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Who Is a Typical Patient with Visceral Leishmaniasis? Characterizing the Demographic and Nutritional Profile of Patients in Brazil, East Africa, and South Asia
Michael O. Harhay
Michael O. Harhay
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Piero L. Olliaro
Piero L. Olliaro
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Michel Vaillant
Michel Vaillant
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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François Chappuis
François Chappuis
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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María Angeles Lima
María Angeles Lima
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Koert Ritmeijer
Koert Ritmeijer
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Carlos Henrique Costa
Carlos Henrique Costa
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Dorcas Lamounier Costa
Dorcas Lamounier Costa
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Suman Rijal
Suman Rijal
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Shyam Sundar
Shyam Sundar
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Manica Balasegaram
Manica Balasegaram
Graduate Group in Demography, Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania; United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Clinical Epidemiology and Public Health Unit, Center for Health Studies, Centre de Recherche Publique (CRP-Santé), Luxembourg; Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland; Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Médecins Sans Frontières, Operational Centre Barcelona-Athens (MSF-OCBA), Barcelona, Spain; Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Amsterdam, The Netherlands; Instituto de Doenças Tropicais Natan Portella, Teresina, Piauí, Brazil; Federal University of Piauí, Piauí, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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Drug-dosing recommendations for visceral leishmaniasis (VL) treatment are based on the patients' weight or age. A current lack of demographic and anthropometric data on patients hinders (1) the ability of health providers to properly prepare for patient management, (2) an informed drug procurement for disease control, and (3) the design of clinical trials and development of new drug therapies in the different endemic areas. We present information about the age, gender, weight, and height of 29,570 consecutive VL patients presenting to 20 locations in six geographic endemic regions of Brazil, East Africa, Nepal, and India between 1997 and 2009. Our compilation shows substantial heterogeneity in the types of patients seeking care for VL at the clinics within the different locations. This suggests that drug development, procurement, and perhaps even treatment protocols, such as the use of the potentially teratogenic drug miltefosine, may require distinct strategies in these geographic settings.
Author Notes
Financial support: MOH is supported by Training Grant T32 AG 000177-21 from the National Institutes on Aging, United States National Institutes of Health (NIH). Although the work of all other authors was funded by their respective institutions, this project was and continues to be orchestrated collaboratively between the United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases and the Drugs for Neglected Diseases Initiative.
Authors' addresses: Piero L. Olliaro, Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland, E-mail: olliarop@who.int. Michael O. Harhay, Population Studies Center, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA 19104-6298, E-mail: mharhay@pop.upenn.edu. Michel Vaillant, Competence Centre in Methodology and Statistics, Centre de Recherche Public - Santé, 1a-b rue Thomas Edison, L-1445 Strassen, Luxembourg, E-mail: michel.vaillant@crp-sante.lu. François Chappuis, Division of International and Humanitarian Medicine, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 6, 1211 Geneva 14, E-mail: francois.chappuis@hcuge.ch. María Angeles (Nines) Lima, Médecins Sans Frontières, Medical Department, Operational Centre Barcelona–Athens, Nou de la Rambla 26, Barcelona 08001, Spain, E-mail: nines.lima@barcelona.msf.org. Koert Ritmeijer, Médecins Sans Frontières, P.O. Box 10014, 1001 EA, Amsterdam, The Netherlands, E-mail: koert.ritmeijer@amsterdam.msf.org. Carlos Henrique Costa, Instituto de Doenças Tropicais Natan Portella R. Artur de Vasconcelos 151-Sul 64001-450 Teresina, Piauí, Brazil, E-mail: chncosta@gmail.com. Dorcas Lamounier Costa, Instituto de Doenças Tropicais Natan Portella, Rua. Artur de Vasconcelos 151 Centro, CEP 64 001-450 Teresina, Piauí, Brazil, E-mail: dorcas.lc@gmail.com. Suman Rijal, Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal, E-mail: sumanrijal2@yahoo.com. Shyam Sundar, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India, E-mail: drshyamsundar@hotmail.com. Manica Balasegaram, Drugs for Neglected Diseases initiative, 15 Chemin Louis Dunant, 1202, Geneve, Switzerland, E-mail: mbalasegaram@dndi.org.
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BibTeX
Zotero
EndNote
-
1.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, 2006. Global Burden of Disease and Risk Factors. Oxford University Press and The World Bank.
-
2.
Desjeux P, 2001. The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg 95: 239–243.
-
3.
Desjeux P, 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305–318.
-
4.
Bern C, Maguire JH, Alvar J, 2008. Complexities of assessing the disease burden attributable to leishmaniasis. PLoS Negl Trop Dis 2: e313.
-
5.
van Griensven J, Balasegaram M, Meheus F, Alvar J, Lynen L, Boelaert M, 2010. Combination therapy for visceral leishmaniasis. Lancet Infect Dis 10: 184–194.
-
6.
Mubayi A, Castillo-Chavez C, Chowell G, Kribs-Zaleta C, Ali Siddiqui N, Kumar N, Das P, 2009. Transmission dynamics and underreporting of Kala-azar in the Indian state of Bihar. J Theor Biol 262: 177–185.
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