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KALA, Z.; OMISHORE, A.; SEITL, S.; KREJSA, M.; KALA, J. Identification of variation coefficient of equivalent stress range of steel girders with cracks. International Journal of Mechanics, 2019, roč. 13, č. 2019, s. 69-78. ISSN: 1998-4448. Detail Link
To assess the knowledge, attitude, and preventive practices related to kala-azar in Madhepura district of Bihar, a community-based cross-sectional study was carried out in November 2014. A total of 353 households were interviewed from 24 villages of four blocks of Madhepura district. Data were collected using structured interview schedule. For knowledge, attitude, and preventive practice indexes, scores were assigned to individual questions based on the accuracy of responses. Univariate and binary logistic regressions were applied for the analysis. Eighty-four percent households had heard of kala-azar disease, but only 15.9% could recognize that sand flies were responsible for transmitting the disease. Overall, only 43.9% had fair knowledge on kala-azar disease (e.g., mode of transmission, signs and symptoms, and the outcome if left untreated) and the vector (breeding place, season, and biting time). Almost 48.6% had a favorable attitude toward treatability and management of kala-azar and 37.7% practiced proper mechanism to prevent and control kala-azar. Occupation emerged as a significant predictor for all three indexes. Other important predictors for the attitude index were literacy, household type, households ever had a kala-azar case, and knowledge index. Despite 61.8% of the households ever reported to have a member diagnosed with kala-azar, the overall knowledge of the disease and vector, attitude, and practices about prevention and control of kala-azar was found to be lagging. Therefore, our investigation suggests that further strengthening of comprehensive knowledge about kala-azar and preventive practices is needed.
Visceral leishmaniasis, popularly known as kala-azar, is a systemic parasitic disease, caused by Leishmania donovani complex.1 Humans and domestic animals, mainly dogs, are the reservoirs of the parasite. The disease is characterized by irregular fever, substantial weight loss, enlargement of the spleen and liver, pancytopenia, anemia, leukopenia, bone marrow suppression, and immunosuppression, making a patient susceptible to super-added infections.2,3 The disease is a progressive and, sometimes, asymptomatic infection and if left untreated, is fatal,4 with a mortality rate of almost 100%.5
A cross-sectional study was carried out in Madhepura district of eastern Bihar in 2014. Annual record of kala-azar cases for every block (an administrative unit and district subdivision in a state) of the district was obtained from the office of Assistant Chief Medical Officer, Madhepura, for the years 2011, 2012, and 2013. As there was high fluctuation in the number of reported cases from year to year, four administrative blocks were randomly selected from the list of 13 blocks in the district. Furthermore, six villages were selected randomly from each block, which comprised 24 villages in total. Mapping and listing of the selected villages (3,627 households) was carried out to identify the households with suspected and confirmed kala-azar cases in previous 3 years. A total of 353 households were identified based on the abovementioned criteria and interviewed to assess the knowledge, practices, and preventive attitudes toward kala-azar. All the selected households participated in the study. Data were collected using a structured interview schedule. The respondent was the head or the knowledgeable person of the household who could provide information about the members of the household, housing conditions, economic status, and availability of basic amenities in the house. The respondent may or may not be the confirmed/suspected case of kala-azar. Data were entered and analyzed using SPSS 21 (IBM Corp., Armonk, NY). Descriptive statistics and binary logistic regression was applied to analyze the data.
Fifty-six percent of the participants were males (Table 1). The mean age of the participants was 41.7 years (standard deviation [SD] ± 17.1). The majority of the participants were Hindus (93.8%), 92.7% belonged to schedule caste/tribe or other backward caste. Half of the participants were working in the agricultural sector. Literacy rate among the study participants was 35.1%. Eighty-one percent households had a below poverty line (BPL), card and 65.4% were living in a house made up of temporary material (kaccha), 31.2% lived in houses constructed with combination of temporary and permanent materials (semi-pucca), and 3.4% had houses made up of permanent material (pucca). More than three-fifths of the households had at least one member, who had been diagnosed with kala-azar anytime in the past.
