Kala-azar: Killer disease that torments the poor

At Kacheliba in West Pokot is a treatment centre that caters to Kala-azar — a neglected tropical disease.

According to doctors without borders, Kala-azar is the second largest parasitic killer in the world — only malaria is more deadly. It is endemic in 47 countries with approximately 200 million people at risk of infection.

The disease is spread to humans through the bite of female sand files that are carriers of the parasite. Once in the body, it attacks the immune system and is almost always fatal if not treated.

The World Health Organisation classifies it as among the 17 neglected diseases that mainly affect populations living in poverty with little or no purchasing power.

In Kenya, it is estimated that about 4,000 people are annually infected with Kala-azar. Hospital records indicate that the prevalence is higher among males than females and the disease is most prevalent among the five to nine and 10 to 14 age groups.

To understand the gravity of this ailment’s situation in Kenya, we recently toured the Kala-azar treatment centre located at the West Pokot sub-county hospital. Here we found ten-year-old Chepterit Lochacharuk calmly seated under a shade outside the treatment centre.

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Looking at her, one cannot tell that she is forced to endure painful injections each day or that she has just received two injections for the day — or even that she has been hospitalised for 17days.

In a barely audible voice, the young girl tells us she spends most of her time standing or lying on her stomach because of the two painful injections she receives daily.

Her father, Lochacharuk Akwiny — who has been here for a week now taking care of his child, is seated on the opposite side conversing with his fellow men as they bask in the morning sun.

Lochacharuk tells us that his wife Salina and son Isaac Ruto are also recovering after they too were found to be suffering from Kala-azar and were treated for the same.

“Chepterit got sick and for one week was exhibiting malaria-like symptoms. We visited Marich Health centre where she was treated for malaria but her health continued to deteriorate. Her mother tried to treat her with herbs but the symptoms were persistent,” he says.

Unlike his age mates, Lochacharuk was not content to let his daughter rely only on herbs to get better and he decided to seek specialised treatment at Sigor sub-county hospital. It was here that the tests came back positive for Kala-azar.

After selling more than ten goats to have his daughter treated, the father of seven could not keep up with the hospital bill and he was advised to move Chepterit to Kacheliba sub-county hospital where Kala-azar patients receive free treatment.

It isn’t just the Lochacharuk family that has been hit by this parasitic ailment, Lopeyek Siang’ale, Assistant Chief of Kopulio sub-location in Kacheliba division also cheated death after suffering from Kala-azar for a year.

It was in 2006 and the whole year he was in and out of hospital with doctors telling him he was suffering from malaria and typhoid.

“I got the diagnosis but could not afford the Sh30,000 treatment. I had just lost my cows to East Coast Fever and I had nothing to sell to raise money for my treatment. I resorted to a traditional medicine man who charged me Sh1,500 though his efforts were fruitless,” he said when we caught up with him in his homestead.

Luckily for Siang’ale, Médecins Sans Frontières (MSF) — an international medical humanitarian organisation, —in 2007, opened a Kala Azar treatment centre in Kacheliba where they offered free medical treatment. The centre was run by MSF until 2012 when they handed it over to Drugs for Neglected Diseases Initiative (DNDI).

According to Dr Mark Riongoita of DNDI, Kala-azar is characterised by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver and anaemia.

Dr Riongoita, who is also doctor-in-charge of the treatment centre says people travel more than 200kms to seek medical care at the facility. He says the most affected places include Central Pokot, West Pokot, Turkana South and Baringo East

“When patients come here, the first step is for us to conduct a blood test. We also take tissue from the spleen to check if the parasite which causes the disease is present. If the results are positive, we admit the patient for 17 days and give them two injections daily,” he said.

According to the doctor, Kala-azar is mostly pre-dominant in these areas because of the presence of sand flies which favour warm temperatures and which live in anthills, cracks in walls and in heaps of cow dung. The lifestyle of locals also exposes them to the disease.

“During dry seasons, locals sleep outside their houses on the sand while naked which exposes them to these sand flies. One does not get sick immediately after the bite, it takes between two weeks to six months, depending on their immunity and diet, for the symptoms to start showing,” he says.

Fortunately, he says, after getting the full dosage of Kala-azar medication, all parasites are cleared out and the body develops high immunity to the disease. Since 2007, Dr Riongoita says more than 5,000 patients have been treated.

According to the head of neglected tropical diseases unit at the Ministry of Health, Dr Sultani Matendechere, Kala Azar affects the poor who go through many challenges to access treatment.

“Sometimes they go to traditional healers for treatment before seeking help from medical facilities. This is mainly due to lack of awareness.

Concerted efforts are therefore needed to not only create awareness but measures in place that will not only control spread of the disease but possibly eliminate it,” he says.