Follow-up assessment of visceral leishmaniasis treated patients and the impact of COVID-19 on control services in Nepal.

IF 3.6 Q1 TROPICAL MEDICINE Tropical Medicine and Health Pub Date : 2023-10-20 DOI:10.1186/s41182-023-00549-1
Anand Ballabh Joshi, Megha Raj Banjara, Murari Lal Das, Nav Raj Bist, Krishna Raj Pant, Uttam Raj Pyakurel, Gokarna Dahal, Krishna Prasad Paudel, Chuman Lal Das, Axel Kroeger, Abraham Aseffa
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Abstract

Background: Follow-up assessment of visceral leishmaniasis (VL) treated cases is important to monitor the long term effectiveness of treatment regimens. The main objective of this study was to identify the gaps and challenges in the follow-up of treated VL cases, to monitor treatment outcome and to assess the impact of COVID-19 on VL elimination services and activities.

Methods: Clinicians treating VL patients, district focal persons for VL, and patients treated for VL in seven high endemic districts in Nepal during 2019-2022 were interviewed to collect data on challenges in the follow-up of VL treated patients as per national strategy.

Results: Follow up status was poor in two districts with the largest number of reported cases. The majority of cases were children under 10 years of age (44.2%). Among 104 VL treated cases interviewed, 60.6% mentioned that clinicians had called them for follow-up but only 37.5% had complied. Among 112 VL treated cases followed up, 8 (7.14%) had relapse and 2 (1.8%) had PKDL. Among 66 cases who had VL during the COVID-19 lock down period, 32 (48.5%) were diagnosed within 1 week; however, 10 (15.1%) were diagnosed only after 4 weeks or more. During the COVID-19 pandemic, there was no active search for VL because of budget constraints and lack of diagnostic tests, and no insecticide spraying was done.

Conclusion: Relapses and PKDL are challenges for VL elimination and a matter of concern. Successful implementation of the national strategy for follow up of treated VL cases requires addressing elements related to patients (awareness, transport, communication) clinicians (compliance) and organization of service delivery (local health worker training and deployment). COVID-19 did not have much impact on VL diagnosis and treatment; however, public health programmes including active case detection and insecticide spraying for vector control were severely reduced.

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对接受内脏利什曼病治疗的患者的随访评估以及新冠肺炎对尼泊尔控制服务的影响。
背景:内脏利什曼病(VL)治疗病例的随访评估对于监测治疗方案的长期有效性很重要。本研究的主要目的是确定治疗后VL病例随访中的差距和挑战,监测治疗结果,并评估新冠肺炎对VL消除服务和活动的影响。方法:在2019-2022年期间,采访了治疗VL患者的临床医生、VL的地区联络人以及尼泊尔七个高流行地区的VL患者,以收集根据国家战略对VL治疗患者进行随访的挑战数据。结果:报告病例最多的两个地区的随访情况较差。大多数病例是10岁以下的儿童(44.2%)。在104例接受VL治疗的病例中,60.6%的患者提到临床医生曾要求他们随访,但只有37.5%的患者遵守了。在112例VL治疗的随访病例中,8例(7.14%)复发,2例(1.8%)PKDL。在新冠肺炎封锁期间患有VL的66例病例中,32例(48.5%)在1周内确诊;然而,10人(15.1%)在4周或更长时间后才被确诊。在新冠肺炎大流行期间,由于预算限制和缺乏诊断测试,没有积极寻找VL,也没有喷洒杀虫剂。结论:复发和PKDL是消除VL的挑战,也是一个值得关注的问题。成功实施治疗后VL病例随访的国家战略需要解决与患者(意识、运输、沟通)、临床医生(合规性)和服务提供组织(当地卫生工作者培训和部署)相关的要素。新冠肺炎对VL的诊断和治疗没有太大影响;然而,公共卫生方案,包括积极的病例检测和用于病媒控制的杀虫剂喷洒严重减少。
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来源期刊
Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
7.00
自引率
2.20%
发文量
90
审稿时长
11 weeks
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