Women in Indian states with endemic visceral leishmaniasis - also known as Kala Azar - should be encouraged to seek care for persistent fever without delay. Raised awareness about the disease and its symptoms, and the prioritization of women's care-seeking over household work could help reduce fatalities and potentially reduce overall transmission, according to research by independent consultant Beulah Jayakumar and colleagues, published in PLOS Neglected Tropical Diseases.
Visceral leishmaniasis is transmitted by sand flies. It is endemic in the Indian subcontinent and since 2005 there have been efforts to eliminate it as a public health problem. Though largely effective, these efforts have not yet achieved the threshold target in India, with four endemic states continuing to harbor disease. Detecting and treating the disease quickly is key, as this interrupts and shortens transmission from human hosts and improves patient outcomes - the only known hosts in the Indian subcontinent.
Beulah Jayakumar and colleagues interviewed 33 female patients from two states, Bihar and Jharkhand, along with 11 unqualified health providers and 12 groups of community elders. Women seem to access care later than men, partly due to the accepted prioritization of household work over what were considered mild and vague symptoms not considered serious enough to seek appropriate care and spend money on associated expenses. Additional causes for delayed treatment include securing a male chaperone for hospital visits and the perception that private facilities provide higher quality care.
Study limitations include the small sample size and lack of comparative analysis with male patients; additionally, patients were found from a national visceral leishmaniasis surveillance register, excluding patients who were not reported or recorded due to private care.
The authors conclude that there is a need for clearer messaging to increase awareness in the general population and among informal and formal care providers, and an emphasis on the need for early care seeking for women with persistent fever. They also identify missed opportunities in government care facilities, where diagnoses were missed either due to lack of testing or diagnostic tests administered too early.
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Citation: Jayakumar B, Murthy N, Misra K, Burza S (2019) "It's just a fever": Gender based barriers to care-seeking for visceral leishmaniasis in highly endemic districts of India: A qualitative study. PLOS Neglected Tropical Diseases 13(6): e0007457. https://doi.org/10.1371/journal.pntd.0007457
Funding: This research was conducted through financial support from UK Aid through the KalaCORE programme, grant PO 6361 (http://www.kalacore.org). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Journal
PLoS Neglected Tropical Diseases