Transcript MSF Kala-Azar Project in Fulbaria: A Project Overview

MSF Experience: Leishmaniasis
control in Fulbaria Upazilla of
Mymensing district
st
Date: 1 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 District
2004: 1st assessment by MSF
2009 (April) : 2nd assessment by MSF
(Resulted in a Project)
2009 (December): MoU signed between MoH
and MSF
May/2010: 1st KA Patient was treated by MSF
in Fulbaria
Project Strategy
Integrated case management
Active case finding
1) Blanket approach
2) Cluster approach (Index
case based)
 Treatment
IRS (Indoor R. Spray)
Ministry of Health
Patient Flow
Treated
F/U
200 M.
Index case
Observation Reffd
KA: 1M, 3M, 6M and
12 M
PKDL: 1M, 6M , 12M
Project description
Clinic
Out Reach
 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
 39 ORWs
 16 OR Monitors
 02 OR Supervisors
 All supervised by 01 Expat
Nurse
Case Definition
Kala – Azar
Suspected: 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% DA
Dose:
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)
No. of KA patients treated by MSF at KATC (n=1634)
(May, 2010 – July, 2012)
1158
169 119
47 43 42 11 11 10
9
5
4
2
Number of PKA cases from Fulbaria only
90
80
Number of cases
70
2010
60
2011
50
2012
40
Linear (2010)
30
Linear (2011)
Linear (2012)
20
10
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
KA Patients from Fulbaria only
200
180
160
140
120
100
80
60
40
20
0
PKA
Relapse
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Fulbaria Sadar Union KA (n=208)
18
16
14
12
10
8
6
4
2
0
2010
2011
2012
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Kushmail (KA=186)
18
16
14
12
10
8
6
4
2
0
2010
2011
2012
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Balian (KA=117)
14
12
10
8
6
4
2
0
2010
2011
2012
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Radhakanai (KA=116)
12
10
8
6
4
2
0
2010
2011
2012
10
9
8
7
6
Putijana
5
Naogao
4
Linear (Putijana)
3
Linear (Naogao)
2
1
0
Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul
2010
2011
2012
No. PKDL treated in MSF KATC
1600
1400
1200
1000
800
600
1447
1215
400
200
78
0
Fulbaria
Trishal
75
Muktagacha
79
Others
Total
Union-wise PKDL treated at KATC (May, 2010 - July, 2012)
140
120
100
80
60
40
20
0
Union-wise PKDL & KA (May, 2010- July-2012)
250
200
150
100
PKDL
KA
50
0
KA load Comparison
10000
No. of KA cases reported
9000
8000
7000
6000
5000
Country
4000
Mymen
3000
2000
1000
0
Outside Mym
Thank You