Ten-year-old Jahid had been suffering from fever for three months, during which time he visited his local upazila health complex in Fulchari, Gaibandha district, several times. Following laboratory tests at the health complex he was prescribed antibiotics for enteric fever. Jahid’s parents spent around 12 thousand taka on his treatment, but unfortunately there was no improvement in his symptoms.
In the same upazila, 15-year-old Hobi Miah and 65-year-old Nurul Islam had also been suffering from fever for more than one month. Both of them visited the upazila health complex for treatment, with no improvement in symptoms but considerable financial loss. Hobi Miah and Nurul Islam also consulted traditional and non-graduate village doctors and spiritual healers with the hope of getting better.
As the fevers subsided, all three experienced gradual weight loss, abdominal distention and weakness. They didn’t know which way to turn for help.
Turning point
Things changed for them when some months later, a five-year-old girl from Fulchari upazila was diagnosed with kala-azar (visceral leishmaniasis) in a hospital in Bogra district. This girl experienced the same signs and symptoms as Jahid, Hobi Miah and Nurul Islam. Following diagnosis, the hospital reported the case to the National Kala-azar Elimination Programme (NKEP) of the Directorate General of Health Service (DGHS).
The NKEP decided to conduct a house-to-house search for undetected kala-azar cases and a vector survey for sand fly and larva to assess the kala-azar situation in Fulchari. A survey team was formed comprising a Surveillance Medical Officer from WHO and experts from both central and local levels of the DGHS. The team was oriented on the index case base active case search under the leadership of the Director of Disease Control, DGHS and NKEP, with technical support from WHO Bangladesh.
The search
Following a house-to-house search, a total of 135 households were screened for both kala-azar and post-kala-azar dermal leishmaniasis (PKDL). Approximately 17 individuals were screened as suspected kala-azar cases and among them three, Jahid, Hobi Miah and Nurul Islam, were confirmed as kala-azar cases after clinical examination.
Jahid, Hobi Miah and Nurul Islam were referred to Pirganj upazila health complex in Rangpur for proper clinical evaluation and treatment with single-dose AmBisome. Compared with the earlier treatment option of injection sodium stibogluconate and miltefosine capsules, single dose injection AmBisome is 100% safe and effective for the treatment of kala-azar. WHO has been providing AmBisome free of charge since 2013.
After a month of treatment, Jahid, Hobi Miah and Nurul Islam were found to be quite well and their clinical signs and symptoms showed remarkable improvement. Programme personnel from WHO Bangladesh were directly involved throughout the search and active case detection process in Fulchari upazila, while maintaining effective coordination at central and peripheral levels under NKEP. WHO Bangladesh also provided support to build capacity among different levels health care staff and strengthen surveillance and referral linkage activities.