title: Accessibility of diagnostic and treatment centres for visceral leishmaniasis in Gedaref State, northern Sudan.
abstract: OBJECTIVE
  To evaluate the accessibility of visceral leishmaniasis (VL) treatment.
  
  
  METHODS
  Community-based study using in-depth qualitative interviews and focus group discussions with key informants, as well as quantitative questionnaires with 448 randomly selected heads of households in nine representative villages in three geographical sub-regions.
  
  
  RESULTS
  Despite the high incidence of the disease, most people in Gedaref State know little about VL, and help at a treatment centre is usually sought only after traditional remedies and basic allopathic drugs have failed. Factors barring access to treatment are: lack of money for treatment and transport, impassability of roads, work priorities, severe cultural restrictions of women's decision-making power and distance to the next health center.
  
  
  CONCLUSIONS
  To provide more VL patients with access to treatment in this highly endemic area, diagnostic and treatment services should be decentralized. Health education would be a useful tool to rationalise people's health-seeking behaviour.
authors.affiliation: Médecins Sans Frontières Holland, Amsterdam, The Netherlands. sgerstl@aol.com
authors.forename: S
authors.initials: S
authors.lastname: Gerstl
authors.forename: R
authors.initials: R
authors.lastname: Amsalu
authors.forename: K
authors.initials: K
authors.lastname: Ritmeijer
mesh_terms: D017281:Cost of Illness; D003469:Culture; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D015994:Incidence; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D009752:Nutritional Status; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012423:Rural Health; D012621:Seasons; D012959:Socioeconomic Factors; D013397:Sudan / Q000453:epidemiology; D014186:Transportation