Neglected and hard to detect, West Pokot residents living in fear of black fever

By Jeckonia Otieno

The afternoon sun bears over Pokot North as patients, most of them women, sit sullen on a veranda waiting to consult staff at Konyao Health Centre.

Although located only 50km away from Kacheliba District Hospital, the centre can only be reached using an off-road vehicle after an hour’s drive. When it rains, the road is barely passable.

For people like Veronica Kalinyang’, the journey to the health centre can be a matter of life and death.

Konyao, located a short distance from the Kenya-Uganda border, is a diagnostic centre for black fever, mostly known as kala-azar or visceral leishmaniasis. While kala-azar is the second-largest parasitic killer in the world after malaria, it is one of the ‘neglected’ diseases for which accurate diagnosis and treatment are hard to come by.

According to the World Health Organisation, nearly one billion people suffer from neglected tropical diseases globally. WHO blames this on little attention from policy-makers, lack of priority within health strategies, inadequate research, limited resource allocation and few interventions.

Hard to detect

However, the situation is changing in Kenya as the Government has come up with new guidelines for the treatment of kala-azar to ensure more accurate diagnoses than the ones Kalinyang’ got when her daughters were infected last year.

Speaking through an interpreter, Kalinyang’ says she went through turmoil when she discovered that two of her children had kala-azar.

Jebet, Kalinyang’s last born child experienced fever in April last year. At first, her mother thought it was malaria. She rushed the girl to the health centre, where she was diagnosed with leishmaniasis and referred to a centre run by Medecins Sans Frontieres (Doctors without Borders) at the Kacheliba District Hospital.

It took three tests at Konyao to confirm that Jebet was indeed infected with kala-azar and to dispel her mother’s initial thoughts that it was just malaria.

Kala-azar is caused by parasitic protozoa Leishmania donovani and transmitted to humans by the bite of an infected female sand fly. It affects the immune system, giving rise to secondary infections such as pneumonia, diarrhoea and tuberculosis and causes fever, anaemia, weight loss, spleen enlargement and, if untreated, death.

 “The first two tests showed that the girl did not have the disease despite the fact that she had all the signs pointing towards kala-azar or malaria. But the third test confirmed that she had it,” Kalinyang’ says.

This is one of the areas where clinical diagnosis proves difficult because confusing it with other tropical diseases that exhibit similar symptoms is easy.

According to Dr Bienvenu Baruani, MSF’s focal person for kala-azar in Kenya, the disease is hard to diagnose because it shares symptoms with more common tropical diseases like malaria, typhoid, brucellosis, schistosomiais and leaukaemia. If a medical practitioner is not well trained to look out for the disease, he may easily overlook it.

 “Since the symptoms of kala-azar and malaria are often difficult to differentiate at face value, a two-week duration should be allowed after the first test before a confirmation test is done,” Dr Baruani says.

The standard case definition for kala-azar is exhibited at all testing sites and is adhered to before laboratory diagnosis. Patients with one or two symptoms and signs missing may end up with negative tests. In such a situation, the test is repeated after two weeks. This often turns positive.

Liitle Jebet went through the usual 30-day treatment period. Before she could even finish her dosage, her elder sister Chemno begun exhibiting the same symptoms and had to be taken to hospital. Chemno has also been treated and is now attending a local nursery school.

Expensive to treat

 A new treatment that takes just 17 days is expected to have better outcomes. However, the treatment is expensive and out of reach for many locals.

According to Dr Harrison Kuboka, MSF’s field coordinator in Kacheliba, it will cost the locals as much as Sh50,000 for a full treatment. Before MSF initiated the diagnosis and treatment project in West Pokot, families of affected victims had to sell their livestock to pay for treatment at distant facilities, where the treatment was offered.

Many, like Kalinyang’, believe kala-azar is a secondary problem that stems from a bigger predicament – the sand fly. “If only the Government can come up with programmes to finish the sand fly like it has done with the tsetse flies, it could curb the problem,” she says.

Timothy Koech, who works with the programme, says many patients don’t visit the hospital until they are extremely sick. “Many of them come wasted because of lack of food accelerated by poverty,” he says.

Apart from Konyao, the treatment centre at Kacheliba receives referrals from other facilities like the Government-run Kasei Health Centre and dispensaries in Alale run by the Africa Inland Church and the Catholic Church. These are the decentralised sites where people who live away from Kacheliba get tested.

Koech says of all the cases examined, about 70 per cent turn out to be positive. He says his main concern is that cases that need referral have to travel far, eating into time that should be used for treatment.

Despite improvements in testing and treatment, a number of patients lost their lives from complications after an outbreak was reported last year. Doctors say those who died suffered haemorrhages after arriving at the hospital late.


 

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