Effectiveness and Feasibility of Active and Passive Case Detection in the Visceral Leishmaniasis Elimination Initiative in India, Bangladesh, and Nepal

Siddhivinayak Hirve KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Shri Prakash Singh KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Narendra Kumar KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Megha Raj Banjara KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Pradeep Das KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Shyam Sundar KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Suman Rijal KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Anand Joshi KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Axel Kroeger KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Beena Varghese KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Chandreshwar Prasad Thakur KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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M. Mamun Huda KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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Dinesh Mondal KEM Hospital Research Center, Rasta Peth, Pune 411011 India; Institute of Medical Sciences, Benares Hindu University, Varanasi, India; Rajendra Memorial Research Institute of Medical Sciences, Patna, India; Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; BP Koirala Institute of Health Sciences, Dharan, Nepal; World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland; School of Tropical Medicine, Liverpool, United Kingdom; Public Health Foundation of India, New Delhi, India; Balaji Utthan Sanstha, Patna, India; International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh

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This study analyzed the effectiveness of active case detection (ACD) for new visceral leishmaniasis (VL) cases. ACD detection was carried out using house to house screening in Bangladesh and India and by neighborhood screening around index cases in Nepal. The percent increase of new VL cases through ACD compared to PCD was 6.7–17.1% in India; 38.8% in Nepal; and 60% in Bangladesh. The screening effort was high in India and Bangladesh (house to house screening) compared to Nepal (index case screening). The additional cost per new VL case detected varied: $50 to $106 in India; $172 in Bangladesh; $262 in Nepal depending on the type of screening staff, transport and training costs. The estimated annual VL incidence in the ACD arm ranged from 315–383 in India; 109 in Bangladesh, and 43 per 100,000 in Nepal. The additional effort and cost rises as disease incidence declines or PCD improves.

Author Notes

*Address correspondence to Siddhivinayak Hirve, KEM Hospital Research Center, Rasta Peth, Pune 411011, Maharshtra, India. E-mail: sidbela@vsnl.com

Authors' addresses: Siddhivinayak Hirve, Vadu Rural Health Program, KEM Hospital Research Center, Rasta Peth, Pune 411011 India, E-mail: sidbela@vsnl.com. Shri Prakash Singh, Department of Community Medicine, Institute of Medical Sciences, Benares Hindu University, Varanasi, India, E-mail: drspsingh_vns@yahoo.com. Narendra Kumar, Rajendra Memorial Research Institute of Medical Sciences, Patna, India, E-mail: narendra54in@yahoo.co.in. Megha Raj Banjara, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal, E-mail: megharajbanjara@yahoo.com. Pradeep Das, Rajendra Memorial Research Institute of Medical Sciences, Patna, India, E-mail: drpradeep.das@gmail.com. Shyam Sundar, Department of Medicine, Institute of Medical Sciences, Benares Hindu University, Varanasi, India, E-mail: drshyamsundar@hotmail.com. Suman Rijal, Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal, E-mail: sumanrijal2@yahoo.com. Anand Joshi, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal, E-mail: abjoshi2018@yahoo.com. Axel Kroeger, World Health Organization, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland, and School of Tropical Medicine, Liverpool, UK, E-mail: kroegera@who.int. Beena Varghese, Public Health Foundation of India, New Delhi, India, E-mail: dr_b_varghese@yahoo.co.in. Chandreshwar Prasad Thakur, Balaji Utthan Sanstha, Patna, India, E-mail: cpthakur1@rediffmail.com. M. Mamun Huda, Parasitology, Laboratory Sciences Division, International Center for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh, E-mail: mhuda83@icddrb.org. Dinesh Mondal, International Center for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh, E-mail: din63d@icddrb.org.

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