Abstract:
Visceral leishmaniasis (V.L.), also known as visceral leishmaniasis, is a tropical
infectious disease caused by female sand flies. This type of Leishmaniasis affects the
internal organs, usually the spleen, liver, and bone marrow. Globally, an estimated 700
000 to 1 million new cases of V.L. occur annually. In Kenya, 4000 cases arise, while 5
million people are at risk of infection annually. The purpose of the study was to evaluate
the risk factors; estimate the transmission and mortality rate of visceral leishmaniasis at
Marsabit County referral hospital and give an insight understanding of V.L. dynamics to
create awareness. The study's specific objectives were to: Evaluate the risk factors
associated with mortality among V.L. patients, estimate the mortality and transmission
rate of V.L. and establish the level of endemicity of V.L. The study adopted a
retrospective cohort design. The study used secondary data from 2890 visceral
leishmaniasis patients enrolled at Marsabit County referral hospital from September 2015
to September 2019. Cox proportional hazard model was used to establish the relationship
between the survival time of V.L. patients and predictor variables. The Susceptible,
Infected, and Recovered (S.I.R.) model was fitted to estimate the transmission and
mortality rates and establish the disease's endemic nature. Data analysis was carried out
using R statistical software. The risk factors that were found to be significant predictors
for survival time of Visceral leishmaniasis patients included; household design (cracked
walls and thatched roof) [β =.435, p=.0001], living near anthills [β =.320, p=.0012], using
bed nets [β= -.151, p=.0080], contact with infected dogs [β =.200, p=.0006], forest
surroundings [β=.151, p=.0340] and sleeping outside at night [β =.169, p=.0260]. The
mortality and transmission rates were estimated at 13.19% and 13.63%, respectively. The
control reproductive number (level of endemicity) was 0.0141, implying that the disease
was not endemic. In conclusion, there was significantly higher mortality among patients
who are not using bed nets, those living in cracked mud walls, those living near the
forests, residing near ant hills, sleeping outside, and those in contact with infected dogs.
The study recommends the adoption of appropriate practices such as avoiding contact
with infected dogs, use of bed nets at night, clearing forests surrounding homesteads,
avoiding sleeping in the open at night, repair wall cracks,reduce house proximity to ant
hills and termite mounds to reduce the transmission and subsequent mortality from
Visceral leishmaniasis.
