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Monitoring & Evaluation studies for end-line evaluation of KalaCORE

As we are approaching the end of the programme, KalaCORE’s Monitoring & evaluation taskforce (based at the London School of Hygiene and Tropical Medicine) have been conducting end-line evaluation studies. Together with base-line studies which were conducted earlier in the programme, end-line studies will help understand the impact and effectiveness of control and elimination activities during KalaCORE in each of the 6 VL-endemic countries of focus.

We anticipate a range of important insights from these studies.

The team are bringing qualitative and quantitative data together from the studies presented in the Table below. More information for the types of studies is also listed below.

Table: KalaCORE M&E end-line studies per country.

Table of studies currently conducted by KalaCORE Monitoring & Evaluation Taskforce

Types of studies

Endline patient survey: To evaluate the treatment seeking practices, diagnosis and treatments received, and household economic burden of VL in endemic areas of Ethiopia, Sudan and India pre and post implementation of KalaCORE interventions.

Theory of Change (ToC): To evaluate the contribution of the KalaCORE programme to reducing the health and economic impact of VL in Bangladesh, Nepal, India, Ethiopia, South Sudan and Sudan using a Theory of Change (ToC) approach.

  • Desk review: constructing individual country ToC and populating them with data from secondary analyses to identify successes and bottlenecks;
  • Stakeholders interview: investigating the drivers of success, bottlenecks, and the influence of contextual factors using in-depth interviews

Extension studies: to explore further the VL post-treatment economic burden from a household perspective, and to gain a better understanding of the health seeking behaviour and drivers of accrual of costs.

  • Pathway to treatment: To gain deeper understanding of VL patients and health providers knowledge and health seeking behaviour choices
  • Long term VL patient follow-up: To assess the physical and economic burden of VL approximately six months after treatment and to explore the availability and potential impact of a government compensation on alleviating catastrophic economic costs for patients.
12 Dec 2018
Publication
Case management, Improving surveillance
India, Nepal, Bangladesh, Sudan, South Sudan, Ethiopia

Age trends in asymptomatic and symptomatic Leishmania donovani infection in the Indian subcontinent: A review and analysis of data from diagnostic and epidemiological studies

Author summary

"As the elimination target for visceral leishmaniasis (VL) in the Indian subcontinent (<1 case/10,000 people/year) is approached, there is a growing need for surveillance tools with which to monitor transmission to ensure the target is sustained, especially given the large proportion of infections which are asymptomatic (~75–95%). One potential approach to estimate underlying transmission patterns may be to track age patterns in infection or cumulative exposure using diagnostic tests. However, current understanding of age patterns in asymptomatic infection and clinical VL is poor, in particular regarding possible age-dependence of infection rates. Our systematic review and pooled-analysis of age-stratified data on infection prevalence and disease incidence suggests that available diagnostics, as currently implemented, fail to meet the requirements for a reliable tool for assessing transmission, due to inconsistent standardisation and highly variable age-prevalence patterns across different settings. It also finds weak evidence for infection rates increasing with age, though further longitudinal studies are needed to test this hypothesis and to assess whether properly standardised diagnostic tests could be used to monitor ongoing transmission."

10 Dec 2018
Academic paper
Improving surveillance
India
125.66 KB
pdf

KalaCORE Good Publication Guide

To ensure research and policy-shaping KalaCORE outputs reach wide and target audiences, we have put together a short Good Publication Guide. The Guide is aimed at members and partners of KalaCORE and it enlists recommendations to bear into consideration when publishing KalaCORE outputs.

 

30 Nov 2018
Training material
Bangladesh, Ethiopia, India, Sudan, Nepal, South Sudan

Intervention Packages for Early Visceral Leishmaniasis Case Detection and Sandfly Control in Bangladesh: A Comparative Analysis

This study accessed different intervention strategies to be used during the consolidation and maintenance phases of the VL elimination program of the Indian subcontinent.
 
