Elimination of visceral leishmaniasis is a priority programme in Indian subcontinent.The World Health Organization has set a new target to eliminate kala-azar by the year 2020 as previous target elimination year(2015)...Elimination of visceral leishmaniasis is a priority programme in Indian subcontinent.The World Health Organization has set a new target to eliminate kala-azar by the year 2020 as previous target elimination year(2015) has passed.The elimination programme has successfully curbed the rate of infection in endemic regions; however, there are still few challenges in its route.The current drug control regime is extremely limited and comprises only two(amphotericin B and miltefosine) drugs, which are also susceptible for parasites resistance.Moreover, these drugs do not produce sterile cure, and cured patients may develop post kala-azar dermal leishmaniasis even after a decade of cure leaving behind a potent source of parasitic reservoirs for further disease transmission.A significant proportion of endemic population remain seropositive but aymptomatic for many years without any clinical symptom that serve as latent parasitic reservoirs.The lack of tools to identify live parasites in asymptomatic infections and there association in disease transmission, parameters of sterile cure along with post kala-azar dermal leishmaniasis progression remain a major threat in its elimination.In this review, we discuss the potential of host immune inhibitory mechanisms to identify immune correlates of protective immunity to understand the mystery of asymptomatic infections, sterile cure and post kala azar dermal leishmaniasis.展开更多
Objective:To examine the choice of healthcare providers for treating kala azar(KA) in Nepal. Methods:Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA end...Objective:To examine the choice of healthcare providers for treating kala azar(KA) in Nepal. Methods:Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts.The survey collected information from more than 25 percent of total KA cases in the country.For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider,a multinomial logit model was defined with five alternative options with self care as the reference category.Results:The empirical model found that price of medical care services,income of households,knowledge of patients on KA and KA treatment,borrowing money,age of patient,perceived quality of provider types,etc.determine the likelihood of seeking care from the alternative options considered in the analysis.All variables have expected signs and are con.vstent with earlier studies.The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes,even for a severe disease like KA.Using the empirical models, we have analyzed two policy instruments:demand side financing and interventions to improve the knowledge index about KA.Conclusions:Due to high price elasticity of KA care and high spillover effects of KA on the society,policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.展开更多
Objective:To identify potential vectors of kala-azar from Northern plains of Uttar Pradesh, India.Methods:The collections were made using sticky paper traps,CDC light-traps,and aspirators from outdoors as well as indo...Objective:To identify potential vectors of kala-azar from Northern plains of Uttar Pradesh, India.Methods:The collections were made using sticky paper traps,CDC light-traps,and aspirators from outdoors as well as indoors.All female sandflies were dissected and identified. Results:During January 2009 to July 2009,528 phlebotomine specimens were collected including 329 males(62.3%) and 199 females(37.7%),approximately 238(45%) of them were captured from indoor and 290(55%) from outdoor resting places.Five species belonging to the genera Phlebotomus(8%) and Sergentomyia(92%) were recorded.Conclusions:Public health measures such as case detection and treatment,the control of sandflies,the conjunction elimination of infected stray dogs and health education can be effective in controlling the disease.展开更多
Objective:Visceral leishmaniasis(Kala-azar) is endemic in many countries including Bangladesh.Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and h...Objective:Visceral leishmaniasis(Kala-azar) is endemic in many countries including Bangladesh.Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and hepatobiliary diseases.Jaundice and ascites are not common in kala-azar patients.Methods:During the period of January 2005 to December 2006,all the records of the confirmed kala-azar patients presented with jaundice were included in this study.Kala-azar was confirmed by serology test ICT(Immuno Chromatography) and Bone Marrow study.Results:Total 12 kala-azar patients were encountered during this period.Among these twelve cases,presenting features were jaundice(7),splenomegaly(12),hepatomegaly(11) and ascites (4).Initial clinical diagnosis of chronic liver disease(CLD) was made in(5),Congenital hemolytic anaemia in(1) and kala-azar in rest of the patients(6 ).Common leucopenia and relative lymphocytosis was not observed in any patients.Conclusion:Kala-azar may present with various clinical manifestation in children and adult.Jaundice can be considered to be a common manifestation particularly in pediatric kala-azar patients.Otherwise,it may mislead to another diagnosis if it is taken as a rare feature in kala-azar.展开更多
