A study on delay in treatment of kala-azar patients in Bangladesh

Abstract

Visceral leishmaniasis (‎kala-azar)‎ continues to be a major rural public health problem in Bangladesh.A cross-sectional study was carried out in two subdistricts of Mymensingh district from January2006 to June 2007 to evaluate the delay kala-azar treatment. Suspected patients who attendedto out patient department (‎OPD)‎ were subjected to a dipstick test (‎RK39)‎ for kala-azar. Sixtyfive from Bhaluka and 60 positive patients from Gafargaon subdistrict were enrolled. Most of thepatients (‎80%)‎ first visited nonqualified private practitioners, while only 15.2% consulted registereddoctors. Fifty per cent were referred to the Upazilla health complex (‎UZHC)‎ by the family membersor relatives. About 49% and 43% patients required third and second health-care providers forkala-azar treatment, respectively. Patient delay ranged from 2 to 30 days; median 4 (‎IQR 3 to 7days)‎, the system delay ranged from 0 days to 225 days; median 54 (‎IQR 40–66 days)‎. Residentialstatus (‎p value <0.05)‎ had impact on patient delay. Educational status and number of treatmentproviders had impact on system delay (‎p<0.05)‎. System delay rather than patient delay is theimportant weakness of the kala-azar control programme in Bangladesh. Residence in rural areas,low educational background and treatment providers are associated with these delays. A propereducational programme may reduce the delay.