Assessment of knowledge, attitude and practice on visceral leishmaniasis in Sunderpur VDC of Mahottari district

Abstract

kala-azar(KA), also known as visceral leishmaniasis, tropical spleenomegaly, Sirkari disease and dumdum or Assam fever, is an important public health problem in many parts of the world. Of the 500,000 new cases of kala-azar which occur annually, 90% are in five countries: Bangladesh, Brazil, India and Nepal. In this region, Visceral leishmaniasis is endemic in Bangladesh, Nepal and India. The incidence is declining as result of improvement of situation in Bangladesh and India, but cases have been rising in Nepal. In India, Bihar which is attached to the study district Mahotari, contributes about 90 % cases and the remaining cases are from UP and west Bengal. The incidence has a focuses in the border districts, particularly on the India-Nepal borders. Leishmaniasis has been the cause of great suffering and death for hundreds of years. Leishman and Donovan first described visceral Leishmaniasis in 1903, hence the causative agent was named leishmania donavani. The Leishmaniases are now endemic in 88 countries on five continents- Africa, Asia, Europe, North America and South America- with a total of 350 million people at risk. 72, out of 88 are in developing countries and 13 of them are among the least developed in the world.

The general objectives of the study is to assess the Knowledge, Attitude and Practice of the general people on VL in rural VDC of an endemic district. And the specific objectives are as (1) To assess the knowledge of the people on VL. (2) To find out the attitude of the people regarding VL. (3)To find out the practices of the people on factors affecting VL. This was a descriptive and cross-sectional study.The study was conducted in sunderpur VDC of Mahottari district (purposively selected) where Bench Mark study was previously conducted in 2002. As described earlier, this is the VDC from where the KA cases are reported relatively in higher number. The total number of HHs of this VDC accounted 593. The study population was the general population of ward no. 4 of sunderpur VDC.

This was multi-stage sampling. Where out of 12 VL endemic districts, mahottari district was selected. In the second stage Sunderpur VDC(Purposive sampling) was selected. In the third stage ward no. 4 (purposive sampling) was selected. And in the fourth stage individuals were selected (Stratified Proportionate Systematic Random Sampling).Finally the sample frame was total population of household heads ( 86 household heads) of ward no. 4 of Sunderpur VDC. The data collection technique was interview and observation. For which structured questionnaires and observation checklists were formulated. After completion of this study I found Since kala-azar in Nepal as in the rest of the world is a disease of poverty, only a small proportion of the kala-azar affected population of the lowest socio-economic strata living in remote rural regions has no access to health institutions. The ultimate goal of kala-azar elimination is to contribute to mitigation of poverty in the 12 kala-azar affected districts of Nepal by reducing the burden of the disease and assisting in the development of equitable health systems. The information of the research drawn from the interview, observation checklists, FGD and literature review to make it more reliable and authentic. Majority of the people are illiterate in the study area. Therefore, there need to be initiated educational based programs by the government and non-governmental agencies. The people of the study have been adopting agriculture. About 46.51 percent of the sampled population involves in the agriculture services and remaining other population adopts non-agricultural activities like population adopts non-agricultural activities like business, service etc. This study shows that intervention can bring about a significant change in people’s knowledge regarding suspecting of KA cases, sand-fly as a transmitting vector, availability of free treatment and also in the referral of KA cases by FCHVs. Regarding preventive/risk factors/ behaviours like sleeping inside the animal shed is found29%.