Ethiopians now seek Kala-azar treatment in Kenyan hospitals

Nawi Lopem would have lost her six-year-old son Nadis Lokolong if not for a peace meeting she had attended in Kibish Sub-county in Kenya. 

For two months, Lokolong had experienced a high fever and lost weight as his appetite dipped. Lopem, 28, from Kang’aten village in Ethiopia, did not know what to do. All traditional medicine she could think of had failed.  

The meeting was between the pastoral Turkana community of Kenya and the Nyangatom from Southern Ethiopia. It is at the meeting that a local priest noticed Lokolong’s enlarged spleen, one of the main symptoms of Kala-azar. 

The priest advised the young mother to take her son to Lopur Health Center in Kenya for treatment.  ‘‘He offered to cater for the transport costs and upkeep until the boy was treated and discharged,’’ she narrates.

The boy would later be referred to Lodwar County and Referral Hospital, 400 kilometres from the Kenya- Ethiopia border. It is here that Healthy Nation team met him recuperating in the stabilisation ward.

At the moment, there is a high burden of Kala-azar in the villages of Kokuro near the border with Ethiopia, and Naturturio, Urum, Loya near the border with Uganda and Mugur at the border with Marsabit County. 

Officials of Turkana County government say they learnt of the situation in Ethiopia after the boy was diagnosed at the health centre. 

Consequently, the devolved unit has increased the number of diagnostics sites from 21 to 24 to reduce the distance patients travel to seek treatment. 

In Turkana West Sub-county, for instance, there are several treatment sites, namely Kakuma Mission Hospital, Makutano and Kakuma Sub-county Hospital. Others are IRC Kakuma and Lopiding Hospital.

In Loima Sub-county, treatment sites are at Lorugum Sub-county Hospital, Urum, Namoruputh and Lokiriama, all which border Uganda and where the situation is dire.  

"We provide free services in all our public health facilities, especially at the border. We encourage people to come out for treatment,’’ says Jimmy Loree, the county coordinator in charge of Kala-azar, locally known as ‘‘etid’’. 

He adds: "We have established a well-coordinated communication network with neighbouring countries to ensure cases are identified and treated irrespective of the boundaries.’’ 

Treating Kala-azar is costly, he explains. "It requires about two pints of blood. Nutrition support during the treatment period and the drugs are expensive.’’ 
There are currently eight cases on treatment in the county, according to the doctor. ‘‘In the last three months, there have been 32 cases from different locations. Out of these, 24 have been treated and discharged.’’

Also known as Visceral leishmaniasis (VL), the disease is caused by protozoan parasites of the genus Leishmania and transmitted by sandflies, which are common in ant-hills. If untreated, the disease is fatal.

The doctor says treatment for Kala-azar occurs at two levels. In the first one, Sodium stabogluconate and Paromomycin are administered for 17 days.

In the second level, Amphotericin B (Limposomal) is administered for between six and 10 days for pregnant mothers, severely sick patients and HIV patients. 

This form of treatment is also given to severely malnourished children under two years and patients older than 60. 

Loree says the cases of Kala-azar surge whenever there is a peace meeting, with most of them coming from Ethiopia and South Sudan. 

There are, however, notable differences between populations in urban areas and villages, with those in rural areas more likely to be affected. The situation is made worse by malnutrition in the villages, according to Loree. He notes that villagers also seek treatment only when the situation worsens.

"Through public awareness, however, the behaviour around seeking healthcare services has improved. Case detection and referrals have improved from 74 per cent in 2017 to the current 97 per cent,’’ Loree notes. 

Without nets

Anthills in the area predispose locals to the disease, some of whom wear shukas and sleep in Manyattas without nets. When migrating, herdsmen sleep outside.  In recent years, Turkana County has intensified awareness campaigns around the disease at the household level. This has boosted early detection and linkages to treatment. 

Medical personnel, community health volunteers and kraal elders are involved in the programme that is supported by the World Health Organization and Doctors Without Borders.

At the Lodwar hospital, Asuron Eseron, 25, is under treatment. He started losing weight and experiencing dizziness in February last year. Eseron was, however, reluctant to go to the hospital, fearing he was suffering from HIV/Aids. 

With thin legs and a swollen stomach, he soon became the talk of his village in Kainuk. Even after visiting Kainuk Health Center where he did a hemoglobin test, he was convinced he had HIV/Aids. 

Through radio one morning, his mother heard a discussion about a disease with symptoms similar to what he was experiencing. He was soon back in hospital for further check-up, which ended in an admission in November last year. 

“I was severely malnourished and in bad shape. The hospital had to stabilise me,’’ he narrates, adding that his family would not afford the treatment if they had to pay for it. 

Visceral Leishmaniasis remains a public health concern in about 30 sub counties in Kenya, mostly in the Rift Valley, Eastern and North Eastern regions. 

Globally, it occurs in 88 countries with half a million cases annually. Brazil, Ethiopia, India, Somalia, South Sudan and Sudan account for more than 90 per cent of global cases.  

More than 550 million people worldwide are at risk of infection, especially the poor and socially marginalised populations living in arid and semi-arid (ASAL) areas.  

Although the disease is curable, morbidity is high, owing to low index of detection, late diagnosis and case management. With treatment being through injection, and toxic side effects often occurring among patients, care is limited only to county and sub county hospitals. 

The situation has not been helped by inadequate information on the prevalence, burden and spatial distribution of the disease. 

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