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Randomized Controlled Trial
. 2019 Jan;100(1):97-107.
doi: 10.4269/ajtmh.18-0290.

Intervention Packages for Early Visceral Leishmaniasis Case Detection and Sandfly Control in Bangladesh: A Comparative Analysis

M Mamun Huda  1 , Debashis Ghosh  1 , Abdul Alim  1 , Md Almahmud  1 , Piero L Olliaro  2 , Greg Matlashewski  3 , Axel Kroeger  4   2 , Dinesh Mondal  1
Affiliations
Randomized Controlled Trial

Intervention Packages for Early Visceral Leishmaniasis Case Detection and Sandfly Control in Bangladesh: A Comparative Analysis

M Mamun Huda et al. Am J Trop Med Hyg. 2019 Jan.

Abstract

We compared the efficacy of three intervention packages for active case detection (ACD) of visceral leishmaniasis (VL)/post-kala-azar dermal leishmaniasis (PKDL) combined with sandfly control around an index case. The packages were 1) no kala-azar transmission activity involving indoor residual spraying (IRS) with deltamethrin, peri-domestic deployment of larvicide with temephos, and house-to-house search for cases; 2) fever camp (FC) plus durable wall lining (DWL) with deltamethrin; and 3) FC plus insecticide (deltamethrin) impregnated bed-nets (ITN) around an index case. Fever camp includes 1-day campaign at the village level to screen and diagnose VL, PKDL, leprosy, malaria, and tuberculosis among residents with chronic fever or skin disease. Efficacy was measured through yield of new cases, vector density reduction, and mortality at 1, 3, 6, 9, and 12 months following intervention. Fever camp + DWL was the most efficacious intervention package with 0.5 case detected per intervention, 79% reduction in vector density (incidence rate ratio [IRR] = 0.21, P = 0.010), and 95.1% (95% confidence interval: 93.4%, 96.8%) sandfly mortality at 12 months. No kala-azar transmission activity was efficacious for vector control (74% vector reduction, IRR = 0.26, P < 0.0001 at 9 months; and 84% sandfly mortality at 3 months), but not for case detection (0 case per intervention). Fever camp + ITN was efficacious in detection of VL/PKDL cases (0.43 case per intervention), but its efficacy for vector control was inconsistent. We recommend index case-based FC for ACD combined with DWL or IRS plus larvicide for sandfly control during the consolidation and maintenance phases of the VL elimination program of the Indian subcontinent.

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Figures

Figure 1.
Figure 1.
No kala-azar transmission activity in NKEP in Bangladesh. ACS = active case search; AHI = assistant health inspector; HH = household; HI = health inspector; IRS = indoor residual spraying; MO = medical officer; MO (DC) = MO (disease control); MT LAB = medical technologist (laboratory); NKEP = national kala-azar elimination program; NKTA = no kala-azar transmission activity; SACMO = sub-assistant community medical officer. (Source: National Guideline for Kala-azar Case Management in Bangladesh, 2016, NKEP, Communicable Disease Control, Directorate General of Health Services, Bangladesh.) This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Study design. CDC = Centers for Disease Control and Prevention; FC + DWL = fever camp and installation of durable wall lining; FC + ITN = fever camp and insecticide-treated net; IRS = indoor residual spraying; NKTA = no kala-azar transmission activity; PKDL = post–kala-azar dermal leishmaniasis; VL = visceral leishmaniasis; WHO = World Health Organization.
Figure 3.
Figure 3.
Effect of vector control intervention on female Phlebotomus argentipes densities per household. CI = confidence interval; FC + DWL = fever camp and installation of durable wall lining; FC + ITN = fever camp and insecticide-treated net; IRR = incidence rate ratio; NKTA = no kala-azar transmission activity. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Abbot-corrected Phlebotomus argentipes sandfly mortality by the interventions at follow-up periods. CI = confidence interval; FC + DWL = fever camp and installation of durable wall lining; FC + ITN = fever camp and insecticide-treated net; NKTA = no kala-azar transmission activity. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

References

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