From a total of 296 respondents who had heard of the disease, a few (15.9%) could recognize the picture of a sand fly (Table 3). One-fourth of them were not aware of the season in which kala-azar spreads; among those who were aware, 22.7% reported that the disease spreads during rainy season. About one-third of the participants knew that the sand fly bites at night whereas 36.5% were not aware of this fact. More than half were aware of one or more breeding places of kala-azar vector, such as stagnant/polluted water (64.4%), garbage sites (33.4%), dark places (28.7%), cracks and crevices (12.1%), and thatched roof (11.5%). The score for knowledge toward kala-azar disease and vector ranged from 0 to 10 with a mean of 4.5 (SD ± 1.3). According to the overall score, 43.9% had good knowledge of kala-azar disease and the vector. Those who were aware of kala-azar, knew about the disease and vector from health workers (42.9%) and friends/relatives (49%). Role of radio/television in spreading the awareness on kala-azar was limited to 4.7% of the participants and 8.8% reported to get awareness from newspaper/magazine.
Seven questions (Table 4) were included to assess the preventive attitude people have toward kala-azar. The majority of the participants (92.2%) disagreed with the statement that the incidence of kala-azar in the family should be kept secret. Approximately 58% believed that kala-azar is a serious disease as compared with malaria whereas 9.8% opined both diseases are equally serious. Twenty-four percent participants were of the opinion that controlling kala-azar through community participation is possible.
Eighty-one percent believed that early diagnosis can cure the disease early and same proportion reported that complete cure of the disease is possible. The public health-care facilities were the most common choice of place for treatment (84.1%), followed by the private sector (15.5%). More than 60% believed that inconsistent or incomplete treatment of the disease could affect the recovery of the patient. The value of preventive attitude index ranged from 0.5 to 7 with a mean score of 5.1 (SD ± 1.2). In all, less than half of the respondents (48.6%) had a positive attitude toward the treatability of kala-azar disease.
Awareness of signs and symptoms of a disease is a prerequisite for early treatment. However, in our study, 30% of the participants had no knowledge of signs/symptoms of kala-azar, although the disease has been endemic in the study area for many decades.13 In fact, the level of poor awareness about the sign and symptoms of kala-azar was much higher or similar to the findings of studies conducted in rural Bihar and other countries.1,21 Few other studies showed better knowledge of the symptoms in similar endemic areas.20,25 However, the knowledge that outcome of the untreated disease is death was found to be universal in our study. This might be due to repeated interactions of the community with the health personnel about kala-azar treatment and management and their own experiences.
Our findings revealed the limited role of mass media on generating awareness about kala-azar. The study highlighted the important role played by relatives and friends and the efforts of the local health workers in spreading awareness of kala-azar. These findings were consistent with the results of a study on kala-azar conducted in the Muzaffarpur district, Bihar.21 On the other hand, the studies carried out on other vector-borne diseases, such as malaria and dengue, reflected the substantial role of mass media in awareness generation.28,29
Kala-azar is also considered to be a poverty-related disease and affects the poorest of the poor.25,34,35 People living in remote rural areas with low nutrition, low education, and poor quality of housing are primarily affected by the disease.25,30 The findings from the present study concurs with this fact as most participants dwelled in poor living conditions (BPL cardholder and population living in kaccha houses). Most participants also opined that endemic kala-azar mainly affects the poor community and agreed that poverty and unhygienic conditions are responsible for the spread of disease. Apart from this, the presence of vegetation, water bodies, and pattern of settlements largely influence the sand fly population.18,36 Researchers have also found that the presence of shrubland/grassland37 and bamboo plantations34,38 near dwellings are likely to provide favorable breeding conditions for sand flies. Many of these factors were found in abundance in our study area in Madhepura district, making the population exposed to endemic kala-azar.
The effect of background characteristics on KAP indexes was also assessed. Occupation of the participants showed considerable positive influence on knowledge and attitude indexes. The finding that participants involved in agricultural activities had poor practices toward control/prevention of kala-azar indicates that the nature of work of the participants does not allow them to have good practice despite having good knowledge and favorable attitude. House type was positively associated with knowledge and preventive attitude index. As expected, good knowledge affected the attitude toward kala-azar. 2b1af7f3a8
