title: Incidence of kala-azar in Nepal: estimating the effects of individual and household characteristics.
abstract: Kala-azar (KA) remains a major public health problem in Nepal. The disease is preventable, but various environmental, socioeconomic, health care and health behaviour related variables affect its transmission. Household or individual related factors determine the magnitude and direction of impacts of these factors. Data were collected from clinically diagnosed KA patients and non-KA patients from hospitals in Nepal. The hospitals are located in the highest KA incidence rate districts. Logistic regressions are used to identify individual and household characteristics affecting the probability of having KA by estimating models with and without the introduction of interaction terms. Poverty incidence, being a member of disadvantaged population group, size of family and literacy are important in explaining the likelihood of having KA. Poverty directly influences the likelihood of KA and modifies the magnitude and direction of the effects of other variables. The traditional approach of controlling KA at the community level should be complemented by poverty alleviation and other developmental activities to ensure rapid decline and eradication of KA. Poverty and illiteracy magnifies the problem of KA at the community level and simultaneous implementation of KA control interventions with effective poverty alleviation strategies is likely to be much more effective than the traditional disease control program alone.
authors.affiliation: Centre for Health Economics, Chulalongkorn University, Bangkok 10330, Thailand. sssadhikari@yahoo.com
authors.forename: Shiva Raj
authors.initials: SR
authors.lastname: Adhikari
authors.forename: Siripen
authors.initials: S
authors.lastname: Supakankunti
authors.forename: M Mahmud
authors.initials: MM
authors.lastname: Khan
mesh_terms: D000328:Adult; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011634:Public Health; D012959:Socioeconomic Factors