By Sharon Atieno
In line with the World Health Organization (WHO) target to end Neglected Tropical Diseases (NTDs) by 2030, Kenya has launched its strategic plan for the control of leishmaniasis, a vector-borne disease.
Leishmaniasis like other NTDs affects the poorest, vulnerable and most marginalized populations living mostly in developing countries. It is transmitted by a parasite from an infected female sand fly.
The disease has four forms namely visceral leishmaniasis (VL/ kala-azar), cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL) and post kala-azar dermal leishmaniasis (PKDL).
Of the four, Kenya is endemic to three. These are visceral leishmaniasis, cutaneous leishmaniasis, and post kala-azar dermal leishmaniasis.
According to Dr. Sultani Matendechero, Head, Division of Vector Borne and Neglected Tropical Diseases, Kenya’s Ministry of Health, the steady increase in the number of reported leishmaniasis cases and the associated loss of lives in the country is what inspired the development of the strategy dubbed Kenya Strategic Plan for Control of Leishmaniasis 2021-2025.
“The reported cases rose from 607 in 2018 to 1,463 in 2019, before dropping to 1,200 in 2020,” he said. “Whereas six counties were listed as being home to leishmaniasis in 2011, we now know that at least 11 counties are experiencing ongoing transmission of this deadly disease.”
These counties include Nakuru, Nyandarua, Turkana, West Pokot, Baringo, Isiolo, Wajir, Garissa, Marsabit, Mandera and Kitui. Sporadic cases have also been reported in Tharaka Nithi and Kajiado Counties.
According to Dr. Rashid Aman, the Chief Administrative Secretary-Ministry of Health, the Strategic Plan seeks to accelerate the gains achieved in the control of leishmaniasis in the past 10 years.
“The main goal of the strategy is to reduce morbidity due to leishmaniasis in Kenya by 60% and reduce the occurrence of leishmanisis outbreaks in Kenya by 50% by 2025,” he said.
“It is envisaged that by the end of 2025, people living in endemic areas will be relieved of the burden and suffering brought about by leishmaniasis, which will eventually lead to improved health and economic productivity.”
The Chief Administrative Secretary noted that the main strategic approaches to be employed during this period will focus on the rapid scale-up of access to interventions, enhanced planning for results, resource mobilization, and financial sustainability.
Key areas that the strategy focuses on
In order to achieve the main objectives, the strategic plan focuses on seven key result areas. These include improved case management; strengthened supply chain management; enhanced vector control mechanisms to reduce transmission; strengthened surveillance, monitoring and evaluation, and operational research; strengthened epidemic preparedness response (EPR); strengthened advocacy, communication and social mobilization; and strengthened coordination, partnership and resource mobilization.
To improve case identification management of the disease, the strategy will train health workers on the diagnosis and treatment of leishmaniasis specifically CL and VL at all levels, establish more testing and treatment sites for management of leishmaniasis, develop and renew guidelines for the management of CL and VL as well as conducting therapeutic efficacy test for leishmaniasis medicines.
Among the strategies to be implemented to ensure correct quantification and an adequate supply of leishmaniasis medical commodities (drugs and diagnostics) include regular monitoring and supervision of treatment sites and storage facilities to ensure adequate inventory control parameters are established to avoid stock-outs and wastage of medicines and diagnostics.
Others include: improvement in warehousing and logistics infrastructure; working closely with Kenya Medical Supplies Agency (KEMSA) to provide adequate logistics support from national to county level for delivery of commodities; and improved reporting on stock levels from the counties.
Vector control targets protecting persons against sandfly bites, controlling vector densities and monitoring the occurrence and distributions of the sandflies in Kenya. This will be achieved through rolling out insecticide-treated nets and conducting indoor residual spraying (IRS) and chemical space spraying in endemic regions.
Also, the community will be engaged in environment management by either destroying sandfly breeding habitats or sealing of open eaves that allow entry of sandflies into houses. Other strategies include, establishment of leishmaniasis vector surveillance sentinel sites and monitoring insecticide resistance.
To strengthen EPR for leishmaniasis, the key activities to be implemented include increasing alerts, prompting investigation of validated alerts and cases, and active case finding both in the health centers and in the community.
Besides advocacy and social mobilization, the strategy also targets improved communication. The aim is to increase community leishmaniasis awareness for exposure avoidance, risk reduction, and improve health-seeking behavior while providing leishmaniasis information to all stakeholders at all levels.
The implementation of the strategy will cost shs. 2 billion (about $20m) over the next five years. The three main cost drivers are: medicines and supplies at shs. 600 million (about 6m), followed by monitoring and evaluation at shs. 518 million (about $5.18m), and training at shs. 250 million (about $2.5m).
“The current resource gap for the implementation of the leishmaniasis national strategy stands at shs. 1.6 billion,” Dr. Aman said. “We do hope that partners, county and national governments will mitigate this gap to facilitate the realization of the goals outlined in the strategy.”
Additionally, Dr. Matendechero called on affected counties to prioritize allocation of funds towards the strategy. He also urged partners to continue supporting the government in the implementation phase of the strategy while encouraging local private sector to join in the effort through robust social responsibility and individual philanthropic gestures.