03060nas a2200289   4500000000100000008004100001653003900042653001800081653001400099653001100113653002900124653003900153653001000192100001500202700001000217700001600227700001200243700001000255700001200265700001300277245013900290856009800429300001300527490000700540520220900547022001402756       2018                            d10aNeglected tropical diseases (NTDs)10aLeishmaniasis10aKnowledge10aStigma10aHealth seeking behaviour10aPost kalaazar dermal leishmaniasis10aIndia1 aGarapati P1 aPal B1 aSiddiqui NA1 aBimal S1 aDas P1 aMurti K1 aPandey K00aKnowledge, stigma, health seeking behaviour and its determinants among patients with post kalaazar dermal leishmaniasis, Bihar, India.  uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0203407&type=printable  ae02034070 v133 a<p><strong>BACKGROUND: </strong>Lesishmaniasis is a neglected tropical disease endemic in Bihar, India. Inappropriate health seeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients may increase the disease duration, severity and transmissibility. Simultaneously, lack of knowledge and perceived stigma may also increase the length of delay in receiving treatment. This ultimately effects the kala-azar elimination program.</p>

<p><strong>METHODS: </strong>A cross sectional study was conducted in 120 confirmed PKDL patients, aged 18 years and older. Data related to knowledge and health seeking behaviour was collected by a pre-tested questionnaire. EMIC stigma scale was used for assessing the perceived stigma. Patients were personally interviewed after taking informed consent. Data analysis was done by using SPSS 16 software.</p>

<p><strong>RESULTS: </strong>The time between appearance of symptoms and first medical consultation (patient delay) ranged from 15 days to 5475 days (15 years) with a median of 285 days. The time between first medical consultations to onset of specific treatment (system delay) ranged from 2 to 5475 days with a median of 365 days. Many patients approached first to quacks (8.4%), homeopathic and ayurvedic practitioners (25.8%) upon recognition of symptoms. Majority of the patients (68.3%) had poor knowledge about PKDL and its vector. Type of skin lesions and gender had significant association with patient delay and system delay respectively (p&lt;0.05). Distance to primary health centre (PHC) had significant association with patients delay as well as system delay (p&lt;0.05). Patients with younger age, unmarried and polymorphic lesions had higher stigma (p&lt;0.05). Patients with PKDL feel stigmatized in different areas.</p>

<p><strong>CONCLUSION: </strong>PKDL treatment delays were unacceptably high and patients had poor knowledge compounded with feelings of stigmatization. To reduce the delay, a system may be evolved to establish some sort of public-private collaboration, besides awareness programs should be tailored, and implemented for improving the patient education regarding the disease and its linkage with VL.</p>
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