esnightingale/vl-spatial-diagnosis-delay

Visceral leishmaniasis (VL) is a debilitating and - without treatment – fatal parasitic disease which burdens the most impoverished communities in northeastern India. Control and ultimately, elimination of VL depends heavily on prompt case detection. However, a proportion of VL cases remain undiagnosed many months after symptom onset. Delay to diagnosis increases the chance of onward transmission, and poses a risk of resurgence in populations with waning immunity. We checked the spatial variation of delayed diagnosis of VL in Bihar, India and aimed to understand the potential driving factors of delayed diagnosis. The spatial distribution of time to diagnosis was explored using a Bayesian hierarchical model fit to 4,270 geo-located cases notified between January 2018 and July 2019 through routine surveillance. Days between symptoms meeting clinical criteria (14 days’ fever) and diagnosis were assumed to be Poisson-distributed, adjusting for individual- and village-level characteristics. Residual variance was modelled with an explicit spatial structure. Cumulative delays were estimated under different scenarios of active case detection coverage. This repository contains the code used to produce the result of "Spatial variation in time to diagnosis of visceral leishmaniasis in Bihar, India".

Alternative Title

Spatial variation in delayed diagnosis of visceral leishmaniasis in Bihar, India

Keywords

Visceral leishmaniasis; Parasitic diseases; Bihar, India; Delayed diagnosis