Academic journal article Journal of Health Population and Nutrition

Screening Utility, Local Perceptions, and Care-Seeking for Reported Jaundeesh among Respondents Lacking Signs of Icterus in Rural Bangladesh

Academic journal article Journal of Health Population and Nutrition

Screening Utility, Local Perceptions, and Care-Seeking for Reported Jaundeesh among Respondents Lacking Signs of Icterus in Rural Bangladesh

Article excerpt

INTRODUCTION

Viral hepatitis is a significant public-health problem in Bangladesh (1). Although hepatitis A and E viruses (both water-borne, faecal-oral pathogens) cause low mortality in the general population, these lead to significant annual morbidity and loss of productivity across much of South Asia (1,2). Exposure to hepatitis A is nearly ubiquitous, resulting in widespread infection in early life and consequent lifelong immunity (1). Assessing clinical data, 1,823 patients in Dhaka, Bangladesh, suspected to suffer from hepatitis B, Khan et al. detected antibodies to hepatitis A and E virus among 39% and 53% of subjects respectively. Hepatitis E, associated with elevated case-fatality ratios in pregnant women (up to 20%) (3), is considered a major public-health problem across most of South Asia and has been shown to contribute up to 10% of pregnancy-related deaths in rural northwest Bangladesh (4,5). Despite this burden, this emerging pathogen remains significantly under-studied and under-recognized as an aetiologic agent in this population (3,6). The ubiquitous risk of exposure to faecal-oral pathogens has been well-documented across rural and urban populations of the country, explaining the elevated burden of viral hepatitis infections (3,6).

Improved contextual understanding of specific diseases in endemic populations is essential to optimize surveillance, control, and targeted care. In settings where clinical consultations may be challenging, population-based surveys seek to elicit reported symptoms and morbidities during routine surveillance. For detection of acute viral hepatitis, population-based surveys often assess report of clinically-proven jaundice, also known as icterus (the yellowing of the eyes or skin as a result of hyper-bilirubinaemia or liver cholestasis--a sign of liver distress or damage) as a symptom that triggers further clinical investigation for presence of hepatitis (7). While local terms may be useful in detecting symptoms warranting further investigation, studies in rural Bangladesh have suggested that local perceptions of illness may differ from biomedical definitions (8-11). For conditions ranging from infectious and chronic diseases to pregnancy-related illnesses, studies have described cultural frameworks of perceived illness aetiology, which influence conceptions of disease as well as subsequent care-seeking behaviours (8-12). Despite the documented elevated burden of viral hepatitis, little has been reported about the medical anthropology of this spectrum of infections, including local perceptions and practices, care-seeking behaviour, and treatments.

In Bangladesh, perceived aetiologies of illness have been linked to care-seeking behaviours (8-10,13). Studies from Bangladesh reveal a plural health system that consists of both informal (defined as care providers lacking formal certification) and formal care providers (defined as healthcare providers who are recognized and regulated by legal authorities), such as doctors, nurses, midwives, or government-trained care providers (8-10,13). For illnesses, including some that are typically believed to arise from non-medical causes, rural residents have reported visiting informal care providers, such as traditional healers, village doctors, shamans, traditional birth attendants, and homeopathic doctors (14). Traditional healers, including shamans, are generally visited for conditions that are perceived to be caused by evil spirits, and they provide blessings against these spirits (15). In Bangladesh, a common traditional healer is called kabiraj, a healthcare provider who practises a combination of ayurvedic medicine and faith healing (15). Allopathic care providers include village doctors and homeopathic care providers, some with training or apprenticeship experience, who provide allopathic treatments for various ailments in rural communities (9,16). Although studies reveal the importance of informal care providers in care-giving for numerous illnesses, care-seeking for hepatitis and hepatitis-like illnesses has not been well-described in this rural population. …

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