Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh
Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced. Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention. Methods...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Journal of Tropical Medicine |
| Online Access: | http://dx.doi.org/10.1155/2012/126093 |
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| author | Megha Raj Banjara Siddhivinayak Hirve Niyamat Ali Siddiqui Narendra Kumar Sangeeta Kansal M. Mamun Huda Pradeep Das Suman Rijal Chitra Kumar Gurung Paritosh Malaviya Byron Arana Axel Kroeger Dinesh Mondal |
| author_facet | Megha Raj Banjara Siddhivinayak Hirve Niyamat Ali Siddiqui Narendra Kumar Sangeeta Kansal M. Mamun Huda Pradeep Das Suman Rijal Chitra Kumar Gurung Paritosh Malaviya Byron Arana Axel Kroeger Dinesh Mondal |
| author_sort | Megha Raj Banjara |
| collection | DOAJ |
| description | Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced. Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention. Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care. Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or spleen palpation was infrequently done in Bangladesh but improved after intervention (from 23% to 47%). Physician awareness of renal or liver toxicity as Miltefosine side effects was lower in Bangladesh. Bio-chemical monitoring was uncommon. Patient satisfaction with services remained low for ease of access or time provider spent with patient. Health facilities were better stocked with rK39 kits and Miltefosine in 2010. |
| format | Article |
| id | doaj-art-79a381ed6af145f8bfca7205722380a4 |
| institution | Kabale University |
| issn | 1687-9686 1687-9694 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Tropical Medicine |
| spelling | doaj-art-79a381ed6af145f8bfca7205722380a42025-02-03T01:06:43ZengWileyJournal of Tropical Medicine1687-96861687-96942012-01-01201210.1155/2012/126093126093Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and BangladeshMegha Raj Banjara0Siddhivinayak Hirve1Niyamat Ali Siddiqui2Narendra Kumar3Sangeeta Kansal4M. Mamun Huda5Pradeep Das6Suman Rijal7Chitra Kumar Gurung8Paritosh Malaviya9Byron Arana10Axel Kroeger11Dinesh Mondal12Institute of Medicine, Tribhuvan University, Kathmandu 44168, NepalKEM Hospital Research Center, Pune, Maharashtra 411011, IndiaRajendra Memorial Research Institute of Medical Sciences, Patna, Bihar 800007, IndiaRajendra Memorial Research Institute of Medical Sciences, Patna, Bihar 800007, IndiaInstitute of Medical Sciences, Banares Hindu University, Varanasi 221105, IndiaInternational Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, BangladeshRajendra Memorial Research Institute of Medical Sciences, Patna, Bihar 800007, IndiaBP Koirala Institute of Health Sciences, Dharan 56700, NepalInstitute of Medicine, Tribhuvan University, Kathmandu 44168, NepalInstitute of Medical Sciences, Banares Hindu University, Varanasi 221105, IndiaSpecial Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, SwitzerlandSpecial Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, SwitzerlandInternational Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, BangladeshBackground. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced. Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention. Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care. Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or spleen palpation was infrequently done in Bangladesh but improved after intervention (from 23% to 47%). Physician awareness of renal or liver toxicity as Miltefosine side effects was lower in Bangladesh. Bio-chemical monitoring was uncommon. Patient satisfaction with services remained low for ease of access or time provider spent with patient. Health facilities were better stocked with rK39 kits and Miltefosine in 2010.http://dx.doi.org/10.1155/2012/126093 |
| spellingShingle | Megha Raj Banjara Siddhivinayak Hirve Niyamat Ali Siddiqui Narendra Kumar Sangeeta Kansal M. Mamun Huda Pradeep Das Suman Rijal Chitra Kumar Gurung Paritosh Malaviya Byron Arana Axel Kroeger Dinesh Mondal Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh Journal of Tropical Medicine |
| title | Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh |
| title_full | Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh |
| title_fullStr | Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh |
| title_full_unstemmed | Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh |
| title_short | Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh |
| title_sort | visceral leishmaniasis clinical management in endemic districts of india nepal and bangladesh |
| url | http://dx.doi.org/10.1155/2012/126093 |
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