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Economic Consequences of Post–Kala-Azar Dermal Leishmaniasis in a Rural Bangladeshi Community
Post–kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis. Bangladesh national treatment guidelines during the study period called for 120 intramuscular injections of sodium antimony gluconate (SAG). We assessed care-seeking behavior, diagnosis and treatment costs, and coping strategies among 134 PKDL patients; 56 (42%) patients had been treated with SAG, and 78 (58%) remained untreated. The median direct cost per patient treated was US$367 (interquartile range [IQR] = 90–284), more than two times the estimated per capita annual income for the study population. The most common coping strategy was to take a loan; the median amount borrowed was US$98 (IQR = 71–150), with a median interest of US$32 (IQR = 16–95). Households lost a median of 123 work-days per patient treated. The current regimen for PKDL imposes a significant financial burden, reinforcing the link between poverty and visceral leishmaniasis. More practical shorter-course regimens for PKDL are urgently needed to achieve national and regional visceral leishmaniasis elimination goals.
Author Notes
Financial support: The study was funded by United States Agency for International Development-CDC interagency agreement GHN-T-00-06-00001-00.
Authors' addresses: Masayo Ozaki, Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: masayo.ozaki@gmail.com. Shamim Islam, Children's Hospital and Research Center Oakland, Oakland, CA, E-mail: sizuba@yahoo.com. Kazi Mizanur Rahman, Anisur Rahman, and Stephen P. Luby, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: mizan@icddrb.org, anis123@icddrb.org, and sluby@icddrb.org. Caryn Bern, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: cxb9@cdc.gov.