Kala-azar: Body-wasting disease, leaves tragedy in its wake

In February 2022, Simon Kimwele, a resident of Wikithuki village in Kitui County, received a phone call that would change his life forever. The local area chief urged him to rush his son to the hospital immediately, as the child was showing all the symptoms of kala-azar, scientifically known as visceral leishmaniasis, a potentially fatal disease if not treated in time. "I had been away from home for several months, and the chief had noticed my son's health deteriorating over time. When he called, I panicked and rushed home," Kimwele recalls. The sight that greeted him was harrowing. His 10-year-old son, once healthy, was now gaunt and sickly, his stomach distended to the point where it seemed it might burst. "Seeing him like that, I almost lost my mind," he recounts, adding, "He looked like he had a severe form of kwashiorkor." Kimwele, right away began a heart-wrenching medical journey. His son was admitted to the children's ward at Mwingi Level IV Hospital, where he stayed for a month. The ward was already overwhelmed, with four other children aged between five and 15 admitted with similar symptoms. Adults too were affected, with Kimwele recalling seeing three adults from his neighbouring village receiving treatment at the same facility. The signs were clear - an outbreak was sweeping through the region. "I saw other patients, both children and adults, being referred to Garissa Teaching and Referral Hospital when the local facility could no longer cope," he recalls. Every day brought new anxiety as he feared the worst for his son. For 30 days, his son endured daily injections, and the financial burden weighed heavily on Kimwele, as some of the required medications had to be purchased from private chemists at exorbitant costs. Yet, against all odds, his son's treatment proved successful. After his discharge, the boy was placed on a six-month routine for follow-up check-ups. "Today, he is a big, healthy boy and is set to join Grade Nine this week," says Kimwele, his voice filled with relief. However, he remains haunted by the mystery of the disease. "It is a very mysterious disease. The body does not ache, but a child just wastes away while the stomach keeps on swelling," he adds. The outbreak's epicentre included villages, such as Ngomeni, Tseikuru, and Mandongoi in Kitui County, as well as Fafi and Daadab in Garissa County. At Garissa Teaching and Referral Hospital, the paediatric ward became a grim scene as 15 children were admitted with kala-azar in 2022, the highest number recorded at the facility. Tragically, two children died within days of each other. Japeth Muthengi, another parent from Ngomeni, found himself caught in the outbreak's grip. His five-year-old daughter, after months of unexplained illness, was referred to Garissa Hospital. She was hospitalised for over a month. "For six months, I watched helplessly as she grew weaker and lost her appetite. Her stomach swelled, but I didn't know what was wrong," Muthengi recalls. At Garissa Hospital, the diagnosis was clear: kala-azar. The treatment she received there saved her life, but the experience left an indelible mark. Back in the village, Muthengi remembers a mother and her child succumbing to the disease before they could reach medical care. Regina Kasyoka, also from Ngomeni, experienced a similar ordeal. She and her three children were admitted to Garissa Hospital during the outbreak. The financial strain was immense, compounded by the stigma they faced. "It was emotionally and financially draining, considering the transport costs and having to buy some of the medicines from private chemists," Kasyoka says with sadness. "The locals branded us the 'kala-azar people.'" Thankfully, all her children survived, but the emotional and financial scars remain. When asked about the cause of kala-azar, Kasyoka and Muthengi both refer to the local belief that it is caused by flies that follow camels in their grazing fields. "We are worried about another outbreak because many camels cross over to our areas from the neighbouring counties of Tana River and Garissa," says Muthengi, with concern etched on his face. Around 70 kilometres from Garissa town, the residents of Fafi faced their own battles. Muna Abdiqadir, a mother of seven, had two of her children, aged eight and 12, admitted to hospital. "They just looked sickly, and their bellies were swollen. My neighbours said it was kala-azar," she recalls. She had to take time off from her vegetable vending business to stay with her children during their hospitalisation. For some, however, hope came too late. Fadumo Imran, a resident of Daadab, mourns the loss of her eight-year-old son. Delayed treatment proved fatal. "I tried to raise money for his medication, but it was too late. He lay motionless on the hospital bed and breathed his last. What could I do? It's God's wish," she says, her voice resigned. Of her five children, her youngest was the only one affected. Like others, Imran admits that she does not know the exact cause of kala-azar or how to prevent it Dr Hussein Buro, Director of Clinical Services at Garissa Teaching and Referral Hospital, explains that kala-azar is endemic in parts of Garissa, such as Daadab, Fafi, and Ijara, as well as in the northern parts of Kitui County. The doctor stresses that the disease is treatable but warns that the success of recovery depends on early detection and the patient's nutritional status. He notes that while both children and adults can be affected, the disease is more severe in children and can be fatal if left untreated. "Chances of recovery are high with early initiation of treatment. Early diagnosis and treatment can lead to a quicker recovery and a reduced length of stay in the hospital," explains Dr Buro. Data from the hospital reveals that 113 cases of kala-azar were recorded between 2020 and 2022, marking the highest spike in recent history. According to the Ministry of Health, kala-azar is endemic in arid and semi-arid regions of Kenya. Since January 2020, 2,233 cases have been reported from nine counties: Marsabit, Garissa, Kitui, Baringo, West Pokot, Mandera, Wajir, Tharaka Nithi, and Isiolo. In West Pokot, where the outbreak remains active, 33 new cases were reported in March 2023. In January 2023, Kenya launched a national strategy to control and ultimately eliminate visceral leishmaniasis (kala-azar) as a public health problem through a project called 'Intensifying Visceral Leishmaniasis Diagnostic Efforts in Support of Disease Elimination in Kenya.' The project, which runs from 2024 to 2027, supports the World Health Organisation's strategic framework for the elimination of kala-azar by 2030 in Eastern Africa countries, including Kenya, Uganda, and South Sudan, where 73 per cent of global cases are reported. The strategy focuses on early diagnosis and treatment to prevent disability and death. According to WHO, an estimated 700,000 to one million new cases occur annually worldwide. Helen Bokea, Director of Neglected Tropical Diseases at Foundation for Innovative and New Diagnostics (FIND), an international organisation involved in the fight against kala-azar, says: "We are committed to working with countries and communities to defeat this deadly disease by boosting testing capacity so that infections can be identified early, and lives can be saved. The clock is ticking on the 2030 WHO elimination target." Kala-azar, caused by the Leishmania parasite, is transmitted through the bites of infected female sandflies. Smaller than mosquitoes, these flies thrive in humid environments, breeding in black cotton soil, termite mounds, and acacia trees. They feed on human and animal blood, transmitting the parasite to subsequent hosts. The disease's symptoms include prolonged fever, loss of appetite, weight loss, and enlargement of the spleen and liver. Without treatment, kala-azar is fatal. Malnutrition worsens its severity, making children and vulnerable adults in impoverished areas particularly at risk. Currently, 11 counties in Kenya report approximately 1,500 cases annually, with over five million people at risk. The disease is closely linked to poverty, poor housing, malnutrition, and environmental changes such as deforestation and climate shifts.

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