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Better use of public health facilities in India could improve kala-azar diagnosis, say researchers

BMJ 2015; 350 doi: (Published 31 March 2015) Cite this as: BMJ 2015;350:h1769
  1. Sanjeet Bagcchi
  1. 1Kolkata

International experts have urged greater public-private partnership to facilitate the early diagnosis of kala-azar (visceral leishmaniasis) in the Indian state of Bihar to prevent delays in detecting cases and to reduce the transmission of the disease.

A team of experts led by Jan Boettcher, from the Centre for Biological Threats and Special Pathogens at the Robert Koch-Institute, Berlin, noted that over 66% of the world’s cases of kala-azar were reported in India, Nepal, and Bangladesh. In these countries nearly 147 million people are at risk of contracting kala-azar, and around 40 000 new cases are registered each year. However, these figures may underestimate the true burden of kala-azar in the region, because of a drastic under-reporting of cases, the experts said.

In 2005 the World Health Organization and the governments of India, Nepal, and Bangladesh committed to eliminate kala-azar from the region by 2015—which would require a substantial reduction in the incidence of the disease to below 10 per 100 000 population. In Bihar, the state with highest annual incidence of kala-azar in India, between 298 and 380 cases per 100 000 population were reported in 2006-07.

The investigation by Boettcher and colleagues, published in BMC Infectious Diseases, found that in countries such as Nepal and India the time lag from “feeling sick” to “seeking healthcare” and from “seeking healthcare” to “receiving a visceral leishmaniasis diagnosis” could be the major hindrances to early diagnosis and treatment of kala-azar.1

“The time from initiating the search for help after feeling sick to reaching a proper diagnosis was particularly long in Bihar (90 days) where ‘doctor shopping,’ i.e. the use of a variety of different informal and formal health care providers, was common,” wrote the investigators.

They recommended better public awareness of the visceral leishmaniasis services provided by Bihar’s public sector, where people could get tests and treatment from government run centres, rather than relying on “doctor shopping” and extensive use of the private sector. Increasing active case detection to identify patients who were not reporting themselves or who had dropped out of the healthcare system would further facilitate early diagnosis and treatment of the disease, they added.

Swapan Jana, secretary of the Society for Social Pharmacology, a Kolkata based non-government organisation that works on various social and public health issues, told The BMJ, “Advocating public-private partnership for combating visceral leishmaniasis is a fascinating approach. It is also important to promote proper training in the private sector in regard to early detection and treatment of the disease. To truly eliminate kala-azar from India, the government should act in collaboration with all its stakeholders, thereby promoting the strategy of early detection and treatment.”


Cite this as: BMJ 2015;350:h1769


  • Feature: India’s ambition to eliminate visceral leishmaniasis (BMJ 2014;349:g6671, doi:10.1136/bmj.g6671)


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