Abstract
BackgroundVisceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients.MethodsFrom March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC) we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient.ResultsWe obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$) than hospitals keeping the patients for the whole treatment (636 US$). However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.
Highlights
Visceral leishmaniasis (VL), known as kala-azar, is a neglected parasitic disease transmitted by sand flies
In North African countries VL is caused by Leishmania infantum and affects primarily children living in poor rural areas with limited access to diagnostic and treatment
We evaluated the changes in the median cost of diagnosing and treating a VL case when (1) the discount rate applied was either 0% or 5%, (2) the cost of a vial of Glucantime varied from 1.2 US$ to 3.4 US$ [15] and (3) when the salary of the nurse administering Glucantime at the Primary Health Centers (PHC) ranged from principal-low grade (US$ 1,186.83/month) to principal-high grade (US$ 1,895.00/month) [11]
Summary
Visceral leishmaniasis (VL), known as kala-azar, is a neglected parasitic disease transmitted by sand flies. In North African countries VL is caused by Leishmania infantum and affects primarily children living in poor rural areas with limited access to diagnostic and treatment. Over 150 VL cases are reported per year in Morocco [3], this figure is suspected to be a fraction of the real burden of the disease. In Morocco VL patients are usually below 5 years old and present the triad of splenomegaly, fever and pancytopenia in most of the cases [4,5,6]. Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients
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