title: The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India.
abstract: OBJECTIVE
  To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India's cases.
  
  
  METHODS
  Using a survey of a stratified multistage sampling of 15 178 households with 214 individuals with VL in the previous 12 months, the study provides data on VL treatment expenditures, financing and days of work lost in the context of overall household expenditures, income sources and assets.
  
  
  RESULTS
  Median household expenditures on VL treatment represent, on average, 11% of annual household expenditures and an estimated 7 months of an individual's income at the daily wage in rural Bihar. With 87% of households forced to take out loans to finance disease costs, VL can contribute to a spiral of increasing poverty. The current pattern of VL treatment, with multiple visits and treatments for a single episode of illness, significantly increases the economic burden on the household.
  
  
  CONCLUSIONS
  India's National Elimination Program to make effective treatments accessible to the rural poor, if combined with expanded efforts to improve timely access to diagnosis by conducting rapid diagnostic tests closer to the community (and mobilizing the rural population to seek effective treatment earlier), can reduce VL's economic burden on India's rural households.
authors.affiliation: Institute for OneWorld Health, San Francisco CA 94111, USA. rsarnoff@oneworldhealth.org
authors.forename: Rhonda
authors.initials: R
authors.lastname: Sarnoff
authors.forename: Jaikishan
authors.initials: J
authors.lastname: Desai
authors.forename: Philippe
authors.initials: P
authors.lastname: Desjeux
authors.forename: Atul
authors.initials: A
authors.lastname: Mittal
authors.forename: Roshan
authors.initials: R
authors.lastname: Topno
authors.forename: Niyamat Ali
authors.initials: NA
authors.lastname: Siddiqui
authors.forename: Arvind
authors.initials: A
authors.lastname: Pandey
authors.forename: Dipika
authors.initials: D
authors.lastname: Sur
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D017281:Cost of Illness; D019353:Endemic Diseases / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000469:parasitology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors