Africa Co-Op

Outbreak Response in Kenya

Story by Catherine Wenger 

August 2021  

I traveled abroad with another Northeastern student for my third co-op to study the epidemiology of Visceral Leishmaniasis (VL) at the African Center for Community Investment in Health (ACCIH) for five months in a rural, northern county of Kenya. Two weeks after our arrival, the ACCIH team had received reports of patients from another VL treatment program in Baringo County that were referred there all the way from Magadi in Southern Kenya. Patients in Magadi suspected of having VL were traveling over several days and hundreds of kilometers to receive treatment at Kimalel Health Center about an hour south of Chemolingot where ACCIH is based. The outbreak of VL was forcing patients and family members to take weeks away from their homes and responsibilities in order to receive treatment because there were no health facilities in Kajiado County set up to treat VL.  

To address this, the ACCIH team partnered with the Kajiado West Sub-County Ministry of Health, Kenya Medical Research Institute (KEMRI), and International Centre of Insect Physiology and Ecology (ICIPE) to visit and evaluate several health facilities in the new endemic area to decide which facility should host a new VL program. Over the course of two days, we visited four facilities spread throughout the sub-county: Entasopia Health Center, Magadi Hospital, Oldoroko Dispensary, and Euwaso Health Center.  

While ACCIH serves the Pokot tribe in Baringo, Kajiado is home to the pastoralist Masaai people. Despite being 400km away from the Chemolingot treatment center, the Masaai face similar environmental risk factors for contracting VL. Components of the sandfly’s preferred habitat, such as acacia trees and termite mounds, are common in this area. The Masaai build temporary stick and mud homes which make them vulnerable to sandfly bites at night. As a herding community, they experience the same risks living in close proximity to animals and sleeping outside as well. Also, while the Masaai know of the disease — they call it intunui — a lack of education and resources makes communities more vulnerable and inhibits infected patients from seeking treatment in a timely manner.  

Looking out over the salt flats of lake Magadi, where the Magadi Soda Company uses the lake to produce soda ash, I could see the severity of the dry, sparsely-populated region. These health facilities, as a result, serve a relatively small patient population compared to the geographical catchment area. The group was looking for a facility that was located in a place that was most accessible via public transportation for the largest number of people. The facility’s infrastructure, such as lab equipment and bed capacity, needed to be suitable to host a VL program. At each location, the team was given a tour of the facility, a description of the catchment population characteristics, and other details to be used in evaluating the capacity to have a VL program.  

All of the facilities served populations being impacted by VL, but many of them were missing the basic attributes needed to treat VL patients. Some did not have functioning wards to provide inpatient treatment and were geographically very difficult to travel to. Other facilities did not have electricity, running water, or basic equipment such as a microscope. Ultimately, the team recommended to the Ministry of Health that Euwaso Health Center be provided the resources necessary to make it a fully functioning VL treatment center. They have a recently renovated ward with fully functioning utilities and equipment. It is easily accessible via a main road and is well staffed by health care workers prepared to undergo training to treat VL. The facility is somewhat far to travel to for some patients, but its location allows the program to be accessible to the greatest number of people. The team concluded the search — agreeing that Euwaso was the best candidate to provide the region with VL treatment.  

October 2021  

Euwaso Health Center is now a fully operational Visceral Leishmaniasis treatment center, serving the county in addressing the new outbreak and increasing prevalence of the disease. The Ministry of Health provided the facility with medicine, test kits, and hematology and biochemistry machines to fully prepare the center to receive VL patients. Patients are now able to seek treatment at this health facility and efforts are being made to educate the community about the disease so that patients know when and where to seek treatment. Now steps are being taken to understand the full epidemiology of VL in Kajiado and plan prevention and education activities.  

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