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Neglected diseases that wreak havoc on northern Kenya

Kala-azar patient Tuweiti recovers at Kacheliba District Hospital. PHOTO | VERAH OKEYO | NMG
Kala-azar patient Tuweiti recovers at Kacheliba District Hospital. PHOTO | VERAH OKEYO | NMG  

In a section of the sun-baked West Pokot four elements are wrapped in a deadly relationship: a sand fly, animals, a sick man only known as Tuweiti, and the weather in which the potentially fatal disease caused by the sand fly thrives.

Tuweiti is shivering and covered in a heavy tartan clothe at Kacheliba District Hospital.

He has been diagnosed with Visceral Leishmaniasis, better known as kala-azar, transmitted by sand-flies which live in termite mounds.

It is one of the 18 diseases that the World Health Organisation (WHO) classifies as “neglected tropical diseases” (NTDs), a name they got because of two things:  governments pay them little attention, and they occur in the tropics.

Dr Sultani Matendechero, the Head of Neglected Tropical Diseases at the Ministry of Health, reported that kala-azar threatens more than 600,000 people in Turkana, West Pokot, Baringo, Isiolo, Marsabit and Wajir.

In Kenya, kala-azar and other 14 NTDs are a public health concern.

NTDs have killed, maimed and impoverished many Kenyans because of the little body count attributed to them.

In 2016, the Ministry of Health launched the National Strategic Plan for Control of Neglected Tropical Diseases, a strategy to eliminate the diseases borrowed heavily from the World Health Organisation’s blueprint and meant to run until 2020.

The government classified the diseases to help it plan funds allocation.

They include the guinea worm disease, leprosy, and human African trypanosomiasis (sleeping sickness).

They are being fought through vaccination, deworming and other strategies. Those that are set to be controlled include soil transmitted helminthiasis (STH) which are intestinal worms, bilharzia, lymphatic filariasis (elephantiasis), trachoma, kala-azar and rabies. All of these, except trachoma, are fatal if not treated.

The Health ministry is also evaluating dengue and chikungunya to establish their prevalence in the country. Others in this assessment group are echinococcosis, cysticercosis, onchocerciasis (river blindness), food borne trematodiases, and mycetoma.

To manage intestinal worms, the government has introduced a school-based deworming programme in 28 counties which have the disease burden of 20 per cent and where 25 million people are at risk of infection.

Despite the burden Dr Monique Wassuna, the Drugs for Neglected Diseases initiative (DNDi) Africa director, said the diseases have been shunned because of the illusion that they do not kill.

Dr Wassuna said that people think they were eradicated and when they do kill, it is just a few patients.

However, had Tuweiti not made it to Kacheliba hospital on time he would have had a 95 per cent chance of dying from the disease.

The Zoonotic Disease Unit (ZDU) estimates that rabies kills more than 2,000 people in Kenya every year.

Kala-azar made Tuweiti feverish, lose weight and his liver and spleen were enlarged as the parasite fed on blood producing cells in his body.

Without medical attention, kala-azar patients die of multiple organ failure. According to an analysis by medical journal Plos, kala-azar killed 51,600 people in the world in 2010, followed closely by rabies (26,400)

The analysis noted that Ebola, which receives immediate attention and funding whenever it strikes, killed only 6,500 people in 2014.

The few that die of NTDs are mistakably considered a small statistic and passed over in government budgets because Malaria and Aids kill more and demand more attention.

This attitude leads to more deaths from NTDs.

Dr Matendechero said that NTDs attack the poorest people who have no access to clean water, walk for miles to seek healthcare and are so malnourished that their bodies cannot fight diseases like the well-fed.

West Pokot has the highest level of undernourished children under five years in Kenya: 46 per cent, according to the 2014 Kenya demographic health survey.

“The unstable social context including armed conicts, high levels of malnutrition, large population movements between non-endemic and endemic areas, and the inaccessibility of key areas during the rainy season are significant obstacles to progress,” said WHO of the factors that make these diseases thrive.

This is best exemplified by Baringo.

All is not gloom though. NTDs have caught the attention of the global health body.

In April, WHO held a high level meeting in Geneva on the diseases and another in Bangkok on rabies.

In May, more than 70 countries and globally acclaimed institutions congregated in Toledo, Spain, to talk about kala-azar.

More than 300 research papers were unveiled. Robert Kimutai of DNDi was one of those who presented a research paper.

He led the health ministries of Ethiopia, Sudan and Uganda to conduct a study which resulted in the development of a combination of drugs to treat kala-azar called Sodium Stibogluconate and Paromomycin (SSG-PM) therapy.

SSG-PM saved Kenya some money. Before SSG-PM, patients endured a 30-day treatment course involving the use of a fairly toxic regimen of Sodium Stibogluconate alone. SSG-PM reduced the treatment period to 17 days.

A bottle of generic SSG costs Sh8,000 and that of PM Sh200. 

Both children and adults need more than one bottle to complete treatment.

Tuweiti was hospitalised to ensure that he was fed properly and did not veer off the treatment course.

Now Dr Wassuna and colleagues from the Kenya Medical Research Institute (Kemri) are working on a treatment which will be orally administered.

Funding has also been injected into the training of health workers in affected counties to make proper diagnosis.

Dr Gilchrist Lokoel, an epidemiologist and head of Lodwar County and Referral Hospital in Turkana, told the Business Daily that NTDs mimic other diseases hence health workers find it hard to identify them early.

Mis-diagnosis has been reported on rabies in Kenya and Tanzania, where the disease is sometimes confirmed posthumously.