Vector Borne Disease—Kala azar (Visceral Leishmaniasis) in Nepal

Presented byRoshani Rajbanshi

April 2009

Outline of presentation

• Introduction • Objectives of the Research• Study Area• Materials and Methods• Results• Recommendations

Kala-azar (Visceral Leishmaniasis)

• Communicable and vector borne disease.• Fatal if not treated.• Leishmania spp.• Hosts – fox, dogs, rats, horses and donkeys.• Fox Dog Human being• Vector -- female sandfly, Phelbotomus spp.• Types of Leishmaniasis- visceral leishmaniasis,

cutaneous leishmanaisis, mucocutaneous leihsmaniasis.

Hosts (dogs)

Leishmania spp Sandfly

Human Beings

Objectives of the research

The goal of this research are • To study the causative agents and

determinants of Kala-azar.• To compare the determinants and the risk

factors of Kala-azar in Nepal, Sudan and Brazil.• To determine the possible preventive

measures and the best way to implement.• Recommend social policy to prevent disease.

Study area

• Source: Chappuis et al., 2007• Bern et al., 2000

Study area cont.....

• Widely spread in tropical and sub-tropical regions of the world.

• Affects 88 countries in the world (WHO 2007).• 90% of leishmaniasis occurs in India (largest),

Bangladesh, Brazil, Nepal and Sudan.• In Nepal the disease is prevalent only in the

districts that are close to the Bihar, India.• Brazil and Sudan are also chosen for

comparison purpose.

Methods and Materials

• Descriptive research paper.• Published papers, World Health Organization

(WHO) and Centers for Disease Control (CDC). • Finally, the gathered data was tabulated and

analyzed to provide a new perspective on KA disease.

• A comparative study of the three different countries was done.

Methods and Materials

• Incidence rate and Case Fatality rate were also calculated using the formula given below.

• Incidence rate = Total KA cases÷ Total population in area at risk × 100,000

• Case Fatality Rate = Total death cases ÷ Total population in area at risk × 100,000

Result

Number of cases in Sudan Number of cases in Brazil

Number of cases in Nepal

• Source: WHO/CDS 2005• Rabello et al., 2003• Government of Nepal 2005/06

1995 2000 2005 2010 2015 20200

1000

2000

3000

4000

5000

6000

7000

no of cases

2000 2005 2010 2015 20200

50010001500200025003000350040004500

No of infected peopleLinear (No of infected people)

Year

No

of in

fect

ed p

eopl

e

KALA AZAR CASES FROM 2004-2006 IN NEPAL

*Incidence rate is calculated on the basis of number of cases per population at risk .** CFR is calculated on the basis of number of cases per population at risk.Source : Government of Nepal 2005/2006

Year No. of KA cases

Affected population

No. of deaths

Incidence rate *

CFR (%) **

2004 1588 1604741 32 98.95 2.012005 1463 1517098 21 96.43 1.432006 1531 1046852 14 146.24 0.91

Summary of determinants and risk factors in three different countries

S.N. Determinants/Countries

Nepal Brazil Sudan

1. Parasite L. donovani L. braziliensis, L. guyanensis

L. donovani, L. major

2. Vector P. argentipes Lutzomyia longipalpis

P. papatasi, P. orienntalis

3. Host Human beings Fox, dogs, rats, horses, donkeys, mule and human

Nile rats and human

4. Rainfall Low rainfall - Low rainfall5. Climate Dry season

favors- Post monsoon

6. Temperature High - High

Summary of determinants and risk factors in three different countries cont...

S.N. Determinants/Countries

Nepal Brazil Sudan

Risks Factors7. Vegetation Presence of

garden and weed

Presence of garden

Acacia seyal, Belanites aegyptiaca and vertisol

8. Soil Type Alluvial soil - Clay9. Population

movement+ + +

10. Poor access to health services

+ + +

11. Poor nutritional status

+ + +

12. Co-infection of HIV and VL

Not recorded Highest number

Few cases

Discussion

• The activity of vector is enhanced by the climatic condition like temperature and precipitation.

• Presence of weed and garden favors the availability of vector.

• Weak immune system makes people susceptible to the disease.

• Mass migration of infected people causes the outbreak of the disease in new environment.

• Co-infection of HIV and visceral leishmaniasis is creating problem in the treatment.

Conclusion

• Deadly disease if not treated.• The high temperature (35-37 ), low humidity, clayey soil ℃

and dry season help in the increased activity of the vector. • Young and elderly people showed more infection• Migration and unplanned urbanization reason behind the

transmission of disease.• The (Post kala-azar dermal leishmaniasis) PKDL people acts

as reservoir.• Pentavalent antimony as Sodium Stibogluconate is used for

the treatment of the disease.

Recommendations

• Early diagnosis, detection and treatment of the disease

• Spray of the necessary insecticides • Easy access of the health care in endemic area • Availability of free or low-cost drugs • New settlement should be done far from ponds and

river• Financially support the newly established community• Exchange of information regarding the treatment

should be done

References

• Annual Report, Department of Health Services 2062/63 (2005/06); Government of Nepal, Ministry of Health and Population, Department of Health Services, Kathmandu.

• Bern, C., Joshi, A.B., Jha, S.N., Das, M.L., Hightower, A., Thakur, G.D., Bista, M.B., (2000). Factors associated with Visceral Leishmania in Nepal: Bed-net use is strongly protective. The American Society of Tropical Medicine and Hygiene, 63 (3-4), 184-188

• Chappuis, F., Sundar, S., Hailu, A., Ghalib, H., Rijal, S., Peeling, R. W., Alvar, J., Boelaert, M. (2007). Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nature Reviews Microbiology, S7-S16.

• WHO (2007). Report of the Fifth Consultative Meeting on Leishmaniasis/HIV co-infection. Addis Ababa, Ethiopia, 2007. World Health Organization.

• Rabello, A., Orsini, M., Disch, J. (2003). Leishmania/HIV coinfection in Brazil: an appraisal. Annals of Tropical Medicine & Parasitology, 97(1), S17-S28.

• WHO/CDS (2005). Communicable Disease Toolkit, Sudan. World Health Organization/ Communicable disease Working Group on Emergencies/WHO Regional Office for the Eastern Mediterranean/WHO County Office, Khartoum.

Acknowledgement

• Special thanks to Dr. Michael Edelbrock• Dr. William Bill Carter• University of Findlay• Department of Environmental Safety and

Health Management• Parents and sisters.

Thank you