Exposure Factors Associated with Visceral Leishmaniasis (Kala-Azar) in Loima Sub-County of Turkana County, Kenya

Abstract

Visceral Leishmaniasis (Kala-azar) is a life-threatening vector borne disease caused by the obligate intra-macrophage protozoan parasites known as Leishmania donovani and L. infantum in the Old World and L. chagasi in the New World. It is classified as a neglected disease yet it is a public health problem, causing an estimated 500,000 new cases each year and affecting the poorest of the poor in the predisposed areas. In Kenya, kala-azar is common in arid and semi-arid regions of North Eastern and Rift valley, especially the Loima Sub-county of Turkana County, West Pokot, Machakos, Mandera, Garissa, Wajir counties, Marigat and Baringo East areas. The study was conducted between October, 2015 and June, 2016. The objective of the study was to determine the exposure factors associated with kala-azar and cross-sectional design was used to determine prevalence, the socio-demographic characteristics, socio-economic and cultural factors of the respondents, health seeking behaviour, local people’s knowledge, perception and behavior towards the existence of kala-azar in the purposively selected Loima sub-county. Simple random and stratified sampling technique were used to identify study subjects and a sample size of 341 respondents who were household heads or adult members were randomly sampled in the selected locations, sub-locations, villages and households of the two divisions of Loima and Turkwell for collection of quantitative data using structured questionnaires. Four (4) focus group discussions of ten (10) members each among both male and female respondents and twenty four (24) key informant interviews participants, among the knowledgeable and influential people of the community were conducted to gather qualitative data. The data collected were processed and analyzed using Statistical package for Social Science (SPSS version 21.0), with demographic data summarized and presented using tables and graphs, chi-square test used to detect the association between variables while logistic regression through bivariate and multi-variate analysis were used to test for the strength of association between the dependent and independent variables. The qualitative data was analysed using thematic content analysis. The prevalence of kala-azar as self-reported from the households was 49.3%.The key exposure factors to the disease in the community include: Age (AOR=3.2; 95% CI=(1.2 – 8.6), p=0.001), gender (AOR=4.2; 95% CI=(1.3-10.2), p=<0.001), educational level (AOR=2.6; 95% CI=(1.0 – 6.0), p=0.012), housing (AOR=3.1; 95% CI=(1.1-7.6), p=0.002) and resting or sitting near termite-mounds (AOR=3.1; 95% CI= (1.1- 7.0), p=<0.001) that had significant association with suffering from kala-azar. Also, presence of large amount of termite mounds all over the area 53.7% (n=170), low ownership and usage of bed-nets (38%), inaccessibility to health services, varying health-seeking behavior and lack of proper knowledge on transmission of disease; as well as human activities such as deforestation and hunting (52% (n=32) and dancing at night (Edong’a – 64.8% (n=167), when the sand flies are active. Qualitative results showed that a majority of the respondents had a varying level of misconception about the disease. The study concludes that kala-azar is endemic in the area and though the community is aware of its existence, the residents have different beliefs about the transmission. The study recommends the need for health policy makers and other stakeholders to have a multifaceted approach with enhanced general health education and awareness on the transmission cycle of kala-azar. Community social development and involvement in the prevention of the disease should be emphasized as well as structural development plans that include sand fly management strategies and control methods that would ensure the removal of breeding and resting sites of the vectors within human habitation. In addition, individual behavioural change, protective measures and improvement of housing conditions to be encouraged.