Unseen kala-azar deaths in south Sudan (1999-2002)

OBJECTIVE To estimate the number of deaths due to primary or relapse kala-azar (KA), which occurred unseen within the catchment area of Medecins Sans Frontieres (MSF) clinics in southern Sudan. METHOD Review of clinical records of consecutive KA patients presenting between October 1998 and May 2002 in treatment centres at Wudier (Eastern Upper Nile), Lankien (Bieh State), Magang (Sobat Province) and Nimne and Thonyor (Western Upper Nile). To estimate the proportion of patients who either presented for treatment or died undetected, we compared the time-to-presentation of KA patients against the rate at which KA patients died before treatment becomes effective. RESULTS We estimated that the 2891 KA patients who presented at MSF clinics in south Sudan during the period October 1998 to May 2002 represented 55% (2891/5300; 95% CI 29%-77%) of the total number of cases of KA in that area and that 91% (2409/2649; 95% CI 78%-97%) of deaths from KA were undetected. CONCLUSION The huge proportion of undetected KA mortality is deeply troubling and unlikely to improve under prevailing political conditions.