5. Objectives of the research
The goal of this research are
• To study the causative agents and
determinants of Kala-azar.
• To compare the determinants and the risk
factors of Kala-azar in Nepal, Sudan and
Brazil.
• To determine the possible preventive
measures and the best way to implement.
• Recommend social policy to prevent
disease.
7. Study area cont.....
• Widely spread in tropical and sub-tropical
regions of the world.
• Affects 88 countries in the world (WHO 2007).
• 90% of leishmaniasis occurs in India (largest),
Bangladesh, Brazil, Nepal and Sudan.
• In Nepal the disease is prevalent only in the
districts that are close to the Bihar, India.
• Brazil and Sudan are also chosen for
comparison purpose.
8. Methods and Materials
• Descriptive research paper.
• Published papers, World Health Organization
(WHO) and Centers for Disease Control (CDC).
• Finally, the gathered data was tabulated and
analyzed to provide a new perspective on KA
disease.
• A comparative study of the three different
countries was done.
9. Methods and Materials
• Incidence rate and Case Fatality rate were also
calculated using the formula given below.
• Incidence rate = Total KA cases÷ Total
population in area at risk × 100,000
• Case Fatality Rate = Total death cases ÷ Total
population in area at risk × 100,000
10. Result
Number of cases in Sudan Number of cases in Brazil
Number of cases in Nepal
• Source: WHO/CDS 2005
• Rabello et al., 2003
• Government of Nepal 2005/06
0
1000
2000
3000
4000
5000
6000
7000
1995 2000 2005 2010 2015 2020
no of cases
0
1000
2000
3000
4000
5000
2000 2005 2010 2015 2020
Noofinfectedpeople
Year
Linear (No of
infected people)
11. KALA AZAR CASES FROM 2004-2006 IN NEPAL
*Incidence rate is calculated on the basis of number of cases per
population at risk .
** CFR is calculated on the basis of number of cases per population at
risk.
Source : Government of Nepal 2005/2006
Year No. of KA
cases
Affected
population
No. of
deaths
Incidence
rate *
CFR (%) **
2004 1588 1604741 32 98.95 2.01
2005 1463 1517098 21 96.43 1.43
2006 1531 1046852 14 146.24 0.91
12. Summary of determinants and risk factors in
three different countries
S.N. Determinants/
Countries
Nepal Brazil Sudan
1. Parasite L. donovani L. braziliensis, L.
guyanensis
L. donovani, L.
major
2. Vector P. argentipes Lutzomyia
longipalpis
P. papatasi, P.
orienntalis
3. Host Human beings Fox, dogs, rats,
horses,
donkeys, mule
and human
Nile rats and
human
4. Rainfall Low rainfall - Low rainfall
5. Climate Dry season
favors
- Post monsoon
6. Temperature High - High
13. Summary of determinants and risk factors in
three different countries cont...
S.N. Determinants/C
ountries
Nepal Brazil Sudan
Risks Factors
7. Vegetation Presence of
garden and
weed
Presence of
garden
Acacia seyal, Belanites
aegyptiaca and vertisol
8. Soil Type Alluvial soil - Clay
9. Population
movement
+ + +
10. Poor access to
health services
+ + +
11. Poor nutritional
status
+ + +
12. Co-infection of
HIV and VL
Not recorded Highest
number
Few cases
14. Discussion
• The activity of vector is enhanced by the climatic
condition like temperature and precipitation.
• Presence of weed and garden favors the
availability of vector.
• Weak immune system makes people susceptible
to the disease.
• Mass migration of infected people causes the
outbreak of the disease in new environment.
• Co-infection of HIV and visceral leishmaniasis is
creating problem in the treatment.
15. Conclusion
• Deadly disease if not treated.
• The high temperature (35-37℃), low humidity, clayey
soil and dry season help in the increased activity of the
vector.
• Young and elderly people showed more infection
• Migration and unplanned urbanization reason behind
the transmission of disease.
• The (Post kala-azar dermal leishmaniasis) PKDL people
acts as reservoir.
• Pentavalent antimony as Sodium Stibogluconate is
used for the treatment of the disease.
16. Recommendations
• Early diagnosis, detection and treatment of the
disease
• Spray of the necessary insecticides
• Easy access of the health care in endemic area
• Availability of free or low-cost drugs
• New settlement should be done far from ponds and
river
• Financially support the newly established community
• Exchange of information regarding the treatment
should be done
17. References
• Annual Report, Department of Health Services 2062/63 (2005/06); Government of
Nepal, Ministry of Health and Population, Department of Health
Services, Kathmandu.
• Bern, C., Joshi, A.B., Jha, S.N., Das, M.L., Hightower, A., Thakur, G.D., Bista, M.B., (2
000). Factors associated with Visceral Leishmania in Nepal: Bed-net use is strongly
protective. The American Society of Tropical Medicine and Hygiene, 63 (3-4), 184-
188
• Chappuis, F., Sundar, S., Hailu, A., Ghalib, H., Rijal, S., Peeling, R.
W., Alvar, J., Boelaert, M. (2007). Visceral leishmaniasis: what are the needs for
diagnosis, treatment and control? Nature Reviews Microbiology, S7-S16.
• WHO (2007). Report of the Fifth Consultative Meeting on Leishmaniasis/HIV co-
infection. Addis Ababa, Ethiopia, 2007. World Health Organization.
• Rabello, A., Orsini, M., Disch, J. (2003). Leishmania/HIV coinfection in Brazil: an
appraisal. Annals of Tropical Medicine & Parasitology, 97(1), S17-S28.
• WHO/CDS (2005). Communicable Disease Toolkit, Sudan. World Health
Organization/ Communicable disease Working Group on Emergencies/WHO
Regional Office for the Eastern Mediterranean/WHO County Office, Khartoum.
18. Acknowledgement
• Special thanks to Dr. Michael Edelbrock
• Dr. William Bill Carter
• University of Findlay
• Department of Environmental Safety and
Health Management
• Parents and sisters.
The disease is found in the places close to Bihar India.
CheckPopulation for each countries
references
VL = Visceral Leishmaniasis
Health care service are far and takes 1-2 days to reach.
Socioeconomic condition. Females are neglected. Discuss females being neglected as they r not the source of income. So support financially means provide them with the job.
