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

Table 4

Physician perspectives of VL management.

	India		Nepal		Bangladesh		Overall
	2009	2010	2009	2010	2009	2010	2009	2010
No. of physicians interviewed	(𝑛=19)	(𝑛=21)	(𝑛=7)	(𝑛=2)	(𝑛=4)	(𝑛=4)	(𝑛=30)	(𝑛=27)
Rk39 test as decision criteria to treat VL	18/19; (95%)	13/21; (62%)	7/7; (100%)	2/2; (100%)	4/4; (100%)	4/4; (100%)	29/30; (97%)	19/27; (70%)
Physician’s use of VL drug
(i) SAG	8/19; (42%)	10/21; (48%)	0/7; (0%)	0/2; (0%)	4/4; (100%)	4/4; (100%)	12/30; (40%)	14/27; (52%)
(ii) Amphotericin B	11/19; (58%)	3/21; (14%)	5/7; (71%)	1/2; (50%)	0/4; (0%)	0/4; (0%)	16/30; (53%)	4/27; (15%)
(iii) Miltefosine	17/19; (89%)	20/21; (95%)	5/7; (71%)	1/2; (50%)	0/4; (0%)	4/4; (100%)	22/30; (73%)	25/27; (93%)
Physician criteria for VL drug selection
(i) Available	14/19; (74%)	19/21; (90%)	4/7; (57%)	2/2; (100%)	4/4; (100%)	3/4; (75%)	22/30; (73%)	24/27; (89%)
(ii) Affordable	8/19; (42%)	11/21; (52%)	1/7; (14%)	0/2; (0%)	4/4; (100%)	3/4; (75%)	13/30; (43%)	14/27; (52%)
(iii) Safe	18/19; (95%)	21/21; (100%)	4/7; (57%)	1/2; (50%)	4/4; (100%)	3/4; (75%)	26/30; (87%)	25/27; (93%)
(iv) Effective	12/19; (63%)	12/21; (57%)	4/7; (57%)	1/2; (50%)	4/4; (100%)	3/4; (75%)	20/30; (67%)	16/27; (59%)
No. physician advises blood tests (%)?	12/19; (63%)	12/21; (57%)	7/7; (100%)	2/2; (100%)	4/4; (100%)	2/4; (50%)	23/30; (77%)	16/27; (59%)
Reason for not advising blood tests?
No need	4/7; (57%)	—	—	—	—	1/2; (50%)	4/7; (57%)	1/11; (9%)
No lab technician	—	9/9; (100%)	—	—	—	1/2; (50%)	—	10/11; (91%)
No. physician aware of Miltefosine side effects (%)
(i) Diarrhea	19/19; (100%)	21/21; (100%)	5/7; (71%)	2/2; (100%)	0/4; (0%)	0/4; (0%)	24/30; (80%)	23/27; (85%)
(ii) Vomiting	19/19; (100%)	21/21; (100%)	5/7; (71%)	2/2; (100%)	0/4; (0%)	3/4; (75%)	24/30; (80%)	26/27; (96%)
(iii) Jaundice	0/19; (0%)	12/21; (57%)	0/7; (0%)	1/2; (50%)	0/4; (0%)	1/4; (25%)	0/30; (0%)	14/27; (52%)
(iv) Abdominal pain	5/19; (26%)	9/21; (43%)	1/7; (14%)	2/2; (100%)	0/4; (0%)	3/4; (75%)	6/30; (20%)	14/27; (52%)
(v) Renal toxicity	14/19; (74%)	4/21; (19%)	2/7; (29%)	1/2; (50%)	0/4; (0%)	0/4; (0%)	16/30; (53%)	5/27; (19%)
(vi) Teratogenicity	11/19; (58%)	11/21; (52%)	1/7; (14%)	1/2; (50%)	0/4; (0%)	0/4; (0%)	12/30; (40%)	12/27; (44%)
No. physician recommend home based Miltefosine treatment (%)	10/19; (53%)	20/21; (95%)	5/7; (71%)	1/2; (50%)	3/4; (75%)	4/4; (100%)	18/30; (60%)	25/27; (93%)
No. physician feel home-based Miltefosine treatment is effective (%)?	15/19; (79%)	20/21; (95%)	6/7; (86%)	2/2; (100%)	1/4; (25%)	4/4; (100%)	22/30; (73%)	26/27; (96%)