Introduction: Visceral leishmaniasis (kala-azar) caused by Leishmania donovani and transmitted by the sand-fly Phlebotomus martini is endemic in certain foci in north-eastern Uganda where it is thought to be confined ...Introduction: Visceral leishmaniasis (kala-azar) caused by Leishmania donovani and transmitted by the sand-fly Phlebotomus martini is endemic in certain foci in north-eastern Uganda where it is thought to be confined to Pokot county, Amudat district. Amudat hospital records (April 1998-March 1999) indicated that kala-azar accounted for about 17% of hospital in-patients. However the actual prevalence of kala-azar infection in the community in Pokot county is unknown. This lack of information limits efforts geared towards its control. Objective: To determine the prevalence of kala-azar infection in Pokot county. Methods: A cross-sectional study was conducted in Pokot county in March 2010. The study participants were ≥ 5 years and were randomly selected from the age and sex strata in the chosen clusters. A questionnaire that elicited demographic profiles of participants was used for data collection. Standard procedure for direct agglutination test using blood samples collected from participants on blotting papers was performed. Data was entered in EPIINFO 3.3 and exported to STATA 10, where descriptive statistics were generated. Results: The overall prevalence of kala-azar infection in Pokot county was 17.2% but the prevalence of symptomatic infection in the community was 2.5%. The ratio of symptomatic to asymptomatic kala-azar was 1:6. Loroo sub-county had the highest prevalence of kala-azar infection followed by Karita and Amudat sub-counties at 31.9%, 14.6% and 5.3%, respectively. Conclusion: With kala-azar infection prevalence at 17.2% in the community, there is an urgent need to institute control program spearheaded by ministry of health, in the region. Furthermore, recent reports of cases from other districts within the region, the heterogeneous distribution of infection within the county and the current risk factors, including the role of animals in kala-azar transmission in this area need to be evaluated.展开更多
Background:Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options.This paper ma...Background:Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options.This paper makes an attempt to understand how and why consumers make specific decisions,what motivates them to adopt a specific health intervention,and what features they find attractive in each of the options.Method:The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers.Information was collected through focus group discussions and in-depth interviews.Results:The results suggest that the decision making related to seeking healthcare for Kala Azar(KA)treatment is a complex,interactive process.Patients and family members follow a well-defined road map for decision making.The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors,such as indigenous knowledge,healthcare alternatives,and available resources.Household and individual characteristics also play important roles in facilitating the process of decision making.The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care.Conclusion:The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion.Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs,and then modifying it to show the influences of indigenous knowledge,healthcare alternatives,and available resources.展开更多
基金A part of the grant received from Science and Engineering Research Board,Department of Science and Technology,New Delhi(SB/SO/HS/0091/2013) was utilized in this work
文摘Elimination of visceral leishmaniasis is a priority programme in Indian subcontinent.The World Health Organization has set a new target to eliminate kala-azar by the year 2020 as previous target elimination year(2015) has passed.The elimination programme has successfully curbed the rate of infection in endemic regions; however, there are still few challenges in its route.The current drug control regime is extremely limited and comprises only two(amphotericin B and miltefosine) drugs, which are also susceptible for parasites resistance.Moreover, these drugs do not produce sterile cure, and cured patients may develop post kala-azar dermal leishmaniasis even after a decade of cure leaving behind a potent source of parasitic reservoirs for further disease transmission.A significant proportion of endemic population remain seropositive but aymptomatic for many years without any clinical symptom that serve as latent parasitic reservoirs.The lack of tools to identify live parasites in asymptomatic infections and there association in disease transmission, parameters of sterile cure along with post kala-azar dermal leishmaniasis progression remain a major threat in its elimination.In this review, we discuss the potential of host immune inhibitory mechanisms to identify immune correlates of protective immunity to understand the mystery of asymptomatic infections, sterile cure and post kala azar dermal leishmaniasis.
基金support for the survey was provided by UNICEF/ UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases(TDR),Geneva
文摘Objective:To examine the choice of healthcare providers for treating kala azar(KA) in Nepal. Methods:Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts.The survey collected information from more than 25 percent of total KA cases in the country.For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider,a multinomial logit model was defined with five alternative options with self care as the reference category.Results:The empirical model found that price of medical care services,income of households,knowledge of patients on KA and KA treatment,borrowing money,age of patient,perceived quality of provider types,etc.determine the likelihood of seeking care from the alternative options considered in the analysis.All variables have expected signs and are con.vstent with earlier studies.The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes,even for a severe disease like KA.Using the empirical models, we have analyzed two policy instruments:demand side financing and interventions to improve the knowledge index about KA.Conclusions:Due to high price elasticity of KA care and high spillover effects of KA on the society,policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.
