Abstract Post-kala-azar dermal leishmaniasis is a skin disorder occurring in 5-10% of visceral leishmaniasis patients after treatment with miltefosine,the first-line drug for this skin disorder. We reported a case of acute anterior uveitis,a rare adverse effect, experienced by a patient treated with miltefosine for post-kala-azar dermal leishmaniasis. This adverse effect developed after 15 days of miltefosine consumption, and the patient himself discontinued the treatment. The ophthalmic complication was completely resolved with antibiotics and steroid eye drops. After recovery from the ophthalmic complication, the patient was successfully treated with liposomal amphotericin B for the skin lesions.

The breeding habitat of sandflies is a little studied and poorly understood phenomenon. More importantly, oviposition behaviour is a largely neglected aspect of sandfly biology and this knowledge gap further undermines our understanding of the biology of sandflies. Pheromones released by the eggs play an important role in identifying good sites for oviposition by female insects. Several recent studies have examined the oviposition pheromone. The present study provides a preliminary report on the oviposition behaviour of Phlebotomus argentipes, the only vector of kala-azar (or visceral leishmaniasis) on the Indian sub-continent. Sandflies prefer to oviposit their eggs on surfaces that contain organic substances, especially substances with an odour of decaying animal products and the remains of conspecific eggs. The results presented here suggest that the odour released by the organic substances of old sandfly colony remains that contain dead flies, old unhatched eggs, larval food containing vertebrate faeces, frass and other organic matter serves as an attractant for the ovipositing females of P. argentipes and hence greatly increases the number of oviposited eggs compared to eggs deposited in controlled oviposition pots. This result will be helpful in maintaining an efficient colony of P. argentipes and may be a promising tool for monitoring and controlling the target insect as part of a synergistic approach.

Visceral leishmaniasis, or kala-azar, is recognised as a serious emerging public health problem in India. In this study, environmental parameters, such as land surface temperature (LST) and renormalised difference vegetation indices (RDVI), were used to delineate the association between environmental variables and Phlebotomus argentipes abundance in a representative endemic region of Bihar, India. The adult P. argentipes were collected between September 2009-February 2010 using the hand-held aspirator technique. The distribution of P. argentipes was analysed with the LST and RDVI of the peak and lean seasons. The association between environmental covariates and P. argentipes density was analysed a multivariate linear regression model. The sandfly density at its maximum in September, whereas the minimum density was recorded in January. The regression model indicated that the season, minimum LST, mean LST and mean RDVI were the best environmental covariates for the P. argentipes distribution. The final model indicated that nearly 74% of the variance of sandfly density could be explained by these environmental covariates. This approach might be useful for mapping and predicting the distribution of P. argentipes, which may help the health agencies that are involved in the kala-azar control programme focus on high-risk areas.

Remote sensing and geographical information technologies were used to discriminate areas of high and low risk for contracting kala-azar or visceral leishmaniasis. Satellite data were digitally processed to generate maps of land cover and spectral indices, such as the normalised difference vegetation index and wetness index. To map estimated vector abundance and indoor climate data, local polynomial interpolations were used based on the weightage values. Attribute layers were prepared based on illiteracy and the unemployed proportion of the population and associated with village boundaries. Pearson's correlation coefficient was used to estimate the relationship between environmental variables and disease incidence across the study area. The cell values for each input raster in the analysis were assigned values from the evaluation scale. Simple weighting/ratings based on the degree of favourable conditions for kala-azar transmission were used for all the variables, leading to geo-environmental risk model. Variables such as, land use/land cover, vegetation conditions, surface dampness, the indoor climate, illiteracy rates and the size of the unemployed population were considered for inclusion in the geo-environmental kala-azar risk model. The risk model was stratified into areas of "risk"and "non-risk"for the disease, based on calculation of risk indices. The described approach constitutes a promising tool for microlevel kala-azar surveillance and aids in directing control efforts.

In visceral leishmaniasis, phlebotomine vectors are targets for control measures. Understanding the ecosystem of the vectors is a prerequisite for creating these control measures. This study endeavours to delineate the suitable locations of Phlebotomus argentipes with relation to environmental characteristics between endemic and non-endemic districts in India. A cross-sectional survey was conducted on 25 villages in each district. Environmental data were obtained through remote sensing images and vector density was measured using a CDC light trap. Simple linear regression analysis was used to measure the association between climatic parameters and vector density. Using factor analysis, the relationship between land cover classes and P. argentipes density among the villages in both districts was investigated. The results of the regression analysis indicated that indoor temperature and relative humidity are the best predictors for P. argentipes distribution. Factor analysis confirmed breeding preferences for P. argentipes by landscape element. Minimum Normalised Difference Vegetation Index, marshy land and orchard/settlement produced high loading in an endemic region, whereas water bodies and dense forest were preferred in non-endemic sites. Soil properties between the two districts were studied and indicated that soil pH and moisture content is higher in endemic sites compared to non-endemic sites. The present study should be utilised to make critical decisions for vector surveillance and controlling Kala-azar disease vectors.

