Kala Azar Project Proposal

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Kala Azar Project Proposal

• AID Milwaukee, AID Austin
• 04/24/04

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• Kala Azar
• vector borne, serious tropical disease number
  one killer in some areas.
• if untreated, has mortality rate of 100.
• transmitted by sand flies, which breed in damp
  and warm places (crevices of mud wall, rubble
  heaps, soak pits and soft soil).
• endemic in North Bihar districts and adjacent
  areas of U.P, West Bengal and Orissa.
• 36 districts in Bihar, 10 districts in West
  Bengal affected.

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Kala Azar contd

• these figures do not take into account those
  cases treated by private practitioners, and
  quacks.
• poor economic status, ignorance, illiteracy,
  superstition and poor living and sanitary
  conditions non-existent govt. health system are
  main causes for prevalence of KA.

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• About the NG0
• Center for Health and Resource Management
  (CHARM)
• non profit, voluntary organization started by Dr
  Shakeel ur Rahman in 1991.
• two full time volunteers, four part-time
  volunteers and six consultants.
• About the polyclinic
• established in Patna in 1983 by Dr. Shakeel and
  Dr. Gaur.
• provides free immunization, and curative
  services like running OP clinics, lab, etc. and
  organizes health camps.
• minimal fee of Rs 40 - includes free
  consultation for 60 days lab investigation,
  x-ray, ECG at subsidized rate.

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Previous projects implemented by CHARM

• health needs assessment of women, dalits and
  tribals
• community health workers training
• sensitization workshop of grassroot workers on
  HIV/AIDS/STD
• traditional birth attendant training.
• capacity building of village doctors
• Other NGOs operating in the area
• BGVS, Swaim Sebi Sanstha Sangh, Nadi Wapsi
  Abhiyan are supposed to help CHARM in
  implementing this project.

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• Overall project goal
• Decrease mortality rate in the target population
  and improve their health status.
• Improve the economic conditions of these
  families.
• Kala Azar Control Strategy
• Undertaking indoor residual DDT spray twice
  (over a course of one year)
• Treatment of 75 patients with amphotericin B.
• Health education for community awareness.

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• Project Area
• Darbhanga district in Bihar.
• In six blocks of Darbhanga district, 449 people
  affected and 316 dead.
• Prone to flooding and water-logging for 4-9
  months each year.
• Unscientific construction of embankments leading
  to increased breeding of sand flies.
• High humidity and crevices in mud walls are
  perfect breeding ground for the sand fly.

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• Target Population
• Musahars (rat eaters), who are at the lowest
  rung of society.
• Landless agricultural laborers.
• Mostly illiterate below poverty line (monthly
  income less than 20 for a family of 5).
• General health status very poor diarrhoea, TB,
  typhoid,
• malaria very common.

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• Site visits
• Kamayani (AID Milwaukee)
• very impressed by CHARM fully supports the
  project. Has made a very persuasive case for
  taking up the project.
• Dinesh Prasadji (HBP co-ordinator in Bihar, BGVS
  state head)
• 16-17 March, 2004.
• met with affected people, organisations, Govt.
  doctors and Dr. Shakeel.
• recommends AID taking up the project.

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Initial Budget Breakdown
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Current Budget Breakdown
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• Current project status
• AID Milwaukee has approved 3,000 but sent a
  cheque for 4,680.
• 400 contribution by Dr. Anil Agarwal (4680
  4005080)
• AID Austin has been asked for 1,680 towards the
  project.

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• DDT
• pesticide that has been widely used to contain
  malaria.
• two modes of application spraying on fields,
  indoor spraying.
• has adverse affects on the environment, leads to
  bio-magnification, and accumulation in the food
  chain.
• effects on human health breast cancer?,
  lactation? Clear data yet to emerge.

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• Our concerns and suggestions
• given the exigency of the current situation, we
  feel that DDT might be the more practical
  solution, but
• explore the possible alternatives to DDT, and
  their implementation by CHARM.
• explore other alternative curative medicines
  that could be cheaper than the proposed drug,
  Amphotericin B (miltefosine?)
• focus more on raising awareness and preventive
  measures for controlling KA.

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• Major questions raised by AID Milwaukee
• Basis for choosing 100 patients?
• Is treating only 100 patients an effective
  strategy for the problem?
• Why only Kala Azar?
• What was the last round of DDT spraying done by
  the Govt.?