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Kala-Azar & PKDL

MSF Experience: Leishmaniasis control in Fulbaria Upazilla of Mymensing district Date: 1 st 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

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Kala-Azar & PKDL

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  1. MSF Experience: Leishmaniasis control in Fulbaria Upazilla of Mymensing districtDate: 1st September, 2012

  2. 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.

  3. 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

  4. 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

  5. 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

  6. Patient Flow • ORWS • Self • MoH • Others KATC Treated Observation Reffd KA: 1M, 3M, 6M and 12 M PKDL: 1M, 6M , 12M F/U 200 M. Index case

  7. 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

  8. 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)

  9. 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)

  10. Thank You

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