Comparison of Insecticide-Treated Nets and Indoor Residual Spraying to Control the Vector of Visceral Leishmaniasis in Mymensingh District, Bangladesh

Chowdhury, Rajib Nayan; Dotson, Ellen M.; Blackstock, Anna J.; McClintock, Shannon; Maheswary, Narayan Prosad; Faria, Shyla; Islam, Saiful; Akter, Tahmina; Kroeger, Axel; Akhter, Shireen; Bern, Caryn

doi:10.4269/ajtmh.2011.10-0682

Cited by 28 publications

(55 citation statements)

References 12 publications

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“…Treatment duration can be reduced substantially by considering alternative VL drugs to miltefosine as single-dose liposomal amphotericin B or a short course combination therapy [18]). Vector control, such as indoor residual spraying, has been shown to be effective in reducing the number of sandflies inside the house [19], [20] and may therefore reduce disease transmission. Since 2011, the Government of Nepal has also introduced a conditional cash transfer programme whereby households receive Rs.…”

Section: Discussionmentioning

confidence: 99%

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

et al. 2013

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Background and objectivesVisceral leishmaniasis (VL) is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs.MethodsBetween August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies.ResultsThe median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days). Direct and indirect costs (income losses) represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71%) or taking a loan (56%).ConclusionsThe provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control.

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Section: Discussionmentioning

confidence: 99%

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

et al. 2013

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“…2 Downgraded by 1 for serious risk of bias: Trials are at high or unclear risk of selection bias and reporting bias. 3 Downgraded by 1 for serious inconsistency: Chowdhury 2011 BGD reports a statistically significant difference in total vector numbers over 12 months follow‐up, Emami 2009 IRN reports statistically significant reduction but did not provide data. Joshi 2009 ASIA found no difference in mean number of vectors per household.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“… Joshi 2009 ASIA found no difference in mean number of vectors per household. 4 No serious indirectness: Chowdhury 2011 BGD distributed PermaNet® 2.0 to all households in trial sites in Bangladesh, Emami 2009 IRN distributed Olyset® in Iran, and Joshi 2009 distributed PermaNet® to households in India, Bangladesh and Nepal. 5 The assumed risk of CL over 12 months follow‐up is taken from Reyburn 2000 AFG which contributed 99.5% of weight to this analysis.…”

Section: Summary Of Findingsmentioning

confidence: 99%

Vector and reservoir control for preventing leishmaniasis

González¹,

Pinart

Sinclair

et al. 2015

Cochrane Database of Systematic Reviews

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Background Leishmaniasis is caused by the Leishmania parasite, and transmitted by infected phlebotomine sandflies. Of the two distinct clinical syndromes, cutaneous leishmaniasis (CL) affects the skin and mucous membranes, and visceral leishmaniasis (VL) affects internal organs. Approaches to prevent transmission include vector control by reducing human contact with infected sandflies, and reservoir control, by reducing the number of infected animals. Objectives To assess the effects of vector and reservoir control interventions for cutaneous and for visceral leishmaniasis. Search methods We searched the following databases to 13 January 2015: Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS and WHOLIS, Web of Science, and RePORTER. We also searched trials registers for ongoing trials. Selection criteria Randomized controlled trials (RCTs) evaluating the effects of vector and reservoir control interventions in leishmaniasis‐endemic regions. Data collection and analysis Two review authors independently searched for trials and extracted data from included RCTs. We resolved any disagreements by discussion with a third review author. We assessed the quality of the evidence using the GRADE approach. Main results We included 14 RCTs that evaluated a range of interventions across different settings. The study methods were generally poorly described, and consequently all included trials were judged to be at high or unclear risk of selection and reporting bias. Only seven trials reported clinical outcome data which limits our ability to make broad generalizations to different epidemiological settings and cultures. Cutaneous leishmaniasis One four‐arm RCT from Afghanistan compared indoor residual spraying (IRS), insecticide‐treated bednets (ITNs), and insecticide‐treated bedsheets, with no intervention. Over 15 months follow‐up, all three insecticide‐based interventions had a lower incidence of CL than the control area (IRS: risk ratio (RR) 0.61, 95% confidence interval (CI) 0.38 to 0.97, 2892 participants, moderate quality evidence ; ITNs: RR 0.32, 95% CI 0.18 to 0.56, 2954 participants, low quality evidence; ITS: RR 0.34, 95% CI 0.20 to 0.57, 2784 participants, low quality evidence ). No difference was detected between the three interventions ( low quality evidence ). One additional trial of ITNs from Iran was underpowered to show a difference. Insecticide treated curtains were compared with no intervention in one RCT from Venezuela, where there were no CL episodes in the intervention areas over 12 months follow‐up compared to 142 in control areas (RR 0.00, 95% CI 0.00 to 0.49, one trial, 2938 participants, low quality evidence ...

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“…LLIN is complementary and the most effective alternative to IRS when the transmission intensity is low. The strategy to achieve a rapid and sustained reduction in sandfly density by IRS, followed by widespread distribution and use of LLIN to prevent transmission when the sand fly density rebounds, needs to be tested [109]. A recent study showed that IRS combined with ITN was more effective in reducing sandfly density, had better bioavailability over a 12-month period, and was better accepted by the community [112].…”

Section: Resultsmentioning

confidence: 99%

Towards elimination of visceral leishmaniasis in the Indian subcontinent—Translating research to practice to public health

et al. 2017

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BackgroundThe decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR’s engagement and contribution to this initiative.Methodology/principal findingsMultiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid–recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with in-country researchers, national programme managers, and partners to generate evidence-based interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and environmental management as tools for integrated vector management in reducing sandfly density.Conclusions/significanceTDR’s engagement with country policy makers, scientists, and clinicians in the development of effective diagnosis, treatment, case detection, and vector control represents an important example of TDR’s stewardship toward the elimination of VL in the Indian subcontinent.

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Comparison of Insecticide-Treated Nets and Indoor Residual Spraying to Control the Vector of Visceral Leishmaniasis in Mymensingh District, Bangladesh

Cited by 28 publications

References 12 publications

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

Vector and reservoir control for preventing leishmaniasis

Towards elimination of visceral leishmaniasis in the Indian subcontinent—Translating research to practice to public health

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