Low castes have poor access to visceral leishmaniasis treatment in Bihar, India

Médecins Sans Frontières - Operational Center Barcelona-Athens, Barcelona, Spain  Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium  Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
Tropical Medicine & International Health (Impact Factor: 2.33). 03/2012; 17(5):666-73. DOI: 10.1111/j.1365-3156.2012.02960.x
Source: PubMed


Objectives  Bihar, the poorest state in India, concentrates most of the visceral leishmaniasis (VL) cases in the country. A large proportion of the poor rural communities where VL is endemic are marginalized by their socio-economic status, intrinsically related to the caste system. In this study, we evaluated whether people from low socio-economic strata had difficulties accessing VL treatment in Bihar. As a secondary outcome, we evaluated whether people delaying their VL treatment had poorer clinical indicators at admission. Methods  Data on 2187 patients with VL treated by Médecins Sans Frontières (MSF) in Vaishali district from July 2007 to December 2008 were analysed. Patients who reported having onset of symptoms ≥8 weeks before admission were defined as 'late presenters'. Logistic regression models were used to evaluate whether low castes had higher risk to be 'late presenters' compared to the rest of castes and whether 'late presenters' had poorer indicators at admission (i.e. haemoglobin level, spleen size). Results  After adjusting for age, gender and distance to VL treatment facility, Mushars (the lowest caste in Bihar) had twice the odds to be 'late presenters' compared to the rest of castes (OR 2.05, 95% CI: 1.24-2.38). Subjects that had VL symptoms for ≥8 weeks had a larger spleen and lower haemoglobin level than those that were treated earlier. Conclusion  Low castes have poor access to VL treatment in Bihar, and late presenters have poorer clinical indicators at admission. These findings have implications at individual and community levels and should stimulate targeted VL control programmes to ensure that marginalized communities in Bihar are properly treated.

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    • "The aetiology of AUF is fairly diverse and includes a wide range of infectious diseases such as dengue (Reller et al., 2012), malaria (Joshi et al., 2008), typhoid (Gasem et al., 2009), tuberculosis (Abrahamsen et al., 2013), hantavirus (Chandy et al., 2009) and Japanese encephalitis (Robertson et al., 2013). Socio-economic disparities are a key driver not only of high rates of infectious diseases (Gupta et al., 2011, Pascual Martinez et al., 2012), especially in rural areas (Patil et al., 2002), but also of a wide range of other health problems including neonatal mortality (Kumar et al., 2013), inequalities in immunisation coverage (Lauridsen and Pradhan, 2011), mental disorders (Shidhaye and Patel, 2010) and low birth-weight (Bharati et al., 2011). The vulnerability to infectious diseases among various disadvantaged population sub-groups such as scheduled castes and scheduled tribes varies widely among and within the states of India (Raju et al., 1999), depending on the local interplay between agent, host and environmental factors (Gupte et al., 2001). "
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    ABSTRACT: The System for Early-warning based on Emergency Data (SEED) is a pilot project to evaluate the use of emergency call data with the main complaint acute undifferentiated fever (AUF) for syndromic surveillance in India. While spatio-temporal methods provide signals to detect potential disease outbreaks, additional information about socio-ecological exposure factors and the main population at risk is necessary for evidence-based public health interventions and future preparedness strategies. The goal of this study is to investigate whether a spatial epidemiological analysis at the ecological level provides information on urban-rural inequalities, socio-ecological exposure factors and the main population at risk for AUF. Our results displayed higher risks in rural areas with strong local variation. Household industries and proximity to forests were the main socio-ecological exposure factors and scheduled tribes were the main population at risk for AUF. These results provide additional information for syndromic surveillance and could be used for evidence-based public health interventions and future preparedness strategies. Copyright © 2014. Published by Elsevier Ltd.
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    ABSTRACT: To identify factors associated with incidence of visceral leishmaniasis (VL), we surveyed 13,416 households in Bihar State, India. VL was associated with socioeconomic status, type of housing, and belonging to the Musahar caste. Annual coverage of indoor residual insecticide spraying was 12%. Increasing such spraying can greatly contribute to VL control.
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