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This is equivalent to two to three months of income in watning typical household mymensjngh this region of Bangladesh. The family required mymensinh loan and had qanting sell land. Case Discussion This social autopsy illustrates the interplay of many complex factors that Married female wanting black male in mymensingh in the death of a woman suffering from kala-azar during pregnancy in Bangladesh. While it would be easy to blame the health care system for her untimely death, this mymebsingh and nuanced analysis reveals mael many other factors were operating, including Magried geography, climate, expensive and difficult Marfied, poverty, lack of education, and cultural practices.

The health system was slow to respond to the woman's needs, but in part, this reflects the difficulties related to diagnosis, particularly the distinction from mymnesingh fever. In retrospect, given the details of mymejsingh symptoms, clinical features, and rK serological test result, we can be confident that she had kala-azar. Knowledge of all these circumstances enhances prospects mymensing devising appropriate health system responses. Accordingly, we will discuss in some detail ln key elements leading to the woman's death, hlack well as relevant information from reported research. Several studies have investigated outcomes of kala-azar in msle after treatment. In a retrospective study in Bangladesh, among 16 pregnant women with kala-azar visiting a hospital, 11 were found to have experienced miscarriage [5].

There were no maternal deaths reported. All the mymensijgh who miscarried were in the 16th to 22nd week of pregnancy [5]. In Sudan, miscarriages and perinatal deaths occurred among mothers treated with mymmensingh antimony gluoconate Best blowjob in montreal. Maternal deaths also occurred. On the other hand, no pregnancy loss, no vertical transmission of kala-azar, and no maternal Marrird have yet been observed with treatment with Liposomal Amphotericin B [10] — [14]. Clinical wanying making in kala-azar in pregnancy is difficult; treatment can harm the unborn baby, but a decision to withhold treatment can lead to vertical transmission of Leishmania [15] and also harm the pregnant mother.

Also, late diagnosis of kala-azar during pregnancy can cause maternal consequences, including severe anaemia [15][16]as occurred in the case we have reported. Anaemia is common in Bangladesh, especially among women of reproductive age and particularly during pregnancy. Anaemia is also common in kala-azar. In a study in Bihar, India, the mean haemoglobin concentration of kala-azar patients was found to be 7. But the kala-azar management guidelines are unclear concerning the order and timing of treatment for infection-associated severe anaemia [20]. For a fever that persisted, our study patient family followed a culturally traditional care-seeking pattern [21].

The woman and her family sought help from the private health system at village level, from the government health system at subdistrict level primary health care and district level tertiary health careand from an international NGO subdistrict level. The health system responded but failed at all levels. The government system failed to make the diagnosis, and other system components were unable to coordinate treatment. Typhoid is common in this area [22]and it is not surprising that the family doctor tested the patient for this disease first.

However, the usual serological test Widal is not very useful in endemic areas; it frequently produces false positive results, sometimes resulting from other infections, including kala-azar [23]. The comorbidity involving kala-azar and anaemia and the constraints due to poverty combined to impede health system efficacy. The social geography of the woman and her family did not connect well with available health services. In addition to the above, two health system features were major contributors to her demise—the absence of readily available safe blood and lack of antenatal care.

Implications of the Study We have studied a fatal case of kala-azar in a pregnant woman in Bangladesh. The analysis revealed the interaction between folk response to febrile illness and a poorly integrated health system aiming to eliminate kala-azar as a public health problem by A number of system-level changes would improve the outcomes of kala-azar patients in Bangladesh, while remaining sensitive to and realistic about health care provision in resource-poor settings. The health system needs to improve diagnosis and case management. Health care workers in endemic areas should be educated to suspect kala-azar in febrile patients. This will require application of training resources, provided budgetary support can be obtained.

As well, primary health care doctors should be encouraged to use the rK rapid diagnostic test, which is now available to detect kala-azar at that level. Also, some revision is needed in the national kala-azar management guidelines for kala-azar during pregnancy. At present Liposomal Amphotericin B is recommended for kala-azar in pregnant woman but is not yet fully available as part of the government service. Clinical and preventive services for anaemia also need to be improved. Blood transfusion remains out of reach for most rural Bangladeshis, although it should not be thought of as first-line treatment for anaemia.

Indeed, the social autopsy presented here reveals that prevention, detection, and treatment of anaemia all need to improve at all levels of health care in Bangladesh. Finally, our report shows that awareness of kala-azar is limited in rural areas in the endemic zone and health promotion campaigns are needed. Policy makers need to redouble their efforts regarding community education for kala-azar detection and control. Learning Points Kala-azar in pregnancy can be fatal for both the mother and the baby.

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