Risk factors for visceral Leishmaniasis in Turkana county: a case-control study in Loima and Turkana West sub-counties, Northern Kenya

Abstract

Background: Globally Visceral Leishmaniasis (VL) a neglected tropical disease caused by Leishmania donovani, transmitted by the sandfly vector Phlebotomus martini, is ranked number one in terms of disease burden. East Africa is the second- largest VL focus in the world. In Kenya, VL mainly affects the rural communities with the majority of cases found in children of the age group 2-15 years. Health facility records from Turkana County annual reports show a VL incidence of about 300 Cases. Broad objective: Was to identify the risk factors associated with VL, determine knowledge and assess practices among the study participants in Loima and Turkana West Sub Counties. Methods: A case-control study design where 267 (89 cases and 178 controls) were enrolled at a ratio of 1:2. Cases were recruited from the five active VL treatment facilities in Loima and Turkana West Sub-counties while controls were recruited from the villages where the cases came from and frequency- matched by age category. Sample size: was calculated using the Kelsey formula. Data collection tools: Pretested questionnaires, which tested variables, that included; Social- demographic, animal and human activities, Cultural/ behavioral, social economic, household and environmental, Co-morbidities and malnutrition assessment, knowledge and practices factors. Health facility VL registers, in and outpatient’s cards accessed. Data analysis; data coded, cleaned, and entered for analysis using Microsoft Excel and Epi info 7.2. Descriptive statistics done where means, mediums, proportions/frequencies calculated, Bivariate and Multivariate analysis was undertaken and presented data by pros, tables, and graphs. Results: Descriptive statistics was undertaken. At the bivariate level, variables with a p= < 0.2 were entered into unconditional logistic regression backward stepwise elimination process for multivariable analysis. All factors with a p= (<0.05) at Multivariate level were considered statistically significant for VL. Significant factors independently associated with VL included; Presence of domesticated animals at the household level AOR 5.6(1.85-16.80), travel to VL endemic Counties or Countries AOR 4.9(1.95-12.25), playing or sleeping around the termite mounds while in the field or within the homestead 4.0(1.91-8.18). Majority of the participants 212 (79.4%) from which cases 58(27.4%) and 154 (72.6%) controls whereas 234 (87.6%) participants 75(32%) Cases and 159(68%) of controls reported VL being highly severe. Majority of the respondents 230(71.2%); from which 74(57.4%) cases and 156(80.4%) controls were not practicing any prevention and control measures towards VL, Conclusion: Presence of domesticated animals at the household level as a risk factor to VL was highly associated with VL. Majority of the respondents were aware of VL disease however were not aware of the cause but reported as highly severe. Two-thirds of the respondents were not practicing VL prevention and control measures. Recommendations: The study recommends the need for multi-sectoral approach through the key departments of health, Agriculture livestock and Fisheries and Education on need to develop contextualized health messages for facility and community health education and awareness on the risk factors associated with the disease. Community empowerment and participation should be emphasized as well as structural development plans that shall address causes, control and prevention measures towards Visceral.