{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:21:46Z","timestamp":1780730506183,"version":"3.54.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011138","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000}}],"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016285","name":"TDR","doi-asserted-by":"publisher","award":["Project ID P21- 00145"],"award-info":[{"award-number":["Project ID P21- 00145"]}],"id":[{"id":"10.13039\/100016285","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In Nepal, the burden of post kala-azar dermal leishmaniasis (PKDL) is not known since there is no active case detection of PKDL by the national programme. PKDL patients could pose a challenge to sustain visceral leishmaniasis (VL) elimination. The objective of this study was to determine the prevalence of PKDL and assess PKDL patients\u2019 knowledge on VL and PKDL, and stigma associated with PKDL.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>Household surveys were conducted in 98 VL endemic villages of five districts that reported the highest number of VL cases within 2018\u20132021. A total of 6,821 households with 40373 individuals were screened for PKDL. Cases with skin lesions were referred to hospitals and examined by dermatologists. Suspected PKDL cases were tested with rK39 and smear microscopy from skin lesions. An integrated diagnostic approach was implemented in two hospitals with a focus on management of leprosy cases where cases with non-leprosy skin lesions were tested for PKDL with rK39. Confirmed PKDL patients were interviewed to assess knowledge and stigma associated with PKDL, using explanatory model interview catalogue (EMIC) with maximum score of 36. Among 147 cases with skin lesions in the survey, 9 (6.12%) were confirmed as PKDL by dermatologists at the hospital. The prevalence of PKDL was 2.23 per 10,000 population. Among these 9 PKDL cases, 5 had a past history of VL and 4 did not. PKDL cases without a past history of VL were detected among the \u201cnew foci\u201d, Surkhet but none in Palpa. None of the cases negative for leprosy were positive for PKDL. There was very limited knowledge of PKDL and VL among PKDL cases. PKDL patients suffered to some degree from social and psychological stigma (mean \u00b1 s.d. score = 17.89 \u00b1 12.84).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>Strengthening the programme in PKDL case detection and management would probably contribute to sustenance of VL elimination. Awareness raising activities to promote knowledge and reduce social stigma should be conducted in VL endemic areas.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0011138","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T18:54:16Z","timestamp":1675968856000},"page":"e0011138","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prevalence of post kala-azar dermal leishmaniasis (PKDL) and treatment seeking behavior of PKDL patients in Nepal"],"prefix":"10.1371","volume":"17","author":[{"given":"Anand Ballabh","family":"Joshi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-6127","authenticated-orcid":true,"given":"Megha Raj","family":"Banjara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murari Lal","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragyan","family":"Ghale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna Raj","family":"Pant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj","family":"Parajuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uttam Raj","family":"Pyakurel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokarna Raj","family":"Dahal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuman Lal","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Kroeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Aseffa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"key":"pntd.0011138.ref001","unstructured":"Department of Health Services, Nepal. Annual report, 2020\/2021."},{"key":"pntd.0011138.ref002","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1086\/648727","article-title":"Increasing incidence of post\u2013kala-azar dermal leishmaniasis in a population based study in Bangladesh","volume":"50","author":"KM Rahman","year":"2010","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pntd.0011138.ref003","doi-asserted-by":"crossref","first-page":"e0007653","DOI":"10.1371\/journal.pntd.0007653","article-title":"Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh","volume":"13","author":"D Mondal","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pntd.0011138.ref004","doi-asserted-by":"crossref","first-page":"e0008429","DOI":"10.1371\/journal.pntd.0008429","article-title":"Long-term incidence of relapse and post-kala-azar dermal leishmaniasis after three different visceral leishmaniasis treatment regimens in Bihar, India","volume":"14","author":"V Goyal","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0011138.ref005","doi-asserted-by":"crossref","first-page":"e1433","DOI":"10.1371\/journal.pntd.0001433","article-title":"Post-kala-azar dermal leishmaniasis in Nepal: A retrospective cohort study (2000\u20132010)","volume":"5","author":"S Uranw","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"pntd.0011138.ref006","doi-asserted-by":"crossref","first-page":"e0005877","DOI":"10.1371\/journal.pntd.0005877","article-title":"Post-kala-azar dermal leishmaniasis in the Indian subcontinent: A threat to the South-East Asia Region Kala-azar Elimination Programme","volume":"11","author":"EE Zijlstra","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0011138.ref007","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1093\/cid\/ciy891","article-title":"Quantifying the infectiousness of post-kala-azar dermal leishmaniasis toward sandflies","volume":"69","author":"D Mondal","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pntd.0011138.ref008","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/136346159703400204","article-title":"Explanatory Model Interview Catalogue (EMIC): Framework for Comparative Study of Illness","volume":"34","author":"M. 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