Conflict and kala-azar: determinants of adverse outcomes of kala-azar among patients in southern Sudan.
We analyzed data obtained from 3365 patients with kala-azar (KA) or post-KA dermal leishmaniasis (PKDL) treated by Medecins Sans Frontieres-Holland in south Sudan from October 1998-May 2002. Patients were malnourished (median body mass index [BMI], 15.5; median weight for height [WFH], 75.5%) and anemic (median hemoglobin (Hb) level, 8.5 g/dL). The proportion of patients with primary KA who were children <5 years old increased from 2.5%, in 1998, to 19.8%, in 2002 (P<.0001). Therapy with sodium stibogluconate cured 91.9% of patients with primary KA, and dosages of >850 mg per day did not decrease the chances of survival. Risk factors for death among adults were age > or =45 years (odds ratio [OR], 4.6), malnutrition (BMI, <13; OR, 11.0), anemia (Hb level, <8 g/dL; OR, 4.0), and duration of illness (duration, > or =5 months; OR, 2.3). Risk factors for death among children and adolescents were age <2 years (OR, 5.4,), malnutrition (WFH, <60%; OR, 5.0), anemia (Hb level, <6 g/dL; OR, 3.7), and splenomegaly (OR, 2.9). A higher risk of death was associated with episodes of diarrhea (OR, 1.4), vomiting (OR, 2.7), and bleeding (OR, 2.9). Relapse and PKDL occurred in 3.9% and 10.0% of cases, respectively.
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Simon
S
Collin
Robert
R
Davidson
Koert
K
Ritmeijer
Kees
K
Keus
Yosef
Y
Melaku
Sammy
S
Kipngetich
Clive
C
Davies
D000293:Adolescent; D000367:Age Factors; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use*; D001835:Body Weight / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D013397:Sudan / Q000453:epidemiology; D016896:Treatment Outcome; D014857:Warfare
D000967:Antimony Sodium Gluconate