title: Performance of kala-azar surveillance in Gaffargaon subdistrict of Mymensingh, Bangladesh.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Kazi Mizanur
authors: KM
authors: Rahman
authors: National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Indira V M
authors: IV
authors: Samarawickrema
authors: National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors: David
authors: D
authors: Harley
authors: University of New South Wales, Sydney, New South Wales, Australia.
authors: Anna
authors: A
authors: Olsen
authors: 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.
authors: Colin D
authors: CD
authors: Butler
authors: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors: Shariful Amin
authors: SA
authors: Sumon
authors: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors: Subrata Kumar
authors: SK
authors: Biswas
authors: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors: Stephen P
authors: SP
authors: Luby
authors: National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Adrian C
authors: AC
authors: Sleigh
mesh_terms: D000293:Adolescent; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D011159:Population Surveillance
chemical_list: D000981:Antiprotozoal Agents