Challenges and Changing Trends in Visceral Leishmaniasis: A Study at Bheri Hospital, Nepal

Abstract

Introduction: Visceral Leishmaniasis (VL) is one of the major public health problems of Nepal and is almost a fatal disease if not managed timely. VL cases have been reported in Nepal since 1980. The Government of Nepal is committed to reducing VL morbidity and mortality and to eliminating this disease through early case detection and treatment via effective diagnostic and treatment facilities at hospitals and health facilities through various trainings on revised national guidelines and treatment protocol, review meetings, disease surveillance, indoor residual spraying in priority affected areas by 2026. The study was conducted to investigate the current challenges and evolving trends in the epidemiology, clinical presentation, diagnosis, and management of visceral leishmaniasis at Nepal, with the goal of informing improved healthcare strategies and control measures.

Methods: This prospective hospital-based study was conducted in the Department of Medicine, Bheri Hospital, Nepal, from July 2016 to June 2018. Data were entered in Excel and analyzed using SPSS 18th version. Descriptive data were presented in a pie chart and table with frequency and percentages.

Results: A total of 60 patients were diagnosed with VL during the study period. Males comprised 52 (87%) and females 8 (13%) patients. Eighty-eight percent (53) of patients were above 15 years of age and twelve percent (7) were below 15 years. The median age was found to be 28 years. Twenty (33%) patients belonged to hilly regions, 31 (52%) were from Terai and 9 (15%) patients belonged to mountains. Our result shows that VL is not only found in the South and East but also prevalent in the North and West, it is not only seen in the Terai region but also found in hills and mountain regions. Relapse after treatment with liposomal amphotericin B was seen in 10 (16.7%) cases.

Conclusions: VL is a chronic protozoal infection requiring specific and expensive treatment, having near 100% mortality if not treated in time. Relapses made the disease further challenging. Reporting cases from so-called nonendemic areas has made this disease more challenging. Urgent revision of treatment protocol is needed for appropriate management of visceral leishmaniasis and to prevent relapse and expansion of dedicated kala-azar elimination program in a new emerging geographical area is demanding