Barriers of visceral leishmaniasis reporting and surveillance in Nepal : : comparison of governmental VL-program districts with non-program districts

Abstract: Background
At the time when Nepal is on the verge of reaching the maintenance phase of the visceral leishmaniasis (VL) elimination program, the country is faced with new challenges; the disease is now found in 61 of the country’s 75 districts including previously non-endemic areas called non- program areas where there is no control or patient management program in place. This study aimed to assess which elements of the surveillance and reporting systems need strengthening to identify cases at an early stage, prevent further transmission and ensure sustained VL elimination.
Methods
In a cross sectional, mixed-method study, quantitative and qualitative data was collected from two study populations in VL-program and non-program districts. From February to May 2016, structured interviews were conducted with 40 VL patients, and 14 in-depth and semi-structured interviews were conducted with health managers.
Results
The total delay from onset of symptoms to successful reporting to the Ministry of Health was 104 days in the VL-program and 129 days in non-program districts. The main difference was in patient’s delay (from onset of symptoms to seeking health care), which was 14 days in VL-program and 31 days in non-program districts; the diagnostic delay (73 days and 80 days, respectively), treatment delay (5 vs. 2 days) and reporting delay (17 vs. 18 days) were similar. The diagnostic delay increased three-fold from 2012, while treatment and reporting remained unchanged. The main barriers to surveillance were; 1) Access and awareness in new-endemic districts, 2) Not included private sector for referral, treatment and reporting, 3) Lack of cooperation and coordination among stakeholders for training and interventions, 4) Insufficient validation, outreach and process optimization of the reporting system.
Conclusions
Corrective measures are needed to maintain the achievements of the VL elimination campaign and prevent resurgence of the disease. A clear patient referral structure, reinforcement of report notification and validation, direct information of district health offices by local hospitals and involvement of the private sector is needed to ensure timely and reliable information to facilitate a responsive system of interventions

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch
• Notes: Albert-Ludwigs-Universität Freiburg, Dissertation, 2017

Classification and Topics

• Classification: Soziale Probleme, Sozialdienste, Versicherungen
• Keyword: Leishmania donovani

Contributors, Places and Time

• Event: Veröffentlichung
• (where): Freiburg
• (who): Universität
• (when): 2018
• Creator: Lim, DaJull
• Contributor: Wittwer-Backofen, Ursula ; Brüggemeier, Franz-Josef ; Albert-Ludwigs-Universität Freiburg. Biologische Anthropologie ; Albert-Ludwigs-Universität Freiburg. Medizinische Fakultät ; Albert-Ludwigs-Universität Freiburg

Further information

• DOI: 10.6094/UNIFR/13828
• URN: urn:nbn:de:bsz:25-freidok-138285
• Rights: Kein Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 14.08.2025, 10:47 AM CEST