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.
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.
Age trends in asymptomatic and symptomatic Leishmania donovani infection in the Indian subcontinent: A review and analysis of data from diagnostic and epidemiological studies
"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."
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.
Intervention Packages for Early Visceral Leishmaniasis Case Detection and Sandfly Control in Bangladesh: A Comparative Analysis
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).
Follow on social media: #FLcontrolVL
Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
"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."
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.
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.
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.
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".