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Journal of Tropical Medicine
Volume 2012 (2012), Article ID 126093, 8 pages
http://dx.doi.org/10.1155/2012/126093
Research Article

Visceral Leishmaniasis Clinical Management in Endemic Districts of India, Nepal, and Bangladesh

1Institute of Medicine, Tribhuvan University, Kathmandu 44168, Nepal
2KEM Hospital Research Center, Pune, Maharashtra 411011, India
3Umeå Center for Global Health Research, Umea University, 90187 Umeå, Sweden
4Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar 800007, India
5Institute of Medical Sciences, Banares Hindu University, Varanasi 221105, India
6International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
7BP Koirala Institute of Health Sciences, Dharan 56700, Nepal
8Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland
9Liverpool School of Tropical Medicine, Liverpool L35QA, UK

Received 20 December 2011; Accepted 21 February 2012

Academic Editor: Aditya Prasad Dash

Copyright © 2012 Megha Raj Banjara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.