It "compared the efficacy of three intervention packages for active case detection (ACD) of visceral leishmaniasis (VL)/post–kala-azar dermal leishmaniasis (PKDL) combined with sandfly control around an index case". The authors recommend an "index case–based FC for ACD combined with DWL or IRS plus larvicide for sandfly control".
29 Nov 2018
Academic paper
Improving surveillance, Operational research
Bangladesh

Second run of open-access on-line course "The Control and Elimination of Visceral Leishmaniasis (kala-azar)"

Start date: Monday, 7th of January 2019
Developed by the London School of Hygiene and Tropical Medicine with invaluable guidance, expertise and training material from KalaCORE partners and the support of UK aid by the UK government, we invite you to join the second run of our open-access on-line course on the Control and Elimination of Visceral Leishmaniasis.

The course serves as a unique platform to learn about the practical tools, and the requirements and the complexities of VL control and elimination programmes. Topics covered include:
•           An introduction to the basic biology and epidemiology of VL
•           Clinical management, diagnosis and treatment
•           Sand fly biology, behaviour and VL vector control tools
•           Other key tools to strengthen VL control and elimination programmes including surveillance, monitoring and evaluation, outbreak management, health systems and community health education.

The course is available on the online educational platform, FutureLearn and it is suitable for anyone who is directly involved with, or interested in, the disease. We recommend that you take advantage of a unique opportunity by the “Study UK campaign” and gain free “Upgrade” access to our course on FutureLearn, https://www.futurelearn.com/study-uk (Deadline: 16 January 2019).

Registration: http://bit.ly/controlVL
Follow on social media: #FLcontrolVL

Positive rk39 test - positive for VL

15 Nov 2018
Training material
Training health workers
India, Nepal, Bangladesh, South Sudan, Sudan, Ethiopia

Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study

Author summary

"Ethiopia bears a high burden of visceral leishmaniasis (VL)—a neglected tropical  disease transmitted through the bite of a sand fly that  disproportionately affects vulnerable populations. Without treatment, VL  progresses, causing increasingly severe symptoms and ultimately death  within two years, in most cases. Early access to VL diagnosis and care  improves clinical prognosis and reduces transmission from infected  humans; however, significant obstacles exist. To our knowledge, our  study is the first in Ethiopia to use qualitative methods to assess  barriers to VL diagnosis and care among seasonal mobile workers.  Strikingly, we found that contrary to what health policy for VL dictates  in this endemic setting, study participants reported very poor access  to diagnosis and, consequently, significantly delayed access to  treatment. Our findings have important public health and policy  implications. Specifically, our results offer strategies that may  increase access to VL diagnosis and care, allowing for earlier treatment  and better prognoses for VL patients, and reducing the potential health  disparities and the overall burden of VL."

Coulborn RM, Gebrehiwot TG, Schneider M, Gerstl S, Adera C, et al. (2018) Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study. PLOS Neglected Tropical Diseases 12(11): e0006778. https://doi.org/10.1371/journal.pntd.0006778
12 Nov 2018
Publication
Case management, Operational research
Ethiopia

Kala-azar Outbreak Management Guidelines, Bangladesh, 2016.

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in August of 2016.

5 Nov 2018
Policy paper
Improving surveillance
Bangladesh

National Guideline For Kala-azar Case Management, Bangladesh, 2016

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in 2016. Third edition.

5 Nov 2018
Policy paper
Case management
Bangladesh

Monitoring and Evaluation Guideline, National Kala-azar Control Program, Bangladesh, 2018

Published by the National Kala-azar Elimination Program (NKEP), Communicable Disease Control (CDC), Disease control Unit, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of the People’s Republic of Bangladesh in 2018.

5 Nov 2018
Policy paper
Improving surveillance, Health education, Training health workers, Case management
Bangladesh

Quantifying the infectiousness of post-kala-azar dermal leishmaniasis towards sandflies

A xenodiagnosis study on PKDL and VL patients using laboratory-reared Phlebotomus argentipes was conducted to determine whether PKDL patients can act as an infection reservoir. The study concludes that nodular and macular PKDL, and VL, can be infectious to sand flies. The authors therefore advise that "active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs".

29 Oct 2018
Academic paper
Case management, Improving surveillance
Bangladesh

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