基金the University Grants Commission(U.G.C.) New Delhi,India,through project No. F.6-2(46)/2008(MRP/NRCB)
文摘Objective:To identify potential vectors of kala-azar from Northern plains of Uttar Pradesh, India.Methods:The collections were made using sticky paper traps,CDC light-traps,and aspirators from outdoors as well as indoors.All female sandflies were dissected and identified. Results:During January 2009 to July 2009,528 phlebotomine specimens were collected including 329 males(62.3%) and 199 females(37.7%),approximately 238(45%) of them were captured from indoor and 290(55%) from outdoor resting places.Five species belonging to the genera Phlebotomus(8%) and Sergentomyia(92%) were recorded.Conclusions:Public health measures such as case detection and treatment,the control of sandflies,the conjunction elimination of infected stray dogs and health education can be effective in controlling the disease.
文摘Objective:Visceral leishmaniasis(Kala-azar) is endemic in many countries including Bangladesh.Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and hepatobiliary diseases.Jaundice and ascites are not common in kala-azar patients.Methods:During the period of January 2005 to December 2006,all the records of the confirmed kala-azar patients presented with jaundice were included in this study.Kala-azar was confirmed by serology test ICT(Immuno Chromatography) and Bone Marrow study.Results:Total 12 kala-azar patients were encountered during this period.Among these twelve cases,presenting features were jaundice(7),splenomegaly(12),hepatomegaly(11) and ascites (4).Initial clinical diagnosis of chronic liver disease(CLD) was made in(5),Congenital hemolytic anaemia in(1) and kala-azar in rest of the patients(6 ).Common leucopenia and relative lymphocytosis was not observed in any patients.Conclusion:Kala-azar may present with various clinical manifestation in children and adult.Jaundice can be considered to be a common manifestation particularly in pediatric kala-azar patients.Otherwise,it may mislead to another diagnosis if it is taken as a rare feature in kala-azar.
文摘Introduction: Visceral leishmaniasis (kala-azar) caused by Leishmania donovani and transmitted by the sand-fly Phlebotomus martini is endemic in certain foci in north-eastern Uganda where it is thought to be confined to Pokot county, Amudat district. Amudat hospital records (April 1998-March 1999) indicated that kala-azar accounted for about 17% of hospital in-patients. However the actual prevalence of kala-azar infection in the community in Pokot county is unknown. This lack of information limits efforts geared towards its control. Objective: To determine the prevalence of kala-azar infection in Pokot county. Methods: A cross-sectional study was conducted in Pokot county in March 2010. The study participants were ≥ 5 years and were randomly selected from the age and sex strata in the chosen clusters. A questionnaire that elicited demographic profiles of participants was used for data collection. Standard procedure for direct agglutination test using blood samples collected from participants on blotting papers was performed. Data was entered in EPIINFO 3.3 and exported to STATA 10, where descriptive statistics were generated. Results: The overall prevalence of kala-azar infection in Pokot county was 17.2% but the prevalence of symptomatic infection in the community was 2.5%. The ratio of symptomatic to asymptomatic kala-azar was 1:6. Loroo sub-county had the highest prevalence of kala-azar infection followed by Karita and Amudat sub-counties at 31.9%, 14.6% and 5.3%, respectively. Conclusion: With kala-azar infection prevalence at 17.2% in the community, there is an urgent need to institute control program spearheaded by ministry of health, in the region. Furthermore, recent reports of cases from other districts within the region, the heterogeneous distribution of infection within the county and the current risk factors, including the role of animals in kala-azar transmission in this area need to be evaluated.
基金We would like to thank the UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases(TDR),Geneva for providing the financial support for this study.
文摘Background:Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options.This paper makes an attempt to understand how and why consumers make specific decisions,what motivates them to adopt a specific health intervention,and what features they find attractive in each of the options.Method:The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers.Information was collected through focus group discussions and in-depth interviews.Results:The results suggest that the decision making related to seeking healthcare for Kala Azar(KA)treatment is a complex,interactive process.Patients and family members follow a well-defined road map for decision making.The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors,such as indigenous knowledge,healthcare alternatives,and available resources.Household and individual characteristics also play important roles in facilitating the process of decision making.The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care.Conclusion:The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion.Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs,and then modifying it to show the influences of indigenous knowledge,healthcare alternatives,and available resources.
