A 50-year battle with kala azar in Kenya’s North Rift
Wednesday July 27 2016
Inside the 14-bed male ward at Kacheliba Level Four Hospital in West Pokot County in the northern part of Kenya’s Rift Valley, lies an emaciated 14-year-old boy with sunken eyes and prominent cheekbones.
He could easily pass off as yet another case of malnutrition, which is common in the area, but doctors at the health facility have diagnosed Kangsur Lodoiywa with kala azar.
Kala azar is also prevalent in the area and is marked by emaciation, anaemia, fever and enlargement of the liver and spleen.
To get treatment, Kangsur and his father Mzee Lodoiywa had to make a 250 kilometre journey from their home to the hospital. The boy had been bed ridden for a week with pains, a fever that wouldn’t go away and was frail from not eating due to lack of an appetite.
Medics at the local dispensary where the old man sought help after herbs from the traditional healer failed to cure his son advised that he make the journey to Kacheliba hospital.
“When our children get sick, we take care of them using locally available herbs. They get well and life moves on but for Kangsur, the story was different,” said Mzee Lodoiywa. “We had to cross the lake to the other side in search of treatment.”
There are only two kala azar health facilities in the North Rift region, which is made up of eight counties including West Pokot. This forces patients to travel long distances over rough terrain in search of medication.
For the past 50 years, communities in the region have been battling the neglected tropical disease they call Termes. It is common among livestock- herding nomadic populations.
Apart from the long distances travelled in search of a cure, the cost of treatment is prohibitive. Residents therefore first try their luck with the village herbalist.
Area chief Lopeyok Siang’ale who has suffered the excruciating pains caused by kala azar said that at the time he became sick in 2006, only those who had herds of cattle to sell could afford the treatment.
“The rule was simple. Treatment was available to those who could raise the Ksh30,000 ($300) needed,” said Siang’ale. “With herbalists, you can always pay in installments as long as you have made the down payment of Ksh500 ($5) for sourcing the herbs.”
Today, treatment for Kala azar at the Kacheliba hospital will set a patient back up close to $400.
Fortunately, the treatment duration has been reduced from 30 to 17 days, thanks to a new drug introduced in 2010.
A clinical officer in charge of Kacheliba’s kala azar clinic Mark Riongoita said that as many as 70 per cent of young boys from the nomadic community are susceptible to the disease because they are often in close contact with cattle that attract the disease-causing sandflies.
However, many who get sick die before the age of 15 because they are often taken to hospital when the disease is already at an advanced stage.
“Most people believe that herbalists can cure them but instead they end up in hospital writhing in pain,” said Mr Riongoita.
The World Health Organisation ranks Kala azar as the second largest parasitic killer in the world after malaria, and one of the most dangerous neglected tropical diseases (NTDs).
The disease, which is hard to detect with the naked eye, is caused by the parasitic protozoa, Leishmania donovani, which is transmitted to humans through the bite of an infected female sandfly.
Sandflies thrive in hot and dry areas, and where there is livestock. The parasite, which is endemic in 47 countries, attacks the immune system, and is almost always fatal if not treated.
In Kenya, it is common in the semi-arid counties of Baringo, Turkana and West Pokot.
“The vector thrives in the cracks and crevices of mud-plastered houses, heaps of cow dung and the anthills that dot these areas,” said Mr Riongoita.
Statistics show that the East African region records between 20,000 and 40,000 new cases annually with the highest numbers being in Sudan (8,000), Ethiopia (6,000) and Kenya (4,000).
At the Kacheliba kala azar clinic, between 30 and 70 patients are treated every month.
In the same ward housing Lodoiywa and his son for example, lay 65-year-old Chemonyo Nyangirokwa and her grandchild. Nyangirokwa has had to bring four of her children to the health facility for treatment for kala azar.
Robert Kimutai, a clinical trial manager at Drugs for Neglected Diseases (DNDi) said that those affected continue to die due to the complexity of diagnosis and lack of affordable medicines.
“Because the disease presents similar symptoms to those of malaria and malnutrition, we tell healthcare workers to look out for children with enlarged spleens and those who are not responding to antimalarial drugs,” said Dr Kimutai.
He said that the death rate as a result of the disease is usually low among patients undergoing treatment but when there is an outbreak, the fatalities shoot up by about 10 per cent.
He attributes the high cost of medication to the lack of interest by big pharmaceuticals in manufacturing drugs used in the treatment of neglected tropical diseases like kala azar.
“There is a big market failure for drugs for neglected tropical disease because pharmaceutical companies know that they will not recoup the cost of manufacturing,” said Dr Kimutai. “We will not be able to deal with the cases without enough resources and one of the ways to do so is by enticing manufacturers to make the drugs.”
The WHO has come up with a 2020 roadmap on NTDs to control or eliminate at least 10 of them — including Guinea worm disease, lymphatic filariasis, leprosy, sleeping sickness and blinding trachoma — by the end of the decade.
Yet, according to a report published in the Lancet, of the 850 new therapeutic products approved between 2000 and 2011, only four per cent (and only one per cent of all approved new chemical entities) were indicated for neglected diseases, even though these diseases account for 11 per cent of the global disease burden.
To mitigate the high cost of drugs, scientists are developing an oral medication for the treatment of Kala azar that is safe, effective, low-cost and requires only a short course of treatment.
Currently, the first line treatment drug for kala azar is a 17-day double injection drug known as Stibogluconate and Paromomycin (SSG&PM) which requires a patient to be admitted in hospital.