1. Variations in visceral leishmaniasis burden, mortality and the pathway to care within Bihar, India
- Author
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Jervis, S, Chapman, L, Dwivedi, S, Karthick, M, Das, A, Le Rutte, E, Courtenay, O, Medley, G, Banerjee, I, Mahapatra, T, Chaudhuri, I, Srikantiah, S, Hollingsworth, T, and Public Health
- Subjects
Visceral leishmaniasis ,Research ,Age Factors ,Bihar ,India ,Mycology & Parasitology ,Risk Assessment ,Onset-to-diagnosis time ,lcsh:Infectious and parasitic diseases ,Sex Factors ,1117 Public Health And Health Services ,Socioeconomic Factors ,Pathway to care ,RA0421 ,1108 Medical Microbiology ,Statistical analysis ,Case burden ,Tropical Medicine ,Onset-to-treatment time ,Humans ,Leishmaniasis, Visceral ,Topography, Medical ,lcsh:RC109-216 ,Seasons ,Mortality - 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 6081 suspected VL patients who reported being clinically diagnosed during 2012–2013 across eight districts in Bihar were analysed. Graphical comparisons and Chi-square 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
- Published
- 2017