Visceral leishmaniasis on the Indian sub-continent: a multi-centre study of the costs of three interventions for the control of the sandfly vector, Phlebotomus argentipes.
OBJECTIVES Kala-azar or visceral leishmaniasis is one of the major vector-borne diseases in Bangladesh. The disease is transmitted by sandfly. The incidence of the disease, which has been increasing since the early eighties, must be reduced by taking adequate vector-control measures. The objective of the present study was to identify the favorable factors and the constraints of present vector-control management in Bangladesh. METHODS Purposively selected senior entomologist and retired senior entomologist at central level, civil surgeons, entotechnicians, health inspectors and spray men from kala-azar-endemic districts, community leaders, and NGO representatives were key informants of the study. A household survey to learn about knowledge and perceptions of the people about kala-azar vector was carried out, using a structured questionnaire, in 202 randomly selected households. RESULTS Practically, there was no vector-control activity in the nine most kala-azar-endemic districts of Bangladesh. Inadequate human resources, lack of logistics, and unavailability of funds for vector control were the major constraints. Community perception about kala-azar vector was poor. However, the use of bednets in the community was high. No private organization was involved in kala-azar vector control. Knowledge of the spray men about the insecticide-spraying technique was also unsatisfactory. CONCLUSION Kala-azar vector control in Bangladesh needs immediate attention of policy-makers and donors, otherwise, elimination of kala-azar from the country by 2015 may not be achievable.