A new method of kala-azar elimination: shifting the reservoir of infection from that village

Chandreshwar P. Thakur¹, Amit Kumar¹, Anant Kumar¹, Kanishk Sinha¹, Shabnam Thakur¹ and Arun Kumar Sinha²

¹Balaji Utthan Sansthan, Uma Complex, Fraser Road, Patna, Bihar, India

²Professor of Statistics and Principal, Science College, Patna-800005

*Corresponding Author E-mail: cpthakur1@rediffmail.com; Tel: 0612-2226545, 2221797

Accepted 21 July, 2013

Abstract

The elimination of kala-azar is a major objective which should be achieved by 2015, one of the objectives of United Nation (UN) Millennium Development Goals. Kala-azar is present in Bihar for more that 100 years. We undertook a study to achieve elimination by adopting a village as a unit of elimination and shifting all patients to a distant place for treatment with an effective drug amphotericin B so that the contact between infected and noninfected population through sandfly is minimized. We selected six villages for elimination, only those villages were selected which were not cared by the government agency and the villagers sought our direct help. The villages were Goanpura in Phulwari block, Sunderpur in Bikram, Tengraila in Naubatpur and Budhura in Barh in Patna district, Banthu in Bhagwanpur of Vaishali district, and Mehsi in Motihari district. It was decided to collect all patients at one place after 3 days of mike publicity, rk -39 test was to be done to all patients of fever of more than 2 weeks duration with hepato-splenomegaly, all rK-39 +ve cases were to be transferred to Patna for parasitological confirmation of diagnosis, (parasites in splenic / bone marrow aspirates) and treatment with amphotericin B (AMB) (R Fungizone) with all precautions, at a dose of 1 mg/kg body weight intravenous infusion given in  4 hours daily for 20 days and on day 21 splenic aspiration was done to asses the parasite status of patients. It was decide to take help of state government for insecticide spray only which was advertised to be done by the government agencies. In Goanpura 21 cases of kala-azar were identified, shifted to Balaji Utthan Sansthan, Patna for parasitological confirmation of diagnosis and treatment with AMB and were cured, one patient died. Two rounds of supervised DDT spray were done in that village. No new case occurred during 9 years of follow up of that village, no sandfly was detected in 2012 and no case relapsed till 2012. The population of patients mostly belonged to scheduled caste and they were poor. 25 patients detected in 4 camps in which 120 patients were examined, their diagnosis was confirmed parasitologically and they were treated and cured with AMB after shifting them to Patna and kala-azar was eliminated in that village without DDT spray. No sandfly was found in 2012. The population was poor but their housing condition was better as houses were newly built under Indira Awas Yojana.  This village inhabited by very poor people with poor living conditions had 30 patients of kala-azar out of 98 patients examined in six camps. All kala-azar cases were cured. We had to organise six camps to eliminate kala-azar from this village, one round of unsupervised spray of DDT was done. Kala-azar was eliminated from that villages. Sandflies were found in Jan 2012. 32 patients of kala-azar were detected in 5 camps out of 124 patients examined. They were treated with AMB and cured. Kala-azar was eliminated from that villages. No sandfly was found in 2012. An unsupervised spray of DDT was done. The population was mixed type, partly of middle class and partly poor. 15 patients detected out of 75 patients examined in two camps. They were treated and cured and one round of good but unsupervised DDT spray was done. Kala-azar was eliminated from that village. The patients belonged to poor Mushar community. No sandfly was found in Jan 2012. They were living in one corner of the village. 97 patients were detected in one camp out of 170 patients examined. They were sent to Patna for treatment and were cured. 6 patients were detected in second camp and 3 patients were found in 3^rd camp in 2012. The disease was controlled in that village. One round of unsupervised DDT spray was done and no sandfly was detected in 2012 Jan. The population was mixed type and a big water body was situated near the village. There was some floating population in that village. Kala-azar was eliminated in 5 villages and controlled in one by adopting a new method of elimination in which all patients were collected at one place and tested with rK-39, rK 39 +ve patients with fever and hepato splenomegaly, were shifted to Patna for parasitological diagnosis and treatment, thus minimizing the contact between infected and noninfected population. In one village Tengraila kala-azar was eliminated without insecticide spray but more detection camps 4 in number were held for early detection of cases and no spray of DDT or any insecticide was done. In Mehsi the disease was controlled by this method by removing 97 patients in the first camp. Adopting one villages as a unit of elimination and shifting all infected patients to another place for treatment which minimized the contact between infected and non infected population through sandfly and treating the patients with an effective drug amphotericin B at a dose of 1 mg/kg body wt. given as IV infusion for 20 days kala-azar could be eliminated by 2015. The role of insecticide should be reassessed and environment friendly insecticide should be used.

Keywords: village as an unit of elimination- visceral leishmaniasis (kala-azar)- Amphotericin B.