Factors associated with treatment outcome among patients with Visceral Leishmaniasis in Wajir West Sub-County, Wajir County: 2017–2019

Abstract

Background: Leishmaniasis is a parasitic disease caused by intracellular protozoan parasite species of genus Leishmania. Visceral Leishmaniasis (VL) is the most severe of the three forms of leishmaniasis. Globally associated with 50,000-90,000 new cases annually with a mortality of up to 95% in untreated and 5-10% in treated cases. In Kenya, VL is endemic in arid and semi-arid counties and an estimated 2500 cases occur annually. In Wajir, 64% of all cases from 2014 to 2017 occurred in Wajir West sub-county. Data on treatment outcomes and associated factors in Wajir are scarce. Objective: This study is aimed to characterize and identify factors associated with initial treatment outcomes among VL patients in Wajir west sub-county. Methods: The study design was a cross-sectional mixed-method: a retrospective review of hospital records and qualitative data collection from June 22nd through July 25th, 2020 at Giriftu sub-county hospital, Arbajahan health centre, and Athibohol dispensary in Wajir West sub-county. Simple random sampling was used in selecting the patient records for review. A pretested standardized data abstraction tool was used to collect VL treatment data on socio-demographic, clinical, and laboratory information. A total of three Focus Group Discussions (FGDs) and four Key Informant Interviews (KIIs) were conducted for 42 Community Health Volunteers (CHVs) and 8 Healthcare Workers (HCWs) respectively. Interview guides were used in collecting socio-cultural, socio-economic, and healthcare related information and how it influenced treatment outcomes among patients with VL. Quantitative data were analysed using Epi info version 7 software. Measures of central tendency and frequency listing were used for continuous and categorical variables respectively. Fisher’s exact Chi-square tests were used to test for association among socio-demographic characteristics and VL treatment outcomes. Variables with p < 0.20 in bivariate were included in multivariate analysis. Variables with p <0.05 in the final model were considered statistically significant. Qualitative data was transcribed and transcripts analysed thematically. Result: A total of 195 VL patient records were included in the analysis. The median age was 2.5 years (IQR: 3.3 years), 69.2% (135/195) were <5 years old, Males were 56.9 %( 111/195) and 91.3 %( 178/195) lived in Wajir-West Sub-county. Treatment outcomes at initial evaluation consisted of 93.8 % (183/195) cured (good-outcome) , 4.6% (9/195) mortality (poor outcome) and 1.5%(3/195) relapsed cases. Independent factors associated with poor treatment outcome included Age ≥15 years (p value=0.006), Adverse drug event (p value=0.04) and Pneumonia (p value=0.04) FGD-respondents reported distance to health-facility, self-treatment, husbandry- chores, and indirect costs as hindrances to Health-visits. KII revealed lack of training, staff turnover, and stock-outs of drugs or test kits as the challenges. Conclusion: VL is high in <5years, males, Factors associated with the poor outcome are; age ≥15yrs, pneumonia, and adverse drug events while the contributing factors include; distance to facility, home-treatment, indirect-costs, VL-kits, and drugs stock- outs, high staff turnover and lack of VL training. Recommendation: Public education to mitigate VL burden, improved health interventions through staff training, timely supplies of VL kits/drugs, and close monitoring during treatment.