PROBLEM: Irrigated agriculture exposes rural people to health risks associated with vector-borne diseases and pesticides used in agriculture and for public health protection. Most developing countries lack collaboration between the agricultural and health sectors to jointly address these problems. APPROACH: We present an evaluation of a project that uses the "farmer field school" method to teach farmers how to manage vector-borne diseases and how to improve rice yields. Teaching farmers about these two concepts together is known as "integrated pest and vector management". LOCAL SETTING: An intersectoral project targeting rice irrigation systems in Sri Lanka. RELEVANT CHANGES: Project partners developed a new curriculum for the field school that included a component on vector-borne diseases. Rice farmers in intervention villages who graduated from the field school took vector-control actions as well as improving environmental sanitation and their personal protection measures against disease transmission. They also reduced their use of agricultural pesticides, especially insecticides. LESSONS LEARNED: The intervention motivated and enabled rural people to take part in vector-management activities and to reduce several environmental health risks. There is scope for expanding the curriculum to include information on the harmful effects of pesticides on human health and to address other public health concerns. Benefits of this approach for community-based health programmes have not yet been optimally assessed. Also, the institutional basis of the integrated management approach needs to be broadened so that people from a wider range of organizations take part. A monitoring and evaluation system needs to be established to measure the performance of integrated management initiatives.

PROBLEMA: La agricultura de regadío expone a la población rural a riesgos sanitarios asociados a las enfermedades de transmisión vectorial y a los plaguicidas utilizados en la agricultura y para proteger la salud pública. En la mayoría de los países en desarrollo se da una falta de colaboración entre los sectores agrícola y sanitario para abordar conjuntamente estos problemas. MÉTODOS: Presentamos una evaluación de un proyecto que utiliza el método de la «escuela de campo para agricultores» para enseñar a los campesinos la manera de controlar las enfermedades de transmisión vectorial y mejorar la producción de arroz. El adiestramiento simultáneo de los agricultores en esos dos ámbitos es lo que se conoce como «control integrado de plagas y vectores». CONTEXTO LOCAL: Un proyecto intersectorial centrado en los sistemas de riego de plantaciones de arroz en Sri Lanka. CAMBIOS DESTACABLES: Los asociados del proyecto desarrollaron un nuevo programa de estudios para la escuela de campo que incluía un componente de control de las enfermedades de transmisión vectorial. Los cultivadores de arroz de las aldeas de intervención salidos de la escuela de campo tomaron medidas de lucha antivectorial y de mejora tanto del saneamiento ambiental como de su protección personal contra la transmisión de enfermedades. Además redujeron su utilización de plaguicidas agrícolas, especialmente de insecticidas. ENSEÑANZAS EXTRAÍDAS: La intervención motivó a la población rural y le permitió participar en las actividades de control de los vectores y reducir varios riesgos para la salud ambiental. Es posible ampliar el programa de estudios para incluir información sobre los efectos perjudiciales de los plaguicidas en la salud humana y abordar otros aspectos preocupantes para la salud pública. Los beneficios de este enfoque para los programas de salud comunitarios todavía no se han evaluado de manera óptima. Además, es necesario ampliar la base institucional del control integrado para que puedan participar personas de una más amplia variedad de organizaciones, y hay que establecer un sistema de seguimiento y evaluación para medir el desempeño de las iniciativas de control integrado.

PROBLEMATIQUE: L’agriculture irriguée expose la population rurale aux risques sanitaires liés aux maladies à transmission vectorielle et aux pesticides utilisés en agriculture et en santé publique pour protéger les populations. Dans la plupart des pays en développement, la collaboration entre les secteurs agricole et sanitaire est insuffisante pour faire face à ces problèmes. DEMARCHE: Nous présentons l’évaluation d’un projet utilisant des stages pratiques pour agriculteurs en vue d’enseigner aux exploitants agricoles comment gérer les maladies à transmission vectorielle et améliorer les rendements en riz. L’enseignement apporté aux agriculteurs sur ces deux pratiques est appelé « lutte intégrée contre les parasites et les vecteurs ». CONTEXTE LOCAL: Un projet intersectoriel concernant les systèmes d’irrigation des rizières au Sri Lanka. MODIFICATIONS PERTINENTES: Les partenaires au projet ont mis au point un nouveau programme d’enseignement pour la formation pratique des agriculteurs, qui intègre une composante sur les maladies à transmission vectorielle. Des cultivateurs de riz habitant des villages concernés par l’intervention et ayant suivi avec succès cette formation ont pris des actions pour lutter contre les vecteurs, ainsi que des mesures d’assainissement et de protection individuelle pour empêcher la transmission des maladies. Ils ont aussi réduit leur consommation de pesticides agricoles, en particulier d’insecticides. ENSEIGNEMENTS TIRÉS: L’intervention a incité des ruraux à prendre part aux activités de gestion vectorielle et à réduire plusieurs risques menaçant l’hygiène de l’environnement. Elle leur a également apporté les moyens de le faire. Il est possible d’élargir le programme d’enseignement pour y introduire des informations sur les effets préjudiciables des pesticides sur la santé humaine et pour répondre aux préoccupations de santé publique. Les bénéfices de cette approche pour les programmes sanitaires communautaires n’ont pas été évalués au mieux. Il convient aussi d’élargir la base institutionnelle de la démarche de gestion intégrée afin qu’une gamme plus étendue d’organisations puissent y prendre part. Il faut également mettre en place un système de surveillance et d’évaluation pour mesurer les résultats des initiatives relevant de la gestion intégrée.