EPIDEMIOLOGY OF KALA AZAR
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Kala-azar is a parasitic disease caused by Leishmania donovani transmitted through the bites of infected female sand flies. It primarily infects the reticuloendothelial system causing recurrent fever, weight loss, spleen and liver enlargement, and skin discoloration. It is diagnosed through tests detecting antibodies or demonstrating the parasite in bone marrow/spleen/lymph node samples. Treatment includes sodium stibogluconate or miltefosine. India's kala-azar control program through vector control, treatment and capacity building led to a 70% decline in incidence and 80% decline in deaths by 1995. The goal is elimination of the disease by 2010.
EPIDEMIOLOGY OF KALA AZAR
- 1. KALA-AZAR
- 2. WHAT IS KALA-AZAR? • Kala-azar is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania • In India Leishmania donovani is the only parasite causing this disease
- 3. • The parasite primarily infects reticuloendothelial system and may be found in abundance in bone marrow, spleen and liver. • Post Kala-azar Dermal Leishmaniasis (PKDL) is a condition when Leishmania donovani invades skin cells, resides and develops there and manifests as dermal leisions.
- 4. SAND FLY
- 6. • Recurrent fever intermittent or remittent with often double rise • loss of appetite, pallor and weight loss with progressive emaciation • weakness • Splenomegaly - spleen enlarges rapidly to massive enlargement, usually soft and nontender
- 7. • Liver - enlargement not to the extent of spleen, soft, smooth surface, sharp edge • Lymphadenopathy - not very common in India • Skin - dry, thin and scaly and hair may be lost. Light coloured persons show grayish discolouration of the skin of hands, feet, abdomen and face which gives the Indian name Kala-azar meaning "Black fever”
- 8. • Anaemia - develops rapidly • Anaemia with emaciation and gross splenomegaly produces a typical appearance of the patients
- 9. HOW KALA-AZAR IS TRANSMITTED?
- 10. • Indian Kala-azar has a unique epidemiological feature of being Anthroponotic; human is the only known reservoir of infection • Female sandflies pick up parasite (Amastigote or LD bodies)while feeding on an infected human host.
- 11. HOW KALA-AZAR IS DIAGNOSED • Serology tests: Variety of tests are available for diagnosis of Kala-azar. The most commonly used tests based on relative sensitivity; specificity and operationally feasibility include Direct Agglutination Test (DAT), rk39 dipstick and ELISA. • However all these tests detect IgG antibodies that are relatively long lasting. Aldehyde Test is commonly used but it is a non-specific test. IgM detecting tests are under development and not available for field use.
- 12. • Parasite demonstration in bone marrow/spleen/lymph node aspiration or in culture medium is the confirmatory diagnosis. However, sensitivity varies with the organ selected for aspiration. • Though spleen aspiration has the highest sensitivity and specificity (considered gold standard) but a skilled professional with appropriate precaustions can perform it only at a good hospital facility.
- 13. WHAT IS THE TREATMENT OF KALA- AZAR? • Short Term • Sodium Sti SSG IM/IV 20mg/kg/day X 30 daysbogluconate • Long Term • Miltefosine 100 mg daily x 4 weeks
- 15. KALA-AZAR CONTROL EFFORTS IN INDIA • An organized centrally sponsored Control Programme launched in endemic areas in 1990-91. • Government of India provided kala-azar medicines, insecticides and technical support and the State governments implemented the programme through primary health care system and district/zonal and State malaria control organizations and provided other costs involved in strategy implementation.
- 16. • Programme strategy included: • Vector control through IRS with DDT up to 6 feet height from the ground twice annually • Early Diagnosis and Complete treatment • Information Education Communication • Capacity Building
- 17. • Programme intensified in 1991-92 which led to improved case registration through primary health care system • Programme Achievements • Within 3 years of intensification (1995 as compared to 1992) • 70.66% decline in annual incidence • 80.48% decline in deaths
- 19. KALA-AZAR ELIMINATION INITIATIVE • National Health Policy Goal: Kala-azar Elimination by the year 2010 • Elimination Programme is 100 per cent Centrally Supported (except regular staff of State governments & infrastructure) • In addition to kala-azar medicines and insecticides, cash assistance is being provided to endemic states since December 2003 to facilitate effective strategy implementation by states
- 20. •“THE BEST WAY TO GAIN SELF CONFIDENCE IS TO DO WHAT YOU ARE AFRAID TO DO”