Risk factors for kala-azar in Bangladesh

Caryn Bern, Allen W Hightower, Rajib Chowdhury, Mustakim Ali, Josef Amann, Yukiko Wagatsuma, Rashidul Haque, Katie Kurkjian, Louise E Vaz, Moarrita Begum, Tangin Akter, Catherine B Cetre-Sossah, Indu B Ahluwalia, Ellen Dotson, W Evan Secor, Robert F Breiman, James H Maguire, Caryn Bern, Allen W Hightower, Rajib Chowdhury, Mustakim Ali, Josef Amann, Yukiko Wagatsuma, Rashidul Haque, Katie Kurkjian, Louise E Vaz, Moarrita Begum, Tangin Akter, Catherine B Cetre-Sossah, Indu B Ahluwalia, Ellen Dotson, W Evan Secor, Robert F Breiman, James H Maguire

Abstract

Since 1990, South Asia has experienced a resurgence of kala-azar (visceral leishmaniasis). To determine risk factors for kala-azar, we performed cross-sectional surveys over a 3-year period in a Bangladeshi community. By history, active case detection, and serologic screening, 155 of 2,356 residents had kala-azar with onset from 2000 to 2003. Risk was highest for persons 3-45 years of age, and no significant difference by sex was seen. In age-adjusted multivariable models, 3 factors were identified: proximity to a previous kala-azar patient (odds ratio [OR] 25.4, 95% confidence interval [CI] 15-44 within household; OR 3.2 95% CI 1.7-6.1 within 50 m), bed net use in summer (OR 0.7, 95% CI 0.53-0.93), and cattle per 1,000 m2 (OR 0.8, 95% CI 0.70-0.94]). No difference was seen by income, education, or occupation; land ownership or other assets; housing materials and condition; or keeping goats or chickens inside bedrooms. Our data confirm strong clustering and suggest that insecticide-treated nets could be effective in preventing kala-azar.

Figures

Figure 1
Figure 1
A) Kala-azar cases by symptom-onset month, Bangladesh, January 2000 to August 2003. B) Kala-azar cases by quarter of symptom onset, based on aggregated data, 2000–2002. Ascertainment for cases with onset in 2003 was not complete at the time of analysis.
Figure 2
Figure 2
Location of kala-azar patients by year of symptom onset in para 1, Bangladesh, 2000–2003.

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Source: PubMed

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