{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:21:10Z","timestamp":1790011270502,"version":"4.0.1"},"reference-count":62,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4,4]]},"abstract":"<jats:p>Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: \u201cshopping around\u201d for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be \u201chiding,\u201d requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0872","type":"journal-article","created":{"date-parts":[[2018,2,27]],"date-time":"2018-02-27T07:00:34Z","timestamp":1519714834000},"page":"1091-1101","source":"Crossref","is-referenced-by-count":18,"title":["\u201cKala-Azar is a Dishonest Disease\u201d: Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan"],"prefix":"10.4269","volume":"98","author":[{"given":"Temmy","family":"Sunyoto","sequence":"first","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"M\u00e9decins Sans Fronti\u00e8res Campaign for Access to Medicines, Geneva, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamal K.","family":"Adam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atia M.","family":"Atia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yassin","family":"Hamid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabie Ali","family":"Babiker","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nugdalla","family":"Abdelrahman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catiane","family":"Vander Kelen","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koert","family":"Ritmeijer","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Alcoba","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margriet","family":"den Boer","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Amsterdam, The Netherlands;"},{"name":"KalaCORE Consortium, London, United 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