Rijal S, Koirala S, Van der Stuyft P, Boelaert M
Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Trans R Soc Trop Med Hyg. 2006 Sep;100(9):838-41. doi: 10.1016/j.trstmh.2005.09.017. Epub 2006 Jan 10.
Visceral leishmaniasis (VL) affects persons from the lowest socioeconomic strata of the community, but its economic impact is not precisely known. An exploratory survey to document the economic costs of VL to households was conducted in an endemic focus in eastern Nepal. Data were collected from the 20 households in this cluster. Cases of VL over the last 3 years were elicited and information on direct and indirect costs incurred due to the disease as well as income of the households over the last year was estimated. It was reported that 15.0% (16/107) of the residents had suffered from VL and that almost all of the patients had preferred, in the first instance, to visit the private services or local faith healers instead of visiting the local public health facility. Average total costs incurred per episode of VL were above the median annual per capita income, and six of the seven affected households either had to sell part of their livestock or to take a loan to cover the costs. Direct costs consisted of 53% of the total cost, with 75% of this cost incurred before the patients actually received any treatment for VL. This study demonstrates how VL can lead to catastrophic expenditure for affected households.
内脏利什曼病（VL）影响着社区中社会经济地位最低的人群，但其经济影响尚不清楚。在尼泊尔东部的一个流行区开展了一项探索性调查，以记录VL给家庭带来的经济成本。从该地区的20个家庭收集了数据。调查了过去3年的VL病例，并估算了因该病产生的直接和间接成本以及这些家庭上一年的收入。据报告，15.0%（16/107）的居民曾患过VL，几乎所有患者首先选择去私人诊所或当地的信仰治疗师处就诊，而非前往当地的公共卫生机构。VL每次发作的平均总成本高于人均年收入中位数，7个受影响家庭中有6个家庭不得不出售部分牲畜或贷款来支付费用。直接成本占总成本的53%，其中75%的成本在患者实际接受VL治疗之前就已产生。这项研究表明VL如何导致受影响家庭出现灾难性支出。
