The burden of Cystic Echinococcosis in selected regions in Kenya

Abstract

Cystic Echinococcosis (CE) is caused by the larval stage of the tapeworm Echinococcus granulosus. The disease occurs worldwide, and is highly endemic in parts of Kenya, especially Turkana and Maasai areas. The life cycle involves dogs and other canids as definitive hosts and livestock as intermediate hosts. Humans are aberrant intermediate hosts. It’s a chronic debilitating disease resulting in morbidity, mortality and economic losses in human and animal populations. The outcome of the infection in livestock and human is cyst development in the liver, abdomen, lungs and other organ systems. In resource poor countries like Kenya surgical intervention is the main mode of treatment in CE infected individuals. In livestock the infection is typically asymptomatic and the most reliable diagnostic method

is cyst detection during meat inspection and postmortem. Condemnation of animal organs (liver, lungs) at meat inspection results in CE-associated direct monetary loss. This study involved a retrospective review of CE patients’ medical records obtained from AMREF-Kenya (1991-2011), with patients originating from Turkana North district of Kenya. Retrogressive annual meat inspection record review (5 years) and slaughter house surveys from selected regions (Kisumu East and West, Isiolo and Kajiado North districts) were conducted to assess the livestock CEassociated

direct monetary loss. Data obtained were used to calculate CE-associated direct losses in human and livestock populations. A total of 586 surgical cases treated at Kakuma Mission Hospital, Turkana, Kenya were evaluated. The ratio of male: female infection was 1:2, individuals in the 31-40 age groups being most prevalent. The average direct cost of a CE surgical treatment was Kshs 60,000.00. The total direct cost for 586 surgical patients, including an additional factor of 10% for unreported and nonhealthcare seeking patients, over the 20 year study period was Kshs 38,649,000.00 with

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average of Kshs 1,932,450.00 per year. Annual indirect CE-associated monetary losses were calculated based on the lost economic opportunities by a herdsman or housewife in the Turkana community due to CE morbidity or mortality; this amounted to Kshs 411,250.00 for a herdsman and Kshs 117,716.00 for a house wife. The total direct