Arif Syed M, Basher Ariful, Rahman Mohammad R, Faiz Mohammad A
Medicine Department, Dhaka Medical College Hospital, Dhaka, Bangladesh.
Surya Kanta Kala Azar Research Centre, Mymensingh, Bangladesh.
WHO South East Asia J Public Health. 2012 Oct-Dec;1(4):396-403. doi: 10.4103/2224-3151.207041.
Visceral leishmaniasis (kala-azar) continues to be a major rural public health problem in Bangladesh. A cross-sectional study was carried out in two subdistricts of Mymensingh district from January 2006 to June 2007 to evaluate the delay kala-azar treatment. Suspected patients who attended to out patient department (OPD) were subjected to a dipstick test (RK39) for kala-azar. Sixty five from Bhaluka and 60 positive patients from Gafargaon subdistrict were enrolled. Most of the patients (80%) first visited nonqualified private practitioners, while only 15.2% consulted registered doctors. Fifty per cent were referred to the Upazilla health complex (UZHC) by the family members or relatives. About 49% and 43% patients required third and second health-care providers for kala-azar treatment, respectively. Patient delay ranged from 2 to 30 days; median 4 (IQR 3 to 7 days), the system delay ranged from 0 days to 225 days; median 54 (IQR 40-66 days). Residential status (p value <0.05) had impact on patient delay. Educational status and number of treatment providers had impact on system delay (p<0.05). System delay rather than patient delay is the important weakness of the kala-azar control programme in Bangladesh. Residence in rural areas, low educational background and treatment providers are associated with these delays. A proper educational programme may reduce the delay.
内脏利什曼病（黑热病）仍是孟加拉国农村地区的一个主要公共卫生问题。2006年1月至2007年6月在迈门辛希区的两个分区开展了一项横断面研究，以评估黑热病治疗延误情况。到门诊部就诊的疑似患者接受了黑热病快速检测（RK39）。来自巴卢卡的65名患者和来自加富尔冈分区的60名阳性患者被纳入研究。大多数患者（80%）首先就诊于不合格的私人医生，而只有15.2%的患者咨询了注册医生。50%的患者由家庭成员或亲属转诊至乡卫生中心（UZHC）。分别约有49%和43%的患者在接受黑热病治疗时需要第三位和第二位医疗服务提供者。患者延误时间为2至30天；中位数为4天（四分位间距为3至7天），系统延误时间为0天至225天；中位数为54天（四分位间距为40 - 66天）。居住状况（p值<0.05）对患者延误有影响。教育状况和治疗提供者数量对系统延误有影响（p<0.05）。在孟加拉国，系统延误而非患者延误是黑热病控制项目的重要薄弱环节。农村居住、低教育背景和治疗提供者与这些延误有关。适当的教育项目可能会减少延误。
