{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:04:24Z","timestamp":1790633064702,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"PHIDReC the Public Health and Infectious Disease Research Centre in Kathmandu"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>At the time when Nepal is on the verge of reaching the maintenance phase of the Visceral Leishmaniasis (<jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>) elimination program, the country is facing new challenges. The disease has expanded to 61 of the country's 75 districts including previously non\u2010endemic areas where there is no control or patient management program in place. This study aimed to assess which elements of the surveillance and reporting systems need strengthening to identify cases at an early stage, prevent further transmission and ensure sustained <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content> elimination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a cross\u2010sectional mixed\u2010method study, we collected data from two study populations in <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content> program and non\u2010program districts. From February to May 2016, structured interviews were conducted with 40 <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content> patients, and 14 in\u2010depth and semi\u2010structured interviews were conducted with health managers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median total delay from onset of symptoms to successful reporting to the Ministry of Health was 68.5\u00a0days in the <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>\u2010program and 83\u00a0days in non\u2010program districts. The difference in patient's delay from the onset of symptoms to seeking health care was 3\u00a0days in <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>\u2010program and 20\u00a0days in non\u2010program districts. The diagnostic delay (38.5\u00a0days and 36\u00a0days, respectively), treatment delay (1 vs. 1\u00a0days) and reporting delay (45 vs. 36\u00a0days) were similar in program and non\u2010program districts. The diagnostic delay increased three\u2010fold from 2012, while treatment and reporting delay remained unchanged. The main barriers to surveillance were: (i) lack of access and awareness in non\u2010program districts; (ii) growing private sector not included in and not participating to referral, treatment and reporting; (iii) lack of cooperation and coordination among stakeholders for training and deployment of interventions; (iv) insufficient validation, outreach and process optimisation of the reporting system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Corrective measures are needed to maintain the achievements of the <jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content> elimination campaign and prevent resurgence of the disease in Nepal. A clear patient referral structure, reinforcement of report notification and validation and direct relay of data by local hospitals and the private sector to the district health offices are needed to ensure prompt treatment and timely and reliable information to facilitate a responsive system of interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13189","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T02:50:14Z","timestamp":1545187814000},"page":"192-204","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Barriers of Visceral Leishmaniasis reporting and surveillance in Nepal: comparison of governmental <scp>VL<\/scp>\u2010program districts with non\u2010program districts"],"prefix":"10.1111","volume":"24","author":[{"given":"DaJull","family":"Lim","sequence":"first","affiliation":[{"name":"General Medicine Department University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha Raj","family":"Banjara","sequence":"additional","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Public Health and Infectious Disease Research Centre (PHIDReC) Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand Ballabh","family":"Joshi","sequence":"additional","affiliation":[{"name":"Public Health and Infectious Disease Research Centre (PHIDReC) Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra Kumar","family":"Gurung","sequence":"additional","affiliation":[{"name":"Public Health and Infectious Disease Research Centre (PHIDReC) Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murari Lal","family":"Das","sequence":"additional","affiliation":[{"name":"BP Koirala Institute of Health Sciences Dharan Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Matlashewski","sequence":"additional","affiliation":[{"name":"McGill University Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Olliaro","sequence":"additional","affiliation":[{"name":"UNICEF\/UNDP\/World Bank\/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Kroeger","sequence":"additional","affiliation":[{"name":"UNICEF\/UNDP\/World Bank\/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Geneva Switzerland"},{"name":"Center for Medicine and Society University of Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"WHO.http:\/\/www.who.int\/mediacentre\/factsheets\/fs375\/en\/. 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