Kenya: Kala-Azar, World's Second-Largest Parasitic Killer After Malaria, Hits Mandera

25 February 2021

At least 19 cases of the deadly parasitic disease kala-azar have been reported in Mandera, with the patients being treated at the Wajir County Referral Hospital.

The disease needs special treatment centres found in the neighbouring Wajir or Marsabit counties.

Mandera Public Health Chief Officer Rahma Abdullahi said the patients were referred to Wajir as Mandera cannot treat the disease.

"We have reported cases of kala-azar in Kutulo Sub county and about 16 infected persons have been taken to Wajir for treatment," she said.

Two more cases from Mandera North Sub County are being managed at Mandera County and Referral Hospital.

"We are engaging the Vector Borne Disease Control Unit at the Ministry of Health in Nairobi to help us set up treatment centres in Mandera before the situation worsens," she added.

Mandera is negotiating for the establishment of a kala-azar treatment centre at Elwak in Mandera South and the county referral hospital in Mandera East.

The county chief officer said the situation at Kutulo was endemic and those cases can be managed at Elwak, which is closer than Wajir.

"The drought in the area is leading to this situation after the sandflies multiplied and since livestock migrated, the flies now bite people, infecting them," she said.

Sporadic cases of kala-azar have been reported in Mandera North and Mandera West Sub counties.

According to the health administrator, anthills in many parts of Mandera are harbouring the sandflies that transmit the virus.

"Kala-azar is a parasitic disease caused by the Leishmania parasite that typically lives in infected sandflies and one can contract the disease from a bite of the insect," said Mr Mohamed Adawa, the County Deputy Director of Health Services.

The sandflies that carry the parasite typically reside in tropical and subtropical environments and at the moment, Mandera is dry.

Ms Abdullahi said signs of the disease were first reported in the county in January.

A patient can show signs two to eight months after being bitten by a sand fly.

Symptoms include general weakness, bleeding, weight loss, fever, enlarged spleen and liver and decreased production of blood cells.

Swollen lymph nodes are also common among the victims of the sand fly bite.

The disease damages internal organs such as the spleen and liver. It also affects the bone marrow as well as one's immune system.

If not well treated and in time, the condition is fatal and in Mandera, two deaths have been reported by locals.

"We are yet to record any deaths officially despite unconfirmed reports of two deaths," said Ms Abdullahi.

Available information online shows the parasite causing kala-azar lives and multiplies inside the female sand fly. The insect is most active in humid environments during the warmer months and at night.

It is reported that humans can also transmit the parasite to each other through blood transfusion or shared needles.

According to the World Health Organization (WHO), poverty is a determining factor for the disease.

Besides, kala-azar is associated with malnutrition and famine, migration of people caused by urbanisation, emergencies, war and climate change.

Diagnosis of the parasitic disease includes bone marrow biopsy or blood sample examination.

"It is only in Wajir that such tests can be carried out and treatment offered. It is a complicated process that the treatment demands the patient remaining in the ward for almost two months to heal," said Ms Abdullahi.

Despite public health awareness on the unfolding crisis in Mandera, Ms Abdullahi said demolition of anthills is ongoing to destroy the sandflies habitats.

WHO recommends wearing clothes that cover as much skin as possible such as long trousers, long-sleeved shirts tucked into trousers, and high socks.

Spraying of indoor sleeping areas with insecticides, sleeping on the higher floors of a building are recommended since sandflies are poor fliers.

One has to avoid being outdoors between dusk and dawn because this is when sandflies are most active.

Residents are also encouraged to use well-woven bed nets since sandflies are much smaller than mosquitos.

Antiparasitic drugs, such as amphotericin B (Ambisome) are recommended for treatment.

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