Performance of kala-azar surveillance in Gaffargaon subdistrict of Mymensingh, Bangladesh

Rahman, Kazi Mizanur, Samarawickrema, Indira V.M., Harley, David, Olsen, Anna, Butler, Colin D., Sumon, Shariful Amin, Biswas, Subrata Kumar, Luby, Stephen P., and Sleigh, Adrian (2015) Performance of kala-azar surveillance in Gaffargaon subdistrict of Mymensingh, Bangladesh. PLoS Neglected Tropical Diseases, 9. e0003531.

PDF (Published Version) - Published Version
Available under License Creative Commons Attribution.

Download (689kB) | Preview
View at Publisher Website:


Introduction: Elimination of kala-azar is planned for South Asia requiring good surveillance along with other strategies. We assessed surveillance in Gaffargaon upazila (a subdistrict of 13 unions) of Mymensingh district, Bangladesh highly endemic for kala-azar.

Methods: In 4703 randomly sampled households, within nine randomly sampled villages, drawn from three randomly sampled unions, we actively searched for kala-azar cases that had occurred between January 2010 and December 2011. We then searched for medical records of these cases in the patient registers of Gaffargaon upazila health complex (UHC). We investigated factors associated with the medical recording by interviewing the cases and their families. We also did a general observation of UHC recording systems and interviewed health staff responsible for the monthly reports of kala-azar cases.

Results: Our active case finding detected 58 cases, but 29 were not recorded in the Gaffargaon UHC. Thus, only 50% (95% CI: 37%–63%) of kala-azar cases were reported via the government passive surveillance system. Interviews with health staff based in the study UHC revealed the heavy reporting burden for multiple diseases, variation in staff experience, high demands on the staff time and considerable complexity in the recording system. After adjusting for kala-azar treatment drug, recording was found more likely for those aged 18 years or more, males, receiving supply and administration of drug at the UHC, and more recent treatment.

Discussion: Fifty percent of kala-azar cases occurring in one highly endemic area of Bangladesh were recorded in registers that were the source for monthly reports to the national surveillance system. Recording was influenced by patient, treatment, staff and system factors. Our findings have policy implications for the national surveillance system. Future studies involving larger samples and including interviews with health authorities at more central level and surveillance experts at the national level will generate more precise and representative evidence on the performance of kala-azar surveillance in Bangladesh.

Item ID: 52750
Item Type: Article (Research - C1)
ISSN: 1935-2735
Funders: International Centre for Diarrhoeal Disease Research, Bangladesh, Australian Government, Government of Bangladesh, Government of Canada, Government of Sweden, UK Government, Australian National University
Date Deposited: 01 Mar 2018 01:25
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111711 Health Information Systems (incl Surveillance) @ 60%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 40%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 60%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 40%
Downloads: Total: 818
Last 12 Months: 13
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page