title: How far are we from visceral leishmaniasis elimination in Bangladesh? An assessment of epidemiological surveillance data.
abstract: BACKGROUND
  In 2005, Bangladesh, India, and Nepal joined forces to eliminate Visceral Leishmaniasis (or kala-azar) from the region by 2015. In Bangladesh the elimination target is set at less than one new case per 10,000 population per year at upazila (sub-district) level. As the deadline approaches, we review the status of the elimination initiative in this country.
  
  
  METHODS
  We collected all available disease surveillance data at the Disease Control Unit of the Directorate General of Health Services, Government of Bangladesh from 1994 to 2013. Additionally, we retrieved data from the Civil Surgeon Office from the Mymensingh district, one of the most heavily affected areas in Bangladesh.
  
  
  RESULTS
  Between 1994 and 2013, 109,266 kala-azar cases causing 329 deaths were reported from 37 endemic districts in Bangladesh. Only 16 districts reported cases every year. The Mymensingh district was the most affected with 53,582 (49.04%) cases. Between 2008 and 2013 only 16 upazilas showed incidence rates above the elimination target in which they ranged from 1.06 to 18.25 per 10,000 people per year.
  
  
  CONCLUSIONS
  While clear progress has been made towards eliminating VL, 16 upazilas in Bangladesh had not yet reached the target in 2013, based on official notification data that probably suffered from under-reporting bias. The elimination initiative urgently needs to establish methods to ascertain and monitor the elimination target.
authors.affiliation: National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, Bangladesh.
authors.forename: Rajib
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: ICDDR,B, Mohakhali, Dhaka, Bangladesh.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mondal
authors.affiliation: Dhaka College, New Market, Dhaka, Bangladesh.
authors.forename: Vashkar
authors.initials: V
authors.lastname: Chowdhury
authors.affiliation: National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, Bangladesh.
authors.forename: Shyla
authors.initials: S
authors.lastname: Faria
authors.affiliation: DNDi, Geneva, Switzerland.
authors.forename: Jorge
authors.initials: J
authors.lastname: Alvar
authors.affiliation: Directorate General of Health Services (DGHS), Mohakhali, Dhaka, Bangladesh.
authors.forename: Shah Golam
authors.initials: SG
authors.lastname: Nabi
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.affiliation: National Institute for Malaria Research, New Delhi, India.
authors.forename: Aditya Prasad
authors.initials: AP
authors.lastname: Dash
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors