Abstract of Dissertation

Agency : Kala Azar, Indoor Residual Spray, FLW.

Objective : The objectives of the present study were; 1.To study the type of services being provided under the Kala Azar Program. 2. To study the attitude and practice of health providers towards Kala Azar. 3. To know the health seeking behavior of patients. 4. To identify the defaulters and the reasons behind defaulter’s non compliance for the treatment.

Background : Patna contributes to the case loads with > 1%. Its 21 blocks is under the effect of Kala Azar. Due to living conditions, local culture and geography of the region there is prevalence of Kala Azar. Cases recorded have been increased from 124 to 140 in a year from 2012 to 2013. The contributing factors are geography, migratory population, local practices and the poor unhygienic living condition. Delay in diagnosis and treatment may lead to increased prevalence of Kala Azar patients. A long term treatment, lack of compliance by patients, non availability of doctors, low awareness regarding the spread of Kala Azar in the community may be the cause of disease prevalence.

Methodology : Cross sectional descriptive study was carried in Dhanarua Block. One block was selected purposively. Then stratification was done with endemicity level and 4 HSCs were selected. Under each HSC, 2 villages were selected randomly. The total sample collected for qualitative study was 12 in number, 1 MoIC, 7 ASHAs and 4 ANMs. With sample size of 12 for health provider and 67 for Kala Azar patientspurposive sampling for block selection and stratification was done for HSC selection. Sample of 8 villages were randomly selected. Respondents included were 1 MOiC from block PHC, 4 ANMs from all the selected HSCs and 8 ASHAs from the village.

Findings : All the health providers were aware of the Kala Azar program and its components being provided. FLWs refer the patients to PHC for treatment. According to the health providers there was no gender discrimination, or any stigma attached with the disease. Due to delayed incentive to ASHA their attitude toward the treatment and program is not in their priority concern. The findings of patient’s health seeking behavior revealed; 40.5% patients had their diagnosis done after 2 months of illness; In zone of high endemic the 21 % patients visit Block PHC for treatment as compared to nil in low endemic area. Highest number of diagnosis is done at PHC (46%). Sixty percent patients were called up for follow up but none from turned up. About 94% completed their treatment once started. 81% response was in favour of acceptance for indoor residual spray. Only 20% were aware of the spray being done for Kala Azar.

Recommendations : Re-line listing for number of patients suffering from Kala Azar in the blocks to reflect the actual number of case load. Appropriate IEC materials need to be developed keeping in view of the local context.