Early diagnosis of kala-azar in Bangladesh: Findings from a population based mixed methods research: Findings from a population based mixed methods research informing the post-elimination era

Kazi Mizanur Rahman, Anna Olsen, David Harley, Indira Samarawickrema, Colin Butler, Khandaker Zahid, Shariful Amin Sumon, Dinesh Mondal, Stephen Luby, Adrian C. Sleigh

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background
Global annual reports of visceral leishmaniasis or kala-azar (“black fever”) reduced from 200,000 cases in 2012 to 23,804 in 2015. India, Bangladesh and Nepal reported 80% of the global cases in 2012, but 39% in 2015. We sought to identify major amenable barriers to early diagnosis of kala-azar in peripheral areas of Mymensingh district, an area of Bangladesh that was highly endemic for kala-azar.

Methods
We conducted sequential exploratory mixed methods research. Qualitative data were first derived from in-depth interviews and focus group discussions among 29 patients diagnosed with kala-azar, their families, and neighbours. Preliminary results from qualitative analysis were used to design a structured questionnaire, which was administered to collect data on the processes leading to the diagnosis of kala-azar from 102 patients. Qualitative and quantitative data were integrated consistent with the chronology for kala-azar patients seeking care. The study was conducted from September 2011 to May 2012 in Fulbaria and Gaffargaon sub-districts of Mymensingh.

Results
The median delay from fever onset to confirmatory diagnosis of kala-azar was 60 days, with 38% of the cases diagnosed within 30 days. Public health facilities and Gaffargaon sub-district achieved high proportions of early diagnosis. Individual barriers to early diagnosis were low awareness of symptoms and treatment facilities, poverty, and traditional beliefs. Other factors were the remoteness of health care centres, wet season transport difficulty, mis-diagnosis as typhoid, limited availability of rK-39 testing at the community level, and the inclusion of splenomegaly in the case definition.

Conclusions
Targeted community awareness campaigns appropriate for underprivileged communities will increase care seeking and consequently diagnosis. Improved diagnostic guidelines and a strong referral chain for kala-azar will accelerate diagnosis. These steps will contribute significantly to the National Kala-azar Elimination Program of Bangladesh, especially during the post-elimination era.
Original languageEnglish
Article number102421
Pages (from-to)1-11
Number of pages11
JournalParasitology International
Volume85
DOIs
Publication statusPublished - Dec 2021

Fingerprint

Dive into the research topics of 'Early diagnosis of kala-azar in Bangladesh: Findings from a population based mixed methods research: Findings from a population based mixed methods research informing the post-elimination era'. Together they form a unique fingerprint.

Cite this