Data for Variations in visceral leishmaniasis burden, mortality and the pathway to care within Bihar, India

Methods

Data from 6081 suspected VL patients who reported being clinically diagnosed during 2012–2013 across eight districts in Bihar were analysed. Graphical comparisons and Chi-square tests were used to determine differences in the burden of identified cases by season, district, age and sex. Log-linear regression models were fitted to onset (of symptoms)-to-diagnosis and onset-to-treatment waiting times to estimate their associations with age, sex, district and various socio-economic factors (SEFs).

Logistic regression models were used to identify factors associated with mortality. Results Comparisons of VL caseloads suggested an annual cycle peaking in January-March. A 17-fold variation in the burden of identified cases across districts and under-representation of young children (0–5 years) relative to age-specific populations in Bihar were observed.

Women accounted for a significantly lower proportion of the reported cases than men (41 vs 59%, P < 0.0001). Age, district of residence, house wall materials, caste, treatment cost, travelling for diagnosis and the number of treatments for symptoms before diagnosis were identified as correlates of waiting times. Mortality was associated with age, district of residence, onset-to-treatment waiting time, treatment duration, cattle ownership and cost of diagnosis.

Conclusions The distribution of VL in Bihar is highly heterogeneous, and reported caseloads and associated mortality vary significantly across different districts, posing different challenges to the elimination campaign. Socio-economic factors are important correlates of these differences, suggesting that elimination will require tailoring to population and sub-population circumstances.<br><br>STATA code for cleaning data from CARE India’s 2013 situation assessment of visceral leishmanisis (VL) incidence in Bihar State, India, during Jan 2012-Jun 2013, and running statistical analyses of factors affecting onset-to-diagnosis and onset-to-treatment times and all-cause mortality among the identified VL patients.