Bilharzia menace sweeps across Homa Bay

Homa Bay borders the world’s largest freshwater lake. It has the longest shoreline of Lake Victoria, yet most people in the county cannot access clean water for domestic use.

Every morning, women wake up early and trek kilometres to fetch water from rivers, pans and the lake itself.

Some of the water is consumed directly from its source, leading to the spreading of diseases, including bilharzia (schistosomiasis), a neglected tropical disease and one of the silent killers in the county.

In its advanced stages, bilharzia can affect the body’s vital organs and has symptoms similar to those of sexually transmitted diseases. Because of the symptoms, many patients shy away from hospitals fearing stigmatisation.

Some patients have traces of blood in their urine, with men having erectile dysfunction.

Because of this, few people disclose that they have been infected by the disease.

On Mfangano Island, the lake is the only water source for residents.

Phanice Wankio, 28, has spent all her life on the island and she is not sure whether she has ever contracted the disease despite using water directly from the lake.

Like most women, after waking up at 6am, she spends most of her morning hours on the lake shores doing household chores, which includes washing clothes and utensils from her household.

Because the distance from the lake to her home is long, she carries all the items she wants to wash to the lake.

Most women on the island do this daily. Every morning, the lakeshore is turned into a laundry area.

But where does the problem start? As the women wash clothes, others bathe or swim in the lake.

But as they do this, some relieve themselves in water without realising they are contributing to disease transmission (if their stool contains the parasitic worm).

When the water is consumed directly, the parasites causing bilharzia and soil-transmitted ailments (intestinal worms) are ingested into the body.

The parasites will live in their host until they mature to lay eggs before being transmitted to a different person.

Over the years, continuous use of untreated water has led to many people being infected by bilharzia along the lake shores and in areas where residents depend on stagnant water.

Free from contamination

The prevalence of the disease in Homa Bay is 32 percent, according to the county’s department of health, yet a lot of people are still unaware of its existence.

Ms Wankio says she is not convinced that she can contract bilharzia.

"I always boil the water before using it. It is a way of ensuring the water I consume is free from contamination. Besides, the waves in Mfangano are strong and flush away the germs in the lake," she argues.

But Dr Willis Onyango, principal medical laboratory officer and coordinator for neglected tropical diseases in Homa Bay, says the diseases can be transmitted through the skin.

"You can get schistosomiasis (bilharzia) when wading or swimming in water. The parasites can penetrate through the skin and into the bloodstream before moving to vital organs like the liver," he says.

The diseases can cause cancer and infertility, he says, but most people do not know when they are diagnosed with bilharzia until it is too late.

Bilharzia takes three weeks before some of its signs start to show.

In some patients, the virus causes abdominal pain.

Some women have also reported feeling discomfort when going for short calls. Some assume they are infected with sexually transmitted diseases and because they fear being stigmatised, they do not go to the hospital.

"Bilharzia kills and the government should give it a priority. If it’s not death, victims can have permanent body damage like infertility in women," Dr Onyango warns.

The disease does not only affect adults. Children too have fallen victim when they consume water from the lake.

In children, the disease shows symptoms like chronic anaemia and stunted growth.

It also causes stomach problems and contributes to school dropouts in communities near the lake.

Amid the threats the disease poses, the government has made strides as it tries to eliminate the infections that are as lethal as malaria and HIV.

In July, the Kenya Medical Research Institute (Kemri) conducted a clinical trial of a homegrown and local herbal porridge designed to be taken as a school meal for nutrition and deworming to get rid of the diseases.

Researchers have seen a positive result and will soon recommend the product to be introduced on the market as an alternative and child-friendly means of eradicating neglected tropical diseases like bilharzia.

The herbal product, called Ujiplus, whose innovation started in 2012 has patented a formula that has scientifically been proven to be bioactive against common childhood infections.
The flour is a combination of nutrition, deworming and treatment of bacterial and fungal skin infection.

It was developed by scientists at Kemri in partnership with a local flour-processing firm.

Before the clinical trial, at least 20 percent of pupils along the lake were found to be missing school every day because of stomach problems.

Underlying gaps

A study conducted in four schools in Mbita sub-county showed that 80 percent of pupils are diagnosed with bilharzia and other intestinal infections that affect the liver, lungs, nervous system and even the brain.

Before the programme was introduced by Kemri, the government had engaged in a nationwide deworming campaign that started in 2001.

At least 10 million children are dewormed annually after the World Health Organization provided a road map for the drive.

Though the programme has been successful, several other underlying gaps affect children below the age of six.

Prof Elijah Songok, a researcher at Kemri who developed the porridge, said drugs used in the national deworming campaign are toxic to young children and most parents are not always aware of what is happening to their children.

Drugs used in deworming include praziquantel (the available formulation is not child-friendly) and albendazole, which is not recommended for children below two years.

In addition, he said, children should be given deworming drugs when they have eaten but most families struggle to serve three meals a day to their children.

Kemri’s porridge flour is a solution that combines nutrition and deworming.

The use of the flour has been given the green light by the Pharmacy and Poisons Board.

Previous clinical trials of herbal medicine were done in eight schools in Nandi and Kirinyaga counties, where children were given the porridge formulation for two months.

Prof Songok, who is also the director of research and capacity building at the Kemri graduate school, said the outcome of the trial was successful and researchers managed to get the results they were expecting.

The researcher said children who took the formulation were dewormed and their nutritional indicators (weight) improved.

There was also a significant reduction in worm infections, roundworms, hookworms and bilharzia.

The researcher told Nation.Africa that results for the study conducted in Homa Bay will be released in February next year.

"We hope to partner with county governments for the programme to continue in the coming years. The local herbal innovation will likely change the approach to child deworming in Africa because our evaluation has seen positive changes in the health status of children," Prof Songok said.

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