Visceral Leishmaniasis Elimination Program in Bangladesh and Achieving Millennium Development Goal.

ABSTRACT

Aims: The aim of this review is to present the status of Visceral Leishmaniasis (VL) in Bangladesh and various steps taken to achieve the Millennium Development Goal (MDG). Additionally, the review covers the related challenges and opportunities to achieve this goal. Main Body Currently, 45 out of 64 districts of the country are endemic for VL and 20 million people, around 18% of the total population, are considered to be at risk for VL. However, there is a concern about the total number of VL reported cases. It has been mentioned that the number of cases reported in surveillance data is likely to be at least five times underestimated. The current burden of VL disease is 23.4 times higher compare to the MDG of 1 case per 10,000 populations by 2015. In order to achieve the MDG various national strategies have been taken so far to eliminate VL from Bangladesh. Government of Bangladesh constituted a national steering committee and formed a technical working group to provide support to VL elimination program. Lack of trained and efficient labour force, along with lack of knowledge among the people are big challenges for VL elimination in Bangladesh. In addition, drug unavailability, unfriendly behaviour of health worker and existence of unofficial payment to the heath provider in public hospital work as barriers to achieve MDG. A major challenge towards VL elimination is the rising incidence of Post kalaazar dermal Leishmaniasis. Recent introduction of oral therapy with miltefosine and rapid diagnostic with rk39 as cost effective case management have the potentiality to work against all the barriers. Conclusion: From the public health view and guided by research evidence it seems the elimination of VL from Bangladesh is technically feasible and operationally possible. Ensuring sufficient health worker with adequate training remains the major challenges. Strengthening referral services, adapting active case detection strategies, and creating public awareness are also important for achieving MDG.