Alarm in Wajir as Kala-azar kills 26, sends over 100 to hospital
Health workers attend to babies suffering from Kala-azar. Some 111 patients are admitted to Wajir County Referral Hospital.
When one-year-old Zakaria Amin exhibited high fever, fatigue and weight loss, his father Ahmed Amin of Hadado village in Wajir West thought his son had dengue fever.
He asked his wife to get some painkillers while he went to herders to get some camel milk.
“I did not think it was serious so I gave him camel milk that serves as medicine. But he did not improve but became restless,” Mr Amin said.
A few days later, Zakaria's condition worsened as he became unresponsive.
“I rushed him to our local dispensary and we were brought to the Wajir County Referral Hospital. We have been here for six days,” Mr Amin said.
Zakaria is one of 111 patients admitted to Wajir County Referral Hospital.
In the hospital's paediatric ward, Zakaria lies on a bed, suffering from weight loss.
Zakaria could easily be dismissed as another case of malnutrition, which is also common in Wajir. But doctors at the health facility diagnosed him with Kala-azar, a common disease in the area with signs and symptoms of significant weight loss, persistent fever, progressive anaemia (pancytopenia), and the enlargement of the spleen (splenomegaly) and liver (hepatomegaly).
There are four other children in the ward with Zakaria; two of them need specialised treatment in Nairobi, but their parents cannot afford the cost due to financial constraints.
Ms Habiba Ali Maalim, the Wajir County Executive Member for Health, says the two critically ill children are on ventilators and not much can be done because the hospital does not have an Intensive Care Unit (ICU).
Since September last year, 679 people have been infected and 26 have died, most of them children, while 111 have been admitted to Wajir County and Referral Hospital.
“Most of those who have died were brought in when their condition had worsened. A poor healthcare-seeking culture of the locals can be blamed for the deaths,” she said.
She revealed that the county started recording an increase in December after the first cases were reported in September.
“The first cases were reported in September and as we managed them, we noted an upsurge in December. The numbers have kept on increasing from the four sub-counties of Eldas, Wajir West, North and Tarbaj,” she said.
According to Ms Maalim, Eldas and Wajir West are the worst affected and the local administration has since set up four treatment centres across the county.
The administration of Governor Ahmed Mohamed has also imported drugs from as far away as the Netherlands to fight the Kala-azar pandemic.
“We are currently carrying out fumigation in areas that reported an outbreak. We are also carrying out public awareness across Wajir,” she said.
At least 11 sites in Eldas have been successfully fumigated to reduce infections, but Wajir West still has more than 18 sites that need to be fumigated.
“We are still recording cases because we are yet to cover all the areas that are infested by the kala-azar causing parasites,” she revealed.
This fatal disease presents with early symptoms including fever, weight loss and fatigue. Advanced stages include enlarged spleen and liver, severe anaemia and darkening of the skin (hence 'kala-azar', which means 'black fever' in Hindi and is fatal if left untreated).
The causes of kala-azar include environmental factors. Drought and deforestation lead to the expansion of sandfly habitats and poor housing, as cracked mud huts harbour sandflies.
The nomadic lifestyle of Wajir residents has been blamed for the outbreak of kala-azar.
Also admitted to Wajir County and Referral Hospital is 8-month-old Suthes Abdinoor from Eldas. Her mother, Ms Halima Mohamed, says she has eight children but only Suthes is infected.
“I got worried when she lost interest in breast milk. I tried giving goat milk and he always vomited,” she said.
Ms Mohamed says she has heard about Kala-azar since it affected her in 2008 when she was still at school.
“It was a bad experience for me. We stayed in school as we were treated because our parents had moved with livestock,” she said.
Kala-azar is a neglected disease affecting the community. Scientifically known as visceral leishmaniasis (VL), it is caused by the bite of sandflies.
It is a protozoan parasite transmitted to humans by the bite of an infected female sandfly (Phlebotomus species), a tiny insect vector measuring 1.5 to 3.5 millimetres in length.
Sandflies are hairy and much smaller than mosquitoes, almost invisible to the naked eye, and look the same.
Sandflies are most active at dawn and dusk, but can bite throughout the night and on overcast days. They are also more likely to bite in calm weather and are attracted to dark clothing.
In Kenya, kala-azar is common in the arid and semi-arid regions of the North Eastern and Rift Valley, particularly Loima sub-county in Turkana County, Marigat in Baringo East, Machakos, Mandera, Garissa, Wajir and West Pokot counties.
The vector thrives in cracks and crevices of mud houses, heaps of cow dung, ant-hills that dot these areas, and acacia trees – the sap of these trees attract sand flies.
At least four wards have been set aside for patients at Wajir Hospital, but the high number of arrivals is forcing the administration to find alternatives.
“We are erecting tents to serve as wards because the numbers of patients are rising. We are admitting new cases on a daily basis and the four wards are now crowded,” Ms Maalim said.
She also said that the availability of the mobile laboratories provided by the national government will help in diagnosing people in far-to-reach areas.
“Once these mobile labs are taken to those areas that our people reside, then more patients will be brought as per the tests from the mobile laboratories,” she said.
According to Dr Abdi Hakim Ali, treatment for kala-azar requires a patient to be admitted to hospital because of the nature of the treatment, the need for closer monitoring and the distance most patients travel to reach the health facility. Patients are usually accompanied by their relatives as caregivers, as most patients are children.
“We are using combination therapy where we use two drugs called Sodium Stibogluconate (SSG) and Paromomycin (Pm) and this combination is given for 17 days,” he explained.
According to Dr Ali, this combination is usually given very early in the morning between 7am and 7.30am because it is highly reactive to sunlight.
He said some patients with pre-existing conditions are treated with AmBisome (amphotericin B), which is given by intravenous infusion for 6-10 days.
The drug to be given depends on conditions such as pregnancy, whether the patient is a non-responder or critically ill and age e.g. if the child is under two years or the adult is over 45 years.
To confirm Kala-azar infection, clinicians perform the Rk39 random diagnostic test or use the direct agglutination test (DAT).
“DAT is used when Rk39 fails to give accurate results and a patient continues complaining and showing symptoms of kala-azar,” he said.
The mobile laboratories provided by the national government use DAT diagnosis since it is a simple, accurate and efficient test that can be used in the remote areas of Wajir County.
Dr Ali said most patients die from conditions associated with Kala-azar, including anaemia and malnutrition.
The World Health Organization (WHO) ranks kala-azar as the second biggest killer parasitic diseases after malaria.