The World Health Organization (WHO) has shipped medical supplies from its global emergency stockpile (buffer stocks1) to Marsabit County in Kenya, which is currently affected by an outbreak of visceral leishmaniasis (also known as kala-azar).
“We’re working with national and county officials and other implementing partners to provide on-the-spot training so that access to diagnosis and treatment becomes available to people in areas where the outbreak has been reported,” said Dr José A. Ruiz Postigo, Medical Officer in charge of WHO’s leishmaniasis control and elimination programme. “There is an urgent need to expand the number of screening, diagnostic and treatment sites to improve access to health services in this vast and isolated area”.
The shipment to Marsabit was expedited following a WHO regional meeting (Nairobi, 12–14 June) and that of a national task force (15 June). Officials of the ministry of health, WHO and representatives of several partner organizations – such as the University of Nairobi, the Drugs for Neglected Diseases initiative and the Foundation for Innovative New Diagnostics – discussed the best available options to deal with the growing number of cases.
“In February, we had only one case, but this increased to 15 in April and in May we had 37 cases,” said Mr Abduba Liban, Disease Surveillance Coordinator at the Marsabit County Referral Hospital. “We quickly ran out of medicines and test equipment and had to buy the last 300 vials of medicines available in Nairobi at a cost of US$ 6000. As we had to pay so much, we need funds to support other activities”.
The local media has reported four deaths2 from this outbreak so far, three of whom had been on their way to the hospital.
To provide on-the-ground support, staff of the national kala-azar programme in Nairobi and WHO officials visited Marsabit County on 18–21 June. At the time of the visit, 40 kala-azar patients were being treated in the local hospital by clinical officers and medical doctors because of an ongoing two-week strike by nurses.
The medical team and county health authorities have agreed the need to expand treatment sites in the county from one to eight, to establish an emergency stock of antileishmanial medicines at the national level and to conduct active case searches. A smaller outbreak in 2014–2015 was contained by active case searches and vector control activities.
Marsabit is Kenya’s largest county, with Moyale as its largest town. The population of the county exceeds 290 000.
The disease
Leishmaniasis is caused by protozoan Leishmania parasites that are transmitted by the bite of infected female phlebotomine sandflies. The most severe (visceral) form attacks the internal organs and is endemic in more than 80 countries. Left untreated, it is fatal in more than 95% of cases within 2 years after the onset of the disease.
The most prevalent (cutaneous) form causes facial ulcers, disfiguring scars and disability; it is endemic in Kenya.
Leishmaniasis is linked to environmental changes such as deforestation, building of dams, irrigation schemes and urbanization.
1 The supply of antileishmanial medicines is not continuous. Most are produced by only a single manufacturer. The buffer stocks available at WHO headquarters are intended for emergencies and are sent to endemic and non-endemic countries during outbreaks or shortages of medicines.
2 Four die of Kala-azar in Marsabit and Kala-azar claims 4 lives in Marsabit County