Visceral leishmaniasis-associated mortality in Bangladesh: a retrospective cross-sectional study

OBJECTIVE To investigate visceral leishmaniasis (VL) deaths and risk factors in two VL endemic areas of Bangladesh. DESIGN Retrospective cross-sectional. SETTING Two geographically and culturally different VL endemic subdistricts, Godagari in the district of Rajshahi and Trishal in the district of Mymensingh in Bangladesh, August 2009-December 2011. PARTICIPANTS 51 094 inhabitants from randomly selected Unions in the two subdistricts. MAIN OUTCOME MEASURES VL deaths, confirmed independently by qualified physicians using the verbal autopsy procedure ICD10 guideline. RESULTS The total number of people screened for VL deaths was 51 094 from 12 032 households from Godagari and Trishal subdistricts . About 16% of the people from Godagari were Tribals. The average age of the study population was 25.6 years (SD 18.4) and 49.7% were females. The VL case fatality rate averaged 6.12% (12/196) including 2/137 in Trishal and 10/59 in Godagari. Most of the VL deaths (9/12, 75%) occurred at home and the rest in tertiary hospitals. None of these deaths had been reported in the national VL surveillance system. The VL case fatality rate in the Tribal ethnic (22.2%) population was about 17 times higher than that in the Bangali ethnic (1.3%) population (p<0.0001). Tribal ethnicity had an 18 times (OR=18.1, 95% CI 3.6 to 90.6) higher risk for VL deaths compared with Bangali ethnicity (p<0.0001). CONCLUSION VL deaths were found to be high in the study areas and were under-reported. The Tribal ethnic population was at the highest risk for VL deaths. The national VL Elimination Programme should give special attention to the tribal community in the endemic areas, especially for those in Rajshahi, and should strengthen VL surveillance by including tertiary hospitals in the national surveillance system.