title: The economic impact of visceral leishmaniasis on households in Bangladesh.
abstract: OBJECTIVE
  To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh.
  
  
  METHODS
  Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered.
  
  
  RESULTS
  Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%).
  
  
  CONCLUSIONS
  Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Anoopa Sharma
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
authors.forename: Beena
authors.initials: B
authors.lastname: Varghese
authors.forename: Rajib
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.forename: Mustakim
authors.initials: M
authors.lastname: Ali
authors.forename: Josef
authors.initials: J
authors.lastname: Amann
authors.forename: Indu B
authors.initials: IB
authors.lastname: Ahluwalia
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wagatsuma
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
authors.forename: Deborah A
authors.initials: DA
authors.lastname: McFarland
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007182:Income; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008518:Medicine, East Asian Traditional; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011331:Private Practice / Q000191:economics; D012423:Rural Health; D017678:Sex Distribution
chemical_list: D000981:Antiprotozoal Agents