Visceral leishmaniasis diagnosis and reporting delays as an obstacle to timely response actions in Nepal and India

BMC Infectious Diseases

Research Article

Suman Rijal¹  Megha R Banjara²  Jan P Boettcher³  Ana Milojkovic⁴  Chitra K Gurung⁵  Pradeep Das⁶  Niyamat A Siddiqui⁶  Axel Kroeger⁷  Yubaraj Siwakoti⁸ 

[1] BP Koirala Institute of Health Sciences, Dharan, Nepal;Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal;Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany;Clinical and Molecular Oncology, Max Delbrück Centrum für Molekulare Medizin, Berlin-Buch, Germany;Public Health and Infectious Disease Research Center, New Baneshwor, Kathmandu, Nepal;Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India;Special Programme for Research and Training in Tropical Diseases WHO-TDR, Geneva, Switzerland;Freiburg University Medical Centre, Zentrum für Medizin und Gesundheit, Freiburg, Germany;Valley College of Technical Sciences, Purbanchal University, 44600, Maharajgunj, Kathmandu, Nepal;

关键词: Visceral leishmaniasis;    Kala Azar;    Diagnosis;    Treatment;    Reporting;    India;    Nepal;    Bihar;   

DOI  :  10.1186/s12879-015-0767-5

 received in 2014-10-13, accepted in 2015-01-15,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundTo eliminate visceral leishmaniasis (VL) in India and Nepal, challenges of VL diagnosis, treatment and reporting need to be identified. Recent data indicate that VL is underreported and patients face delays when seeking treatment. Moreover, VL surveillance data might not reach health authorities on time. This study quantifies delays for VL diagnosis and treatment, and analyses the duration of VL reporting from district to central health authorities in India and Nepal.MethodsA cross-sectional study conducted in 12 districts of Terai region, Nepal, and 9 districts of Bihar State, India, in 2012. Patients were interviewed in hospitals or at home using a structured questionnaire, health managers were interviewed at their work place using a semi-structured questionnaire and in-depth interviews were conducted with central level health managers. Reporting formats were evaluated. Data was analyzed using two-tailed Mann-Whitney U or Fisher’s exact test.Results92 VL patients having experienced 103 VL episodes and 49 district health managers were interviewed. Patients waited in Nepal 30 days (CI 18-42) before seeking health care, 3.75 times longer than in Bihar (8d; CI 4-12). Conversely, the lag time from seeking health care to receiving a VL diagnosis was 3.6x longer in Bihar (90d; CI 68-113) compared to Nepal (25d; CI 13-38). The time span between diagnosis and treatment was short in both countries. VL reporting time was in Nepal 19 days for sentinel sites and 76 days for “District Public Health Offices (DPHOs)”. In Bihar it was 28 days for “District Malaria Offices”. In Nepal, 73% of health managers entered data into computers compared to 16% in Bihar. In both countries reporting was mainly paper based and standardized formats were rarely used.ConclusionsTo decrease the delay between onset of symptoms and getting a proper diagnosis and treatment the approaches in the two countries vary: In Nepal health education for seeking early treatment are needed while in Bihar the use of private and non-formal practitioners has to be discouraged. Reinforcement of VL sentinel reporting in Bihar, reorganization of DPHOs in Nepal, introduction of standardized reporting formats and electronic reporting should be conducted in both countries.

【 授权许可】

CC BY   
© Boettcher et al.; licensee BioMed Central. 2015