Browsing by Author "Jimba, M"
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Publication Elimination of visceral leishmaniasis in Nepal: Pipe-dreams and possibilities(Kathmandu University, 2006) Joshi, AB; Banjara, MR; Pokhrel, S; Jimba, M; Singhasivanon, P; Ashford, RWIntroduction: Visceral Leishmaniasis (VL) re-emerged in the Indian subcontinent in the mid-1970s after an almost complete absence in the previous fifteen or so years. The disease was first noted in Nepal in 1978 and, since 1980, it has been reported regularly in increasing numbers. Elimination of visceral leishmaniasis by 2015 has been identified as regional priority program in the level of high political commitment. Objective: The objectives of this study are the comprehensive assessment of information related to VL on the basis of past research studies conducted in Nepal, and an assessment of the prospects of control measures. Materials and methods: This was time line comprehensive VL epidemiological assessment study based on the research conducted by main author during the past ten years. During the period the studies were conducted using cross sectional, case control and exploratory study design. The statistical analysis was done using qualitative and quantitative methods. Results: In our study in the visceral leishmaniasis endemic district, Siraha, in the population of 112,029, a total of 996 clinically suspected cases were reported (with fever of long duration and splenomegaly, with no malaria) during 1998-2002. In all, 283 subjects were found positive for visceral leishmaniasis by rK39 and 284 had positive bone marrow. There was no detectable difference in the density of Phlebotomus argentipes between high, and moderate incidence village development committees (VDC: the smallest administrative unit), but collections in the low incidence areas (in winter) were negative. P. argentipes was never numerous (maximum 4.4 females collected per man-hour), and was much less common than P. papatasi. Peaks of abundance were recorded in the March and September collections. We have found that the numbers of reported cases of visceral leishmaniasis in Nepalese villages was unaffected by indoor residual spray (IRS) indicated by parallel trends in case numbers by time series analysis in treated and untreated villages. A series of maps through ten years clearly showed that the infection can move rapidly between villages, and it is impossible to predict where transmission will occur from year to year. Conclusion: If maximum benefit in relation to cost is the goal, it may be preferable to put all possible efforts into active case detection (ACD) with free treatment. ACD should involve the network of Village Health Workers or Female Community Health Volunteers and the rK39 dipstick test at health centre level. Surveillance of disease and vector, communication for behavioural impacts and insecticide spraying should be important component of elimination program. If IRS is to be a part of the intervention, it is essential that it is carried out effectively, both in areas where the disease has been reported and in neighbouring areas. Integrated vector management need to be monitored for its application and effectiveness for VL elimination.Publication Epidemiological status of taenia/cysticercosis in pigs and human in Nepal(Institute of Medicine, 2001) Joshi, DD; Jimba, M; Neave, Lucy; Poudyal, Purna Maya; Mishra, PN; Mishra, MAbstract Two hundred and fifty slaughtered pigs for meat purpose, in various localities of Kathmandu Metropolitan City and Dharan Municipality were examined for Taenia cysts during January 1997 to April 1998. A surveillance study was also carried out with butchers, meat sellers, farmers and pork consumers to study the awareness of taeniasis cysticercosis. Data was collected from the hospitals to determine the status of taeniasis/cysticercosis infection in humans. Out of 250 slaughtered pigs examined, thirty-four (13.6%) were found positive for cysticercosis. The sex wise prevalence rate of infection was 8.77% in male pigs and 24.05% in female pigs. The result reveals that females are infected more than the males. Out of 196 slaughtered pigs examined in Kathmandu, 28 (14.28%) were found positive, whereas in Dharan, out of 54, 6 (11.11%) were found positive. The result further reveals that the number of infected pigs is higher in Kathmandu than Dharan. It is due to the importation of infected pigs to Kathmandu both from rural areas of Nepal and India. The results show that pork consumption is risky from a public health point of view. In environments where animal cysticercosis is prevalent, human taeniasis/cysticercosis is likely to be present. Prevalence of Taenia solium infection in pigs was therefore observed and recorded for the first time in Dharan Municipality and Kathmandu Metropolitan Municipality in Nepal. Human cysticercosis cases were also studied. Out of 23,402 human biopsy cases recorded from Patan Hospital alone during July 1993 - Feb 1998, sixty-two patients were confirmed to have cysticercosis infection. Out of 62 taeniasis/cysticercosis patients, 40 cases were from Kathmandu and 22 were from outside Kathmandu. Among the 62 infected patients, 38 were females while 24 were males. The result reveals that the infection rate is higher in Kathmandu than outside Kathmandu. Sexwise data again reveal that females are infected more frequently than males. The surveillance study findings reveal that taeniasis and cysticercosis are prevalent in Kathmandu and Dharan due to various factors, viz, uncontrolled slaughtering, lack of a meat inspection program, lack of awareness about meat borne diseases, unhygienic conditions of slaughtering places due to lack of slaughter houses, environmental pollution etc. The incidence of human taeniasis/cysticercosis could be controlled by raising pigs under hygienic condition and improving the environmental quality in the pig slaughtering abattoirs under the supervision of medical and veterinary technicians. An effective veterinary public health activities should immediately be established in all 56 municipalities of the country for meat inspection and construction of slaughter houses. Keywords: taeniasis/cysticercosis, biopsy, scanning