Performance of kala-azar surveillance in Gaffargaon subdistrict of Mymensingh, Bangladesh

Kazi Mizanur Rahman; Indira V M Samarawickrema; David Harley; Anna Olsen; Colin D Butler; Shariful Amin Sumon; Subrata Kumar Biswas; Stephen P Luby; Adrian C Sleigh

doi:10.1371/journal.pntd.0003531

Performance of kala-azar surveillance in Gaffargaon subdistrict of Mymensingh, Bangladesh

PLoS Negl Trop Dis. 2015 Apr 10;9(4):e0003531. doi: 10.1371/journal.pntd.0003531. eCollection 2015 Apr.

Authors

Kazi Mizanur Rahman¹, Indira V M Samarawickrema², David Harley², Anna Olsen³, Colin D Butler⁴, Shariful Amin Sumon⁵, Subrata Kumar Biswas⁵, Stephen P Luby⁵, Adrian C Sleigh²

Affiliations

¹ International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Population and Social Health Research Program, Griffith Health Institute, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia.
² National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
³ University of New South Wales, Sydney, New South Wales, Australia.
⁴ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; University of Canberra, Canberra, Australian Capital Territory, Australia.
⁵ International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.

Abstract

Introduction: Elimination of kala-azar is planned for South Asia requiring good surveillance along with other strategies. We assessed surveillance in Gaffargaon upazila (a subdistrict of 13 unions) of Mymensingh district, Bangladesh highly endemic for kala-azar.

Methods: In 4703 randomly sampled households, within nine randomly sampled villages, drawn from three randomly sampled unions, we actively searched for kala-azar cases that had occurred between January 2010 and December 2011. We then searched for medical records of these cases in the patient registers of Gaffargaon upazila health complex (UHC). We investigated factors associated with the medical recording by interviewing the cases and their families. We also did a general observation of UHC recording systems and interviewed health staff responsible for the monthly reports of kala-azar cases.

Results: Our active case finding detected 58 cases, but 29 were not recorded in the Gaffargaon UHC. Thus, only 50% (95% CI: 37%-63%) of kala-azar cases were reported via the government passive surveillance system. Interviews with health staff based in the study UHC revealed the heavy reporting burden for multiple diseases, variation in staff experience, high demands on the staff time and considerable complexity in the recording system. After adjusting for kala-azar treatment drug, recording was found more likely for those aged 18 years or more, males, receiving supply and administration of drug at the UHC, and more recent treatment.

Discussion: Fifty percent of kala-azar cases occurring in one highly endemic area of Bangladesh were recorded in registers that were the source for monthly reports to the national surveillance system. Recording was influenced by patient, treatment, staff and system factors. Our findings have policy implications for the national surveillance system. Future studies involving larger samples and including interviews with health authorities at more central level and surveillance experts at the national level will generate more precise and representative evidence on the performance of kala-azar surveillance in Bangladesh.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Antiprotozoal Agents / therapeutic use
Bangladesh / epidemiology
Female
Humans
Leishmaniasis, Visceral / diagnosis*
Leishmaniasis, Visceral / drug therapy
Leishmaniasis, Visceral / epidemiology*
Male
Population Surveillance*

Substances

Antiprotozoal Agents

Grants and funding

The study was funded by the Core Research Fund of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) which supported all the data collection related expenditure. Icddr,b is thankful to the Governments of Australia, Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. The PhD research fund of the Australian National University provided additional support. KMR also received support through the Endeavour Postgraduate Award of the Australian Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.