Abstract
BackgroundLesishmaniasis is a neglected tropical disease endemic in Bihar, India. Inappropriate health seeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients may increase the disease duration, severity and transmissibility. Simultaneously, lack of knowledge and perceived stigma may also increase the length of delay in receiving treatment. This ultimately effects the kala-azar elimination program.MethodsA cross sectional study was conducted in 120 confirmed PKDL patients, aged 18 years and older. Data related to knowledge and health seeking behaviour was collected by a pre-tested questionnaire. EMIC stigma scale was used for assessing the perceived stigma. Patients were personally interviewed after taking informed consent. Data analysis was done by using SPSS 16 software.ResultsThe time between appearance of symptoms and first medical consultation (patient delay) ranged from 15 days to 5475 days (15 years) with a median of 285 days. The time between first medical consultations to onset of specific treatment (system delay) ranged from 2 to 5475 days with a median of 365 days. Many patients approached first to quacks (8.4%), homeopathic and ayurvedic practitioners (25.8%) upon recognition of symptoms. Majority of the patients (68.3%) had poor knowledge about PKDL and its vector. Type of skin lesions and gender had significant association with patient delay and system delay respectively (p<0.05). Distance to primary health centre (PHC) had significant association with patients delay as well as system delay (p<0.05). Patients with younger age, unmarried and polymorphic lesions had higher stigma (p<0.05). Patients with PKDL feel stigmatized in different areas.ConclusionPKDL treatment delays were unacceptably high and patients had poor knowledge compounded with feelings of stigmatization. To reduce the delay, a system may be evolved to establish some sort of public-private collaboration, besides awareness programs should be tailored, and implemented for improving the patient education regarding the disease and its linkage with VL.
Highlights
Leishmaniasis is a vector-borne disease, caused by protozoan parasite genus Leishmania
Clinical manifestations of the disease ranging from self-curing cutaneous leishmaniasis (CL) to severe visceral leishmaniasis(VL) leads to death if left untreated
Our study revealed that a large proportion of patients have poor knowledge regarding the disease, vector and its transmission, Knowledge, stigma, healthseeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients which has effect on their attitude and practices
Summary
Leishmaniasis is a vector-borne disease, caused by protozoan parasite genus Leishmania. This is one of the neglected tropical diseases affecting the poorest of the poor in developing countries, who are at the risk of over 350 million people[1]. Post kala-azar dermal leishmaniasis (PKDL) is a dermatological consequence of VL, reported in endemic areas of Leishmania donovani. Inappropriate health seeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients may increase the disease duration, severity and transmissibility. Lack of knowledge and perceived stigma may increase the length of delay in receiving treatment.
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