Neglected tropical diseases slowing down Kenya growth

In 2010, Mary Anyango lost her one-and-a-half-year old son to malaria even though he had been put on treatment as soon as he began showing symptoms of the disease.

She later learnt that the baby succumbed rapidly due to a serious case of malnutrition caused by intestinal worms that he had been harbouring before the disease struck.

“I was told that the malnutrition made the disease worse, lowering the child’s immunity and making him succumb to malaria.”

“The worms cost me my child yet I always thought they were harmless. Now I know better.”

These intestinal worms are among the five most common ailments that account for 90 per cent of the neglected tropical diseases (NTDs) burden in sub-Saharan Africa.

The other four include trachoma, schistosomiasis (bilharzia), onchocerciasis (river blindness) and lymphatic filariasis (elephantiasis).

These diseases pose a huge economic and health burden to nations and the already poverty- stricken communities they affect.

They cause thousands of deaths each year and immeasurable suffering including debilitating pain, disabilities and disfigurement to the affected.

If untreated, the NTDs such as intestinal worms (also known as soil transmitted helminths), can cause malnutrition leading to anaemia, low immunity, stunted growth and sub-optimal brain development in children.

They can also block intestines leading to death in severe cases.

Trachoma and river blindness can cause permanent blindness while elephantiasis leads to life-long disability in adults.

Bilharzia on the other hand may result in multiple organ failure when there is late diagnosis and delayed treatment.

Low-cost interventions

Dr Matshidiso Moeti, head of the World Health Organisation (WHO) Africa office, noted that the diseases need not be a problem for the continent as they can easily be eliminated through low-cost interventions such availing affordable treatment and prevention drugs to high risk populations, enhancing access to safe water and sanitation facilities among vulnerable communities, as well as tackling environmental factors that support the breeding of organisms that transmit the NTDs.

“African countries stand to gain a lot by dealing with these diseases once and for all. So they really need to invest in their eradication.”

Indeed, a 2016 study by the Erasmus University showed that sub-Saharan Africa stands to gain $50 billion (Sh5 trillion) if it meets the WHO 2020 targets for eliminating the five NTDs.

Kenya is affected by only four of those diseases, namely; intestinal worms, trachoma, bilharzia and elephantiasis.

The study showed that eliminating these four would see the country save nearly $1.9 billion (Sh192.6 billion) and avert the equivalent of more than 3.5 million years of life that would have otherwise been lost to ill health, disability and early death between 2011 and 2030.

In a bid to hasten the elimination of the diseases in the continent, the African Leaders Malaria Alliance (Alma) scorecard report that has in the past only tracked progress on malaria control, began this year to also follow the continent’s progress on fighting the five major NTDs.

Overall rank

The report, which assessed all 47 NTD affected countries in sub-Saharan Africa, gave Kenya an overall rank of 22 with regards to its efforts in reaching at risk populations with recommended treatment and prevention drugs.

The report shows that even though the situation is improving, the majority of Kenyans (57 per cent) in need of these drugs are still unable to get them, hence the dismal score.

The drugs are often provided to countries at no cost thanks to a massive drug donation programme by selected pharmaceutical companies in collaboration with the WHO.

“The medicines are there. But there aren’t enough domestic resources to administer them to everyone in need. Governments should work on that,” said Thoko Elphick-Pooley, director at the Uniting to Combat NTDs organisation that worked with the WHO to generate the scorecard.

She added: “When it comes to diseases that affect the very poorest and most marginalised communities, it’s up to political leaders to make them a priority.”

Bridging the access gap will not require much. The WHO recommends that affected countries increase their domestic health finances by just 0.1 per cent so as to complement the support already coming from donors and the private sector.

Dr Sultani Matendechero, head on the NTDs unit at the Health ministry noted that even though prevention and drugs are important, improving access to clean water and adequate sanitation facilities for all Kenyans can go a long way in providing a sustainable solution to the NTDs problem in the country.

“So long as people don’t have access to these basic amenities, we will keep relying on the drugs to treat and prevent infections all the time. Yet, these are resources that could be channelled to other health matters.”

In Kitui County for instance, he said that provision of safe water has enabled the government to save about Sh1.5 billion worth of drugs for trachoma treatment over the past five years.

“The disease just disappeared because of the water and so we no longer do mass drug administration there. Yet, what was spent on water provision is much lower than the enormous amount saved.”
Dr Matendechero urged all county governments to invest heavily in water and sanitation so as to replicate such success stories.

Need to prioritise

Government statistics show that in rural areas where the burden of NTDs is high, an estimated 40 (39.2) per cent of households rely on non-improved sources of drinking water, which include surface water, unprotected wells or springs as well as tanker trucks or carts with water drums.

Aside from being prone to pollution, these low quality sources provide suitable breeding grounds for bugs that spread NTDs and other waterborne disease.

Worse still, members of these households usually have to walk over long distances - taking the duration of more than 30 minutes - to fetch water from their preferred sources.

As such, they are forced to use water sparingly, mainly for drinking and cooking.

Household and body cleanliness are seen as luxuries that can be ignored. Yet hygiene is also paramount in the fight against NTDs.

For instance, trachoma - leading cause of preventable blindness worldwide - can be totally prevented through facial cleanliness. Research has also shown that hand washing with soap also reduces the incidence of intestinal worms.

Dr Kepha Ombacho, director of public health at the Ministry of Health (MOH) noted that county governments also need to prioritise the use of quality sanitation facilities (toilets) in their areas.

Open pits

According to the current Kenya Demographic and Health Survey, over 60 per cent of rural households rely on non-improved sanitation facilities, which include open pits, hanging latrines, buckets and open bushes or fields.

A basic proper latrine based on the WHO guidelines consists of a rectangular, square, or circular pit dug into the ground and covered by a hygienic cover slab or floor.

The World Bank estimates that about 1.2 million such facilities are required to eradicate open defecation in Kenya.

Proper sanitation facilities are a primary prevention strategy for intestinal worms (roundworms, whipworms and hookworms) as they are usually transmitted by eggs present in faeces of infected individuals, which end up contaminating the soil in areas where sanitation is poor.

Improved sanitation facilities can also prevent faeces and urine containing eggs of bilharzia-causing parasitic worms from contaminating surface waters.

These parasites usually penetrate human skin and get into the body as people wade, swim, bath, wash or walk barefoot in polluted water bodies.

Poorly constructed latrines also facilitate the breeding of culex mosquitoes, which spread elephantiasis - the leading cause of permanent disability worldwide.
According to Dr Matendechro, bed nets use which has been a cornerstone for malaria prevention can also play a key role in fighting elephantiasis and other NTDs like dengue fever and chikungunya which are also spread by mosquitoes.