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Objectives To determine whether medical staff at PHC level would have the time to take up additional activities such as 1-day fever camps for active VL case detection. Methods This article assessed the workload of health staff of different professional categories working at health facilities in Bangladesh, India and Nepal. Data were collected from different sites in high endemic VL areas. The study population was the health staff of government health facilities at all levels. Workload indicators of staffing need ( WISN) software were adopted to carry out the analysis of staff workload and their availability in the selected health facility. The WISN difference and WISN ratio for a particular health facility were calculated from actual staffing available and calculated staffing requirement. Results The results showed a mixed picture of the availability of health workers. In most settings of Bangladesh and India, physicians with or without laboratory technicians would have time for active case detection. In Nepal, this would be performed by trained nurses and paramedical personnel. Conclusion If all vacant posts were filled, active case detection could be performed more easily. The elimination programme can be scaled up with the current staffing levels in the endemic areas with some short training if and when necessary. [ABSTRACT FROM AUTHOR]

To analyse the feasibility, acceptability and effectiveness of insecticide-treated bed nets with slow-release insecticides (KO Tab 123) as an option for kala-azar vector management in Bangladesh. Intervention study involving an insecticide dipping programme through village health workers supervised by public health officers covering 6967 households in Mymensingh and 8287 in Rajshahi district. In a subsample of households, sandfly densities at baseline, 1, 12 and 18 months were measured with CDC light traps both in intervention and control areas. Bioassays were performed for determining the bioavailability of the insecticide and tests of chemical residues in the treated bed nets were undertaken. Satisfaction surveys and direct observation of use of treated bed net use were conducted. The dipping programme was feasible with the help of communities and public health staff, was well accepted, reached a coverage of 98.2% and 96.2% in the two study sites within 4 weeks and was effective in terms of a significant reduction in sandfly densities (approximately 60%) for a period of 18 months. Bioassay results were satisfactory (>80% sandfly mortality) and the average chemical content of the treated bed nets was sufficient for killing sand flies at the end of the observation period. Bed nets treated with slow-release insecticides can be an important complementary measure for sandfly control in the visceral leishmaniasis elimination programme. [ABSTRACT FROM AUTHOR]

Detection of Leishmania parasites in a clinical sample is necessary to confirm a suspected case of leishmaniasis. We compared the sensitivity of internal transcribed spacer 1-PCR (ITS 1-PCR) assay for parasite diagnosis with that of microscopic detection in clinical samples from kala-azar (KA) or post-kala-azar dermal leishmaniasis (PKDL) suspects in Mymensingh. Of 39 specimens collected from 35 KA and four PKDL suspects, 26 were positive by microscopic examination of smears from bone marrow and skin exudates; 38 specimens spotted on filter paper and 27 of the 28 Giemsa-stained slides tested by PCR proved positive by ITS1-PCR. [ABSTRACT FROM AUTHOR]

The article discusses the initiatives of Bangladesh, India and Nepal to eliminate the parasitic disease, visceral leishmaniasis (VL) or kala azar in their region. In 2005, the three countries have united to eliminate VL through early diagnosis and treatment, vector control and implementation research. To reach this goal, the authors argue that the countries must integrate its early VL diagnosis and treatment efforts into their existing health services and improve the poor's access to VL care.

Objectives To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. Method Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. Results Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). Conclusions Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households. [ABSTRACT FROM AUTHOR]

Key Clinical Message Successful management of cases with visceral leishmaniasis ( VL) and tuberculosis is a challenge for clinicians, because a guideline for that is currently unavailable. We report the first case in Bangladesh who developed VL during her treatment for pulmonary tuberculosis and was treated successfully with multidose liposomal amhptericin B for VL. [ABSTRACT FROM AUTHOR]