Screening Utility, Local Perceptions, and Care-seeking for Reported Jaundeesh among Respondents Lacking Signs of Icterus in Rural Bangladesh|
Hossain, Mohammad Z.; Sikder, Shegufta S.; Zaman, K.; Saha, Parimalendu; Yunus, Mohammad; Nelson, Kenrad E. & Labrique, Alain B.
In rural Bangladesh, acute viral hepatitis presents a significant burden on the public-health system.
As part of the formative work for a large epidemiologic study of hepatitis E in rural Bangladesh, we
sought to identify local terms that could be used for population-based screening of acute viral hepatitis.
Exploration of the local term jaundeesh for screening utility identified a high burden of reported
jaundeesh among individuals without symptoms of icterus. Recognizing that local perceptions of illness
may differ from biomedical definitions of disease, we also sought to characterize the perceived
aetiology, care-seeking patterns, diagnostic symptoms, and treatments for reported jaundeesh in the
absence of icteric symptoms to inform future population-based studies on reported morbidities. We
conducted a cross-sectional survey among 1,441 randomly-selected subjects to identify the prevalence
of reported jaundeesh and to test the validity of this local term to detect signs of icterus. To
characterize the perceived aetiology and care-seeking patterns for jaundeesh among the majority of
respondents, we conducted in-depth interviews with 100 respondents who self-reported jaundeesh
but lacked clinical signs of icterus. To describe diagnostic symptoms and treatments, in-depth interviews
were also performed with 25 kabirajs or traditional faith healers commonly visited for
jaundeesh. Of the 1,441 randomly-selected participants, one-fourth (n=361) reported jaundeesh,
with only a third (n=122) reporting yellow eyes or skin, representative of icterus; Jaundeesh had a
positive predictive value of 34% for detection of yellow eyes or skin. Anicteric patients with reported
jaundeesh perceived their illnesses to result from humoral imbalances, most commonly treated by
amulets, ritual handwashing, and bathing with herbal medicines. Jaundeesh patients primarily
sought folk and spiritual remedies from informal care providers, with only 19% visiting allopathic
care providers. Although the local term jaundeesh appeared to have limited epidemiologic utility
to screen for acute symptomatic viral hepatitis, this term described a syndrome perceived to occur
frequently in this population. Future population-based studies conducting surveillance for acute
hepatitis should use caution in the use and interpretation of self-reported jaundeesh. Further study of
jaundeesh may provide insight into the appropriate public-health response to this syndrome.
Ethnography; Hepatitis; HEV; Jaundice; Medical anthropology; Morbidity; Traditional healers; Bangladesh