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Epidemiologic Correlates of Mortality among Symptomatic Visceral Leishmaniasis Cases: Findings from Situation Assessment in High Endemic Foci in India.

Abstract：

BACKGROUND:Visceral leishmaniasis (VL) is highly prevalent in the Indian state of Bihar and, without proper diagnosis and treatment, is associated with high fatality. However, lack of efficient reporting mechanism had been an impediment in estimating the burden of mortality and its antecedents among symptomatic VL cases. The objectives of the current study were to generate a reliable estimate of symptomatic VL caseload and mortality in Bihar, as well as to identify the epidemiologic and health infrastructure-related predictors of VL mortality. METHODOLOGY AND PRINCIPAL FINDINGS:Using an elaborate index case tracing method, we attempted to locate all symptomatic VL patients in eight districts of Bihar. Interviews and medical-record-reviews were conducted with cases (or next-of-kin for the dead) meeting the eligibility criteria. The information collected during the interviews included socio-demographic characteristics, onset of disease symptoms, place of diagnosis, pre- and post-diagnosis treatment history, type and duration of drugs received. In total, we analyzed data on 4925 VL patients-59% were male and 68% were less than 30 years old. There were 158 (3.2%) deaths and the incidence rate of mortality was 3.2/100 person-years. In the adjusted Cox-proportional-hazards analysis, treatment at public facility [Adjusted Hazard Ratio (AHR) = 0.61; 95% CI = 0.43-0.86], shorter (≤30 days) diagnostic delay [AHR = 0.62, 95% CI = 0.43-0.92], and treatment completion [AHR = 0.03, 95% CI = 0.02-0.05] emerged as significant negative predictors of mortality. CONCLUSION:Mortality reduction efforts in Bihar should focus on improving access to early diagnosis, quality treatment and treatment-adherence measures, with special emphasis on marginalized communities.

journal_name

PLoS Negl Trop Dis

journal_title

PLoS neglected tropical diseases

authors

Das A,Karthick M,Dwivedi S,Banerjee I,Mahapatra T,Srikantiah S,Chaudhuri I

doi

10.1371/journal.pntd.0005150

subject

Has Abstract

pub_date

2016-11-21 00:00:00

pages

e0005150

issue

eissn

1935-2727

issn

1935-2735

pii

PNTD-D-16-01234

journal_volume

pub_type

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Epidemiologic Correlates of Mortality among Symptomatic Visceral Leishmaniasis Cases: Findings from Situation Assessment in High Endemic Foci in India.