluated different ACD approaches and vector control methods in Saptari district. We assessed 1) mobile teams deployed in villages with VL cases in 2015 to conduct combined camps for fever and skin lesions to detect VL/PKDL (post–kala-azar dermal leishmaniasis) and other infections; 2) an incentive approach by trained female community health volunteers (FCHVs) in villages with no VL cases in 2015. Both were followed by house-to-house visits. For vector control, four villages were randomly allocated to insecticide impregnation of bednets, insecticide wall painting, indoor residual spraying (IRS), and control. Sandfly density (by CDC light traps, The John W. Hock Company, USA) and mortality (World Health Organization cone bioassay) were assessed in randomly selected households. One VL, three tuberculosis, one leprosy, and one malaria cases were identified among 395 febrile cases attending the camps. Post-camp house-to-house screening involving 7,211 households identified 679 chronic fever and 461 skin lesion cases but no additional VL/PKDL. No VL/PKDL case was found by FCHVs. The point prevalence of chronic fever in camp and FCHV villages was 242 and 2 per 10,000 populations, respectively. Indoor residual spraying and bednet impregnation were effective for 1 month versus 12 months with insecticidal wall paint. Twelve-month sandfly mortality was 23%, 26%, and 80%, respectively, on IRS, bednet impregnation, and insecticide wall painting. In Nepal, fever camps and insecticidal wall paint prove to be alternative, sustainable strategies in the VL post-elimination program.
Highlights
Visceral leishmaniasis (VL) is a public health problem mostly affecting the poorest of the poor in the tropics.[1]
An incentive-based approach for active detection of VL/post–kala-azar dermal leishmaniasis (PKDL) along with other febrile cases conducted by female community health volunteers (FCHVs) was tested in villages without VL cases in 2015
One each was positive for VL, leprosy, and malaria; and three were positive for tuberculosis
Summary
Visceral leishmaniasis (VL) is a public health problem mostly affecting the poorest of the poor in the tropics.[1]. The elimination target is less than 1 case per 10,000 inhabitants at the subdistrict, district, and block level, respectively, in Bangladesh, Nepal, and India initially by 2015.4 In 2014, the deadline was further extended to 2017, and Bhutan and Thailand were included.[5] Nepal achieved the target in 2014 and Bangladesh in 2016.6. The pillars of the attack phase have been active case detection (ACD) combined with treatment at the primary healthcare level and vector control through indoor residual spraying (IRS) with insecticides in VL-endemic areas This has made it possible to identify more cases of VL and post–kala-azar dermal leishmaniasis (PKDL) and treat them earlier, limiting transmission.[7,8,9] These interventions, may not be sustainable in the long term, and alternative case identification and vector control strategies are needed in Nepal to protect the achievements of the attack phase.[10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The American Journal of Tropical Medicine and Hygiene
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
