Persistence and Changing Distribution of Leishmaniases in Kenya Require a Paradigm Shift

Abstract

Background: Leishmaniases present a major global public health problem, being responsible for between 40,000 and 50,000 deaths annually. The resultant morbidity affects the economic productivity and quality of life of individuals in endemic regions. As zoonotic disease(s), leishmaniases have become persistent with intermittent transmission and a tendency to disappear and reemerge, straining the fragile healthcare infrastructure in Kenya. There is a need to better understand disease(s) dynamics in Kenya. Objectives of the study. The status of leishmaniases in Kenya was reviewed to refocus and influence the attention of the scientific community and intervention strategies/policies on this persistent public health problem. Methodology. Electronic and manual literature were searched for relevant scholarly peer-reviewed published articles on leishmaniases. Literatures were obtained from PubMed, Medline, EBSCO, Host, ScienceDirect, and Google Scholar. Findings. The diseases are reported to be persistent as emerging and reemerging within and outside traditional endemic regions. Cutaneous leishmaniasis (CL) has maintained restricted foci in Nyandarua, Baringo, Nakuru counties, and Mount Elgon area in Bungoma County. Visceral leishmaniasis (VL) was most prevalent with cases in Baringo, Turkana, West Pokot, Isiolo, Kitui, Meru, Machakos, Marsabit, and Wajir counties. New VL cases/foci reported in formerly nonendemic regions/beyond traditional foci of Garissa and Mandera counties. Diagnostics, management, and control strategies have remained unchanged even in the face of changing disease epidemiology.

Conclusion: Leishmaniases are emerging and reemerging persistent infections in remote rural settings in Kenya. The adopted intervention strategies have not been effective over the years, and this has led to disease spread to formerly nonendemic areas of Kenya. The diseases spread have been further enhanced by population growth and movement, environmental and climate changes, and social conflicts. It is evident that without a paradigm shift in control methods, diagnostic techniques, and treatment protocols, the diseases may spread to even more areas in the country.

Figure 1

The visceral leishmaniasis trend in Kenya between 2000 and 2009 (Source: WHO, 2009).

Figure 2

Cases of cutaneous leishmaniasis reported in Kenya from 2000 to 2016 (Source: [17]).

Figure 3

(a) VL cases in Kenya in 2008. (b) Areas reporting new cases of VL in Kenya by 2008 (Source: WHO Kenya Basic Country Data Total Population https://www.who.int/leishmaniasis/resources/KENYA.pdf?ua=1).