Treatment cost on Visceral Leishmaniasis: Case study in endemic districts of Nepal

Background & Objectives: Approximately six million people are at risk of infection from Visceral Leishmaniasis (VL) in Eastern and middle plain region of Nepal. The disease affects the rural poor socio-economical community causing significant death among untreated patients (Per capita income of Nepal US $ 400.00). An effort was made to estimate treatment cost on clinically diagnosed VL patients in three VL endemic districts of Eastern development region of Nepal.Materials & Methods: During one and half year period in 2012/2013, approximately 500 cases were diagnosed as VL from three district hospitals; two zonal hospitals and one tertiary level hospital of Eastern Terai districts of Nepal. Total 172 cases were selected randomly from the three VL endemic districts of Eastern Nepal and interviewed at their homes. Results: On an average, cost for VL treatment during hospitalization was Nepali Rupees (NRS) 4032.67±313.47, where median (IQR) length of hospital stay was 17 (five to 35) days. The patients were iagnosed symptomatically as VL after 45 ± 6 days of feeling illness. The treatment cost of patient before diagnosis was NRS 2379.93 ± 202.30. Patient reached the treatment center after 17 ± 2 days of diagnosis and referral from community level. Total 83.7% patients came for follow-up after average 30 ± 2 days of discharge with an average expense of RS 360.34 ± 49.88. The death rate of VL patients during treatment and within one month of discharge was 7.6%. It was found that the average funeral cost was NRs 9598.00 ± 1259.00. Conclusion: This study concludes that, average treatment cost for VL treatment during hospital stay was NRs 4032 and before treatment was around NRS 2380 and follow up cost was NRs 360. Early diagnosis and treatment in treatment center without significant delay can not only reduce the hospital stay and treatment cost, but also saves life of VL patients.JCMS Nepal. 2016;12(2):60-5

Neurological involvement in visceral leishmaniasis: case report

Visceral leishmaniasis is a severe and potentially fatal vector-borne disease. The most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. Neurological changes are rarely reported. This paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. A diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. Symptoms were reversed by specific treatment. The nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.

The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment

The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.

Epidemiologic surveillance of canine visceral leishmaniasis in the municipality of Recife, Pernambuco

This paper describes an epidemiologic investigation carried out in Imbiribeira district, where a canine visceral leishmaniasis case was recorded. Despite the absence of seropositive dogs and sand flies, these findings are not sufficient to discard the occurrence of a zoonotic cycle of visceral leishmaniasis in Recife.