title: Active case detection in national visceral leishmaniasis elimination programs in Bangladesh, India, and Nepal: feasibility, performance and costs.
abstract: BACKGROUND
  Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal.
  
  
  METHODS
  The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method.
  
  
  RESULTS
  Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing.
  
  
  CONCLUSIONS
  National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.
authors.affiliation: Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh. mhuda83@icddrb.org
authors.forename: M Mamun
authors.initials: MM
authors.lastname: Huda
authors.forename: Siddhivinayak
authors.initials: S
authors.lastname: Hirve
authors.forename: Niyamat Ali
authors.initials: NA
authors.lastname: Siddiqui
authors.forename: Paritosh
authors.initials: P
authors.lastname: Malaviya
authors.forename: Megha Raj
authors.initials: MR
authors.lastname: Banjara
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Kansal
authors.forename: Chitra Kumar
authors.initials: CK
authors.lastname: Gurung
authors.forename: Eva
authors.initials: E
authors.lastname: Naznin
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
authors.forename: Byron
authors.initials: B
authors.lastname: Arana
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mondal
mesh_terms: D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D060740:Disease Eradication / Q000191:economics* / Q000592:standards; D005240:Feasibility Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D007300:Insect Control; D007303:Insect Vectors; D057148:Insecticide-Treated Bednets / Q000191:economics / Q000706:statistics & numerical data*; D007306:Insecticides / Q000008:administration & dosage*; D007898:Leishmaniasis, Visceral / Q000453:epidemiology / Q000517:prevention & control*; D009390:Nepal / Q000453:epidemiology; D016730:Program Development
chemical_list: D007306:Insecticides