Epidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients Under Wartime Conditions and with Limited Resources.

Hdl Handle:
http://hdl.handle.net/10144/23212
Title:
Epidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients Under Wartime Conditions and with Limited Resources.
Authors:
Seaman, J; Mercer, A; Sondorp, H; Herwaldt, B L
Journal:
Annals of Internal Medicine
Abstract:
OBJECTIVES: 1) To determine the proportions of patients with visceral leishmaniasis who had various treatment outcomes when cared for under wartime conditions and with limited resources and 2) to identify patient characteristics associated with the outcomes. DESIGN: Cohort study. SETTING: Médecins sans Frontières-Holland's treatment center in Duar, Western Upper Nile Province, an area in southern Sudan that has been severely affected by Sudan's civil war and a massive epidemic of visceral leishmaniasis. PATIENTS: 3076 consecutive patients who had visceral leishmaniasis, were admitted to the treatment center the first year the center was operational (August 1990 to July 1991), and were treated with the pentavalent antimonial compound sodium stibogluconate. MEASUREMENTS: Patient characteristics on admission and four mutually exclusive treatment outcomes (default during first admission, death during first admission, discharge and readmission for retreatment [relapse], and discharge and no readmission for retreatment [successful treatment]). RESULTS: The patients had a median age of 15 years and were notably anemic (median hemoglobin level, 77g/L) and malnourished (median body mass index of adults [> or = 18 years of age], 15.2 kg/m2); most (91.0%) had been sick less than 5 months. Although patients could not be monitored after treatment to document cure, most (2562 [83.3%]) were successfully treated; 336 (10.9%) died during their first admission, and 79 are known to have relapsed (3.0% of those discharged alive [that is, those whose final treatment outcome was successful treatment or relapse]). In univariable analysis, young and older age (<5 or > or = 45 years of age), long duration of illness (> or = 5 months), markedly low hemoglobin level or body mass index, large spleen, high parasite density, and vomiting at least once during the treatment course were associated with death. In multiple logistic regression analysis of data for a subgroup of 1207 adults (those who did not default or relapse and for whom data were recorded on age, sex, duration of illness, hemoglobin level, body mass index, and spleen size), the approximate risk ratios for death were 2.2 (95% Cl, 1.4 to 3.6) for those with a long duration of illness, 3.6 (Cl, 2.1 to 5.9) for those 45 years of age or older, 4.6 (Cl, 2.2 to 9.4) for those with a hemoglobin level less than 60 g/L, and 12.2 (Cl, 3.2 to 47.2) for those with a body mass index less than 12.2 kg/m2. CONCLUSION; Despite the severe debility of the patients and the exceptionally difficult circumstances under which they were treated, most fared remarkably well.
Affiliation:
Médecins sans Frontières-Holland, Amsterdam, The Netherlands.
Issue Date:
1-Apr-1996
URI:
http://hdl.handle.net/10144/23212
PubMed ID:
8607595
Additional Links:
http://www.annals.org/cgi/content/full/124/7/664
Language:
en
Description:
To access the article, click on "Additional Links"
ISSN:
0003-4819
Appears in Collections:
Leishmaniasis/Kala Azar

Full metadata record

DC FieldValue Language
dc.contributor.authorSeaman, J-
dc.contributor.authorMercer, A-
dc.contributor.authorSondorp, H-
dc.contributor.authorHerwaldt, B L-
dc.date.accessioned2008-04-14T10:55:45Z-
dc.date.available2008-04-14T10:55:45Z-
dc.date.issued1996-04-01-
dc.identifier.citationEpidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients Under Wartime Conditions and with Limited Resources. 1996, 124 (7):664-72 Ann. Intern. Meden
dc.identifier.issn0003-4819-
dc.identifier.pmid8607595-
dc.identifier.urihttp://hdl.handle.net/10144/23212-
dc.descriptionTo access the article, click on "Additional Links"en
dc.description.abstractOBJECTIVES: 1) To determine the proportions of patients with visceral leishmaniasis who had various treatment outcomes when cared for under wartime conditions and with limited resources and 2) to identify patient characteristics associated with the outcomes. DESIGN: Cohort study. SETTING: Médecins sans Frontières-Holland's treatment center in Duar, Western Upper Nile Province, an area in southern Sudan that has been severely affected by Sudan's civil war and a massive epidemic of visceral leishmaniasis. PATIENTS: 3076 consecutive patients who had visceral leishmaniasis, were admitted to the treatment center the first year the center was operational (August 1990 to July 1991), and were treated with the pentavalent antimonial compound sodium stibogluconate. MEASUREMENTS: Patient characteristics on admission and four mutually exclusive treatment outcomes (default during first admission, death during first admission, discharge and readmission for retreatment [relapse], and discharge and no readmission for retreatment [successful treatment]). RESULTS: The patients had a median age of 15 years and were notably anemic (median hemoglobin level, 77g/L) and malnourished (median body mass index of adults [> or = 18 years of age], 15.2 kg/m2); most (91.0%) had been sick less than 5 months. Although patients could not be monitored after treatment to document cure, most (2562 [83.3%]) were successfully treated; 336 (10.9%) died during their first admission, and 79 are known to have relapsed (3.0% of those discharged alive [that is, those whose final treatment outcome was successful treatment or relapse]). In univariable analysis, young and older age (<5 or > or = 45 years of age), long duration of illness (> or = 5 months), markedly low hemoglobin level or body mass index, large spleen, high parasite density, and vomiting at least once during the treatment course were associated with death. In multiple logistic regression analysis of data for a subgroup of 1207 adults (those who did not default or relapse and for whom data were recorded on age, sex, duration of illness, hemoglobin level, body mass index, and spleen size), the approximate risk ratios for death were 2.2 (95% Cl, 1.4 to 3.6) for those with a long duration of illness, 3.6 (Cl, 2.1 to 5.9) for those 45 years of age or older, 4.6 (Cl, 2.2 to 9.4) for those with a hemoglobin level less than 60 g/L, and 12.2 (Cl, 3.2 to 47.2) for those with a body mass index less than 12.2 kg/m2. CONCLUSION; Despite the severe debility of the patients and the exceptionally difficult circumstances under which they were treated, most fared remarkably well.en
dc.language.isoenen
dc.relation.urlhttp://www.annals.org/cgi/content/full/124/7/664en
dc.rightsArchived on this site with kind permission from the American College of Physicians and Annals of Internal Medicineen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAntimony Sodium Gluconateen
dc.subject.meshAntiprotozoal Agentsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCohort Studiesen
dc.subject.meshDisease Outbreaksen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshLeishmaniasis, Visceralen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPrognosisen
dc.subject.meshRisk Factorsen
dc.subject.meshStatistics as Topicen
dc.subject.meshSudanen
dc.subject.meshTreatment Outcomeen
dc.subject.meshWaren
dc.titleEpidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients Under Wartime Conditions and with Limited Resources.en
dc.contributor.departmentMédecins sans Frontières-Holland, Amsterdam, The Netherlands.en
dc.identifier.journalAnnals of Internal Medicineen
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