Inside Kenya's plan to eliminate Neglected Tropical Diseases by 2030

Seven-year-old Nicolas Kipruto was herding his family’s cattle in a nearby farm when he was bitten by a venomous snake.

The Class 2 pupil at Borsiso Primary School in Baringo county was rushed to the nearby Poi dispensary by his father Sammy Kipsang. There was no anti-venom at the facility.

With help from some residents, they went to Kipsaraman dispensary 15 kilometres away, where they were referred to Kabartonjo Subcounty Hospital.

There was no ambulance and they had to be ferried using a vehicle belonging to the area MCA. Unfortunately, the boy died while receiving treatment.

That is the dilemma many Kenyans are facing as the country struggles to eliminate Neglected Tropical Diseases (NTDs), snakebites being one of them.

NTDs are a diverse group of infections which are common in low-income populations in developing regions of Africa. They are caused by viruses, bacteria, protozoa and parasitic worms.

They include snakebites, bilharzia, intestinal worms, leprosy, elephantiasis, kala-azar and trachoma.

The Health ministry has embarked on an ambitious plan to eradicate these diseases. As much as they are neglected, they are a big health problem, some of them killing or disabling people.

Data from the ministry shows that 50 per cent of the population, representing 25 million Kenyans, is at risk of suffering NTDs.

In Kenya, a disease like trachoma is one of the leading causes of blindness.

Bilharzia is also ravaging people in the lake region and central parts of the country. The disease is said to have rendered a number of young women infertile.

Children are being badly affected by intestinal worms.

Apart from the health problem these diseases present, victims, especially those who have elephantiasis suffer stigma, making it difficult to coexist with community members.

THE PLAN

In an effort to reduce deaths and disability caused by snakebites, the ministry through the Division of Vector Borne and Neglected Tropical Diseases plans to train trainers of trainers to enable health workers within the dispensaries and health centres to know how to treat snakebites.

The training will start at the Coast before it is rolled out in other areas with high burden.

“One of the biggest challenges we had is people coming to the facilities with a snakebite and people who are in that facility don’t know how to treat it,” Head of Vector Borne and Neglected Tropical Diseases Sultani Matendechero told the Star.

“So we start blaming the anti-venoms that are there, saying they are not effective but it is actually the way in which they are being used that is not right,” Matendechero added.

The ministry also plans to train communities on the importance of seeking the right treatment at the right time.

Drone technology will be used to transport anti-venoms in cases of emergency to save lives.

“That is going to be a long-term strategy because there are a lot of regulatory barriers which we really need to circumvent but we have already started,” the medic said.

“We want to be able to have these drones so that some snakebites like those of black mamba can be treated because the venom acts very fast and by the time the patient reaches the hospital, they are already dead.”

Matendechero said the government is in the process of registering two more anti-venon brands that will be added to the already existing two as they explore a possible local manufacturer.

Currently, it costs Sh3,500 for an anti-venom vial down from Sh30,000.

The medic said a very small percentage of the bite is what is dangerous, adding that a snake will never come and bite unless it is rattled.

Snakes actually preserve their venom for hunting for food so when startled it will bite most of the bites and not venomous.

He warned that pursuing such a snake in an attempt to kill it will make it prepare a second venomous bite which in most cases turns out to be deadly.

For trachoma, the ministry has signed an MoU with the International Trachoma Initiative to enable the ministry receive medicines approximated at Sh4 billion every year for the next three years to be distributed in eight counties that are affected by trachoma.

They include Turkana, West Pokot, Baringo, Isiolo, Marsabit, Wajir, Narok and Kajiado.

“We are starting with elephantiasis this year then tackle trachoma in the next three to five years,” he said.

The project will be reviewed in the next three years to evaluate its success towards elimination of the disease in all the eight counties.

INTESTINAL WORMS AND BILHARZIA

Kenya will also be rolling out the ‘Breaking Transmission Strategy’ launched in early 2019 in 10 counties this year. Four of them are in Western and six in the Coast.

The new approach will enable Kenya to eliminate intestinal worms as well as bilharzia.

This year, the ministry has received partnerships, funding and donations in terms of drugs which will be used in Lamu, Tana River, Mombasa, Kilifi, Kwale and Taita Taveta in the Coast region and Vihiga, Kakamega, Bungoma and Trans Nzoia in Western.

The project will then be scaled up to five additional counties in the lake region. They are Migori, Homa Bay, Kisumu, Siaya and Busia.

The breaking transmission strategy will involve mass treatment of everybody eligible in the community.

“We will also be looking at providing safe water because these NTDs are also linked to absence of safe water. Then we will be looking at behaviour change communication so our strategy combines those three interventions.”

The medic is optimistic that at the end of five years the country will have started seeing some real elimination of the two diseases.

ELEPHANTIASIS

The government is also seeking to eliminate elephantiasis. 

In 2015, a breaking transmission strategy to eliminate the disease was launched. After five years of successfully implementing mass treatment at the Coast, the ministry this year will be conducting the transmission assessment starting next month (March).

The programme was restarted in six counties in the Coast - Lamu, Tana River, Kilifi, Mombasa, Kwale and Taita Taveta.

Under the project, more than four million people have been reached and given medicine.

“We believe that once the transmission assessment says that there is no transmission we can stop the mass treatment,” Matendechero said.

LEPROSY

The country was certified as having controlled leprosy as a public health problem in 1984.

This has been attributed to the existence of a vibrant TB vaccination programme given at birth that helps protect against leprosy.

Matendechero said this does not mean that the disease has been completely eliminated. He said there are chances of finding small flare-ups.

With the help of World Health Organization, the country has been able to get the medication that is required, as well as establish a countrywide framework where such cases are reported and quickly treated before it becomes a public health problem.

Some regions in the Coast and parts of Western Kenya have been flagged as having had situations that needed extra attention.

However, with some of Kenya’s neighbours yet to achieve that milestone, the risk is still high.

The head of the division said attaining a level of elimination of any of these diseases will be a big achievement not just for the country but the world in general.

For the country to be able to reach elimination of an NTD, it will be a very big celebration globally, he said.

INFOGRAPHICS

SNAKE BITES

• Number of snakebites annually - 50,000

• Cases reported -  15,000

• Deaths per year - 800

• Those who seek treatment late - 10,000

• Global - 81,000 to 138,000 deaths and 400,000 people left with permanent disabilities annually

• Species behind majority of bites in Kenya - Puff adders, black spitting cobras, black mambas and boomslang

• Anti-venoms registered in Kenya - 2

• Cost of anti-venon vial –Sh3,500

Elephantiasis

• Infection occurs when filarial parasites are transmitted to humans through mosquitoes

• Causes swelling of the scrotum, legs, arms or breasts

• Common risk factors for elephantiasis include:

-Living for a long time in tropical and subtropical areas

- Having a high exposure to mosquitoes

- Living in unsanitary conditions

Trachoma

• Amount to be invested in medicines every year - Sh4 billion

• No of years of the project – 3

• No of counties affected by trachoma – 8 (West Pokot, Baringo, Isiolo, Marsabit, Wajir, Narok and Kajiado.)

Bilharzia

• Number of counties where the ‘Breaking Transmission Strategy’ will be rolled out – 10

• Six coastal counties - Lamu, Tana River, Mombasa, Kilifi, Kwale and Taita Taveta

• Four western counties - Vihiga, Kakamega, Bungoma and Trans Nzoia.

• Five additional counties from the lake region - Migori, Homa Bay, Kisumu, Siaya and Busia.