How Far Are We from Visceral Leishmaniasis Elimination in Bangladesh? An Assessment of Epidemiological Surveillance Data

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Abstract

Introduction: In 2005, Bangladesh, India, and Nepal joined forces to eliminate Visceral Leishmaniasis (or kala-azar) from the region by 2015. In Bangladesh the elimination target is set at less than one new case per 10,000 population per year at upazila (sub-district) level. As the deadline approaches, we review the status of the elimination initiative in this country. Methods: We collected all available disease surveillance data at the Disease Control Unit of the Directorate General of Health Services, Government of Bangladesh from 1994 to 2013. Additionally, we retrieved data from the Civil Surgeon Office from the Mymensingh district, one of the most heavily affected areas in Bangladesh. Results: Between 1994 and 2013, 109,266 kala-azar cases causing 329 deaths were reported from 37 endemic districts in Bangladesh. Only 16 districts reported cases every year. The Mymensingh district was the most affected with 53,582 (49.04%) cases. Between 2008 and 2013 only 16 upazilas showed incidence rates above the elimination target in which they ranged from 1.06 to 18.25 per 10,000 people per year. Discussion: While clear progress has been made towards eliminating VL, 16 upazilas in Bangladesh had not yet reached the target in 2013, based on official notification data that probably suffered from under-reporting bias. The elimination initiative urgently needs to establish methods to ascertain and monitor the elimination target.

Figures

  • Figure 1. The total number of Visceral Leishmaniasis (VL) cases and deaths reported from 1994 to 2013 in Bangladesh. Source: Malaria and Vector-Borne Disease Control Unit, Directorate General of Health Services (DGHS), Dhaka, Government of Bangladesh. doi:10.1371/journal.pntd.0003020.g001
  • Figure 2. The 16 districts reporting VL cases consistently from 1994 to 2013. (Source: Malaria and Vector-Borne Disease Control Unit, Directorate General of Health Services, Government of Bangladesh, Dhaka). doi:10.1371/journal.pntd.0003020.g002
  • Figure 3. Comparison of the percentage-wise share in the total number of VL cases per district for the period of eight years before (1998–2005) and after (2006–2013) signing the memorandum of understanding by the Health Ministers from Bangladesh, India, and Nepal to eliminate VL from their respective countries by 2015. Source: Malaria and Vector-Borne Disease Control Unit, Directorate General of Health Services (DGHS), Dhaka, Government of Bangladesh. doi:10.1371/journal.pntd.0003020.g003
  • Figure 4. VL-endemic upazilas above target, where incidence rate is above one per 10,000 people from 2008 to 2013, with their respective districts.

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APA

Chowdhury, R., Mondal, D., Chowdhury, V., Faria, S., Alvar, J., Nabi, S. G., … Dash, A. P. (2014, August 21). How Far Are We from Visceral Leishmaniasis Elimination in Bangladesh? An Assessment of Epidemiological Surveillance Data. PLoS Neglected Tropical Diseases. Public Library of Science. https://doi.org/10.1371/journal.pntd.0003020

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