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Variations in VL burden, mortality and the pathway to care within Bihar, India
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Jervis, Sarah, Chapman, Lloyd A. C., Dwivedi, S., Karthick, M., Das, A., Le Rutte, E. A., Courtenay, Orin, Medley, Graham, Banerjee, I., Mahapatra, T., Chaudhuri, I., Srikantiah, S. and Hollingsworth, T. Déirdre (2017) Variations in VL burden, mortality and the pathway to care within Bihar, India. Parasites & Vectors . ISSN 1756-3305.
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Official URL: https://parasitesandvectors.biomedcentral.com/
Abstract
Background
Visceral leishmaniasis (VL) has been targeted by the WHO for elimination as a public health problem (<1 case/10,000 people/year) in the Indian sub-continent (ISC) by 2020. Bihar State in India, which accounts for the majority of cases in the ISC, remains a major target for this elimination effort. However, there is considerable spatial, temporal and sub-population variation in occurrence of the disease and the pathway to care, which is largely unexplored and a threat to achieving the target.
Methods
Data from 6,081 suspected VL patients who reported being clinically diagnosed during 2012-2013 across eight districts in Bihar were analysed. Graphical comparisons and Chi-squared tests were used to determine differences in the burden of identified cases by season, district, age and sex. Log-linear regression models were fitted to onset (of symptoms)-to-diagnosis and onset-to-treatment waiting times to estimate their associations with age, sex, district and various socio-economic factors (SEFs). Logistic regression models were used to identify factors associated with mortality.
Results
Comparisons of VL caseloads suggested an annual cycle peaking in January-March. A 17-fold variation in the burden of identified cases across districts and under-representation of young children (0-5 years) relative to age-specific populations in Bihar were observed. Women accounted for a significantly lower proportion of the reported cases than men (41% vs. 59%, p-value <0.0001). Age, district of residence, house wall materials, caste, treatment cost, travelling for diagnosis and the number of treatments for symptoms prior to diagnosis were identified as correlates of waiting times. Mortality was associated with age, district of residence, onset-to-treatment waiting time, treatment duration, cattle ownership and cost of diagnosis.
Conclusions
The distribution of VL in Bihar is highly heterogeneous, and reported caseloads and associated mortality vary significantly across different districts, posing different challenges to the elimination campaign. Socio-economic factors are important correlates of these differences, suggesting that elimination will require tailoring to population and subpopulation circumstances.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) Faculty of Science, Engineering and Medicine > Science > Mathematics |
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| Library of Congress Subject Headings (LCSH): | Kala-azar -- Infection -- Prevention -- Bihar (India), Kala-azar -- Epidemiology | |||||||||
| Journal or Publication Title: | Parasites & Vectors | |||||||||
| Publisher: | BioMed Central Ltd. | |||||||||
| ISSN: | 1756-3305 | |||||||||
| Official Date: | 25 October 2017 | |||||||||
| Dates: |
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| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 10 November 2017 | |||||||||
| Date of first compliant Open Access: | 10 November 2017 | |||||||||
| RIOXX Funder/Project Grant: |
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