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Review
.2017 Sep 18:14:10.
doi: 10.1186/s12982-017-0065-3. eCollection 2017.

Challenges in modeling complexity of neglected tropical diseases: a review of dynamics of visceral leishmaniasis in resource limited settings

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Review

Challenges in modeling complexity of neglected tropical diseases: a review of dynamics of visceral leishmaniasis in resource limited settings

Swati DebRoy et al. Emerg Themes Epidemiol..

Abstract

Objectives: Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects challenges and successes related to the modeling of transmission dynamics of VL. Possible ways of creating a comprehensive mathematical model is also discussed.

Methods: Published literature in three categories are reviewed: (i) identifying non-traditional but critical mechanisms for VL transmission in resource limited regions, (ii) mathematical models used for dynamics of Leishmaniasis and other related vector borne infectious diseases and (iii) examples of modeling that have the potential to capture identified mechanisms of VL to study its dynamics.

Results: This review suggests that VL elimination have not been achieved yet because existing transmission dynamics models for VL fails to capture relevant local socio-economic risk factors. This study identifies critical risk factors of VL and distribute them in six categories (atmosphere, access, availability, awareness, adherence, and accedence). The study also suggests novel quantitative models, parts of it are borrowed from other non-neglected diseases, for incorporating these factors and using them to understand VL dynamics and evaluating control programs for achieving VL elimination in a resource-limited environment.

Conclusions: Controlling VL is expensive for local communities in endemic countries where individuals remain in the vicious cycle of disease and poverty. Smarter public investment in control programs would not only decrease the VL disease burden but will also help to alleviate poverty. However, dynamical models are necessary to evaluate intervention strategies to formulate a cost-effective optimal policy for eradication of VL.

Keywords: Dynamical modeling; Kala-azar; Leishmaniasis; Mathematical model; Risk-factors.

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Figures

Fig. 1
Fig. 1
A vicious cycle of socio-economic challenges and difficulty to access disease interventions
Fig. 2
Fig. 2
Cartoon reflecting social aspects on which awareness programs to control spread of VL can be designed to reduce disease burden
Fig. 3
Fig. 3
Caricature of critical categories of modeling frameworks for studying dynamics of vector-borne diseases (green rhombus), types of data needed in such frameworks (orange oval) and their potential links (red arrow).SV andIV represent densities of susceptible and infectious vectors.SH,AH,IH andRH are human epidemiological stages representing susceptible, asymptomatic, infectious, and recovered stages. 1st and 2nd line are for types of treatments whereas DAT and rk39 are for diagnostic methods.Light green box represents the output from respective modeling frameworks. These frameworks are mere examples in each categories and hence, each one of them can incorporate more details depending on the goals
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References

    1. Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, Alvar J, Boelaert M. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007;5(11):873–882. doi: 10.1038/nrmicro1748. - DOI - PubMed
    1. WHO: Leishmaniasis Fact Sheet.http://www.who.int/mediacentre/factsheets/fs375/en/. Accessed: 2017-07-08
    1. Mubayi A, Castillo-Chavez C, Chowell G, Kribs-Zaleta C, Ali Siddiqui N, Kumar N, Das P. Transmission dynamics and underreporting of kala-azar in the Indian state of Bihar. J Theor Biol. 2010;262(1):177–185. doi: 10.1016/j.jtbi.2009.09.012. - DOI - PubMed
    1. WHO: Leishmaniasis.http://www.who.int/leishmaniasis/visceral_leishmaniasis/en/. Accessed: 2017-07-08
    1. WHO: Neglected Tropical Diseases.http://www.who.int/neglected_diseases/diseases/summary/en/. Accessed: 2017-07-08

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