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VISCERAL LEISHMANIASIS: CONSEQUENCES OF A NEGLECTED DISEASE IN A BANGLADESHI COMMUNITY

Visceral leishmaniasis, or kala azar (KA), affects the rural poor, causing significant morbidity and mortality. We examined the epidemiologic, social, and economic impact of KA in a village in Bangladesh. A population-based survey among 2,348 people demonstrated a KA incidence of 2% per year from 2000 to 2002, with a case-fatality rate of 19% among adult women, compared with 6–8% among other demographic groups. Kala azar cases were geographically clustered in certain sections of the village. Anti-leishmanial drug shortages and the high cost of diagnosis and treatment caused substantial emotional and economic hardship for affected families. Communities wanted to learn more about KA, and were willing to take collective action to confront the problems it causes. To decrease the KA burden in endemic areas, community efforts should be supplemented with effective treatment programs to ensure access to appropriate and affordable diagnosis and case management.

Received July 9, 2003. Accepted for publication September 12, 2003.

Acknowledgments: For their essential contributions to the study, we thank our fieldworkers: Nazrul Islam I, Mohammed Shamsuzzaman, Vascor Kanti Sarker, Shikha Rani Dey, Palash Rani Sarker, Nargis Dibra, Nazma Akhter, Mahfuza Akther, Musammat Bilkis Akter, Mohammed Nazrul Islam II, Muhammad Humayun Khaleed, Lovely Akter Lila, Rashida Akter, Soma Rani Chanda, Asima Manda, Asma Begum, Hasina Begum, Moarrita Begum, and Mosammat Nasrin Sultana. In addition, we thank the residents of the study village for their collaboration. For their support of the study, we are grateful to Dilara Sultana, Hasnat Iftekhar Hossain, Pradip Lawrence Rozario, Selim Akhter, Shantanu Roy, Milton Quiah, Mustak Ahmed, Dr. A. S. G. Faruque, Dr. A. K. Siddique, and Dr. David Sack (International Centre for Diarrhoeal Disease Research, Bangladesh); Dr. Kanak Ranjan Talukdar, Dr. Emran Bin Yunus, and Dr. Mohammed Mushfiqur Rahman (Directorate General of Health Services, Government of Bangladesh); Dr. Mohammed Ali Akbar (Civil Surgeon, Mymensingh District); Dr. Madan Gopal Datta, Dr. Mohammed Abdul Hamid, and Dr. Syeed Mahbubul Alam (Fulbaria Thana Health Complex); Brigadier General Dr. Mohammed Waliur Rahman Chowdhury, Dr. Kamal Chowdhury, Dr. Momen, and Dr. Utpal (Mymensingh Medical Center Hospital); Dr. Syamal Raychaudhuri (Inbios International); and Evan Secor, Louise Vaz, Leanne Fox, Ellen Dotson, and Bob Wirtz (Centers for Disease Control and Prevention).

Financial support: This work was supported by a grant from the Centers for Disease Control and Prevention Emerging Infections Initiative.

Authors’ addresses: Indu Ahluwalia, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-66, Atlanta, GA 30341, Telephone: 770-488-5764, Fax: 770-488-8150. Caryn Bern, Cristiane Costa, Josef Amann, and James H. Maguire, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mail-stop F-22, Atlanta, GA 30341, Telephone 770-488-7756, Fax: 770-488-7761. Tangin Akter, Rajib Chowdhury, Mustakim Ali, Didarul Alam, Eben Kenah, Meghla Islam, Yukiko Wagatsuma, Rashidul Haque, and Robert F. Breiman, Health Systems and Infectious Diseases Division and Laboratory Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Centre for Health and Population Research, Moakhali, Dhaka 1212, Bangladesh, Telephone: 880-2-988-1761, Fax: 880-2-882-3963.

Reprint requests: Caryn Bern, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, Atlanta, GA 30341, E-mail: cxb9{at}cdc.gov.

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