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Leprosy scourge lives on in Kenya, years after ‘elimination’

By Evelyn Makena
Sunday, January 26th, 2020
Rhoda Pola, Programme Officer, National Tuberculosis, Leprosy and Lung Disease Department. Photo/PD/Alex Mburu
In summary
    • Alupe Subcounty Referal Hospital was set up as Alupe leprosorium in 1948. The hospital was a referral and a management centre for leprosy cases across East Africa.
    • It was established after the Second World War (1939-1945) to treat war victims from East and Central African countries including Tanzania, Rwanda, Uganda, Sudan and Somali.
    • The victims were first hosted in Kakamega Government Hospital after developing chronic wounds inflicted during the war
    • The hospital also hosted the Leprosy Skin Disease Research Centre for East Africa.

Evelyn Makena @evemake_g

In 1989, leprosy,  the highly feared disease, was declared eliminated. The country received the status after registering a prevalence of less than one case per 10,000 people as per the World Health Organisations (WHO) standards. 

Statistics from the Ministry of Health, however, show that cases of leprosy have recently been on the rise from 93 in 2017, 110 in 2018 and 154 in 2019, creating fear that it could creep back.

Lack of awareness on once forgotten disease remains a huge obstacle to early diagnosis and treatment.

Francis Amakoye, who worked as a senior occupational therapist at Alupe sub-county hospital, Busia county since 1982 until his retirement this year, treated and rehabilitated many patients and survivors confined at a camp within the facility.

Previously known as Alupe Leprosy Hospital, the facility was established during colonial times to quarantine patients of the disease considered to be highly infectious. 

Other patients were sent to another ‘leper colony’ in Tumbe village, Msambweni, Kwale county.

Social isolation remained the fate of cured patients even when they were no longer contagious.

They were also excluded from social life because of physical disabilities that came with the disease. 

Over the years, several things have changed at Alupe. The centre no longer hosts any survivors of leprosy.

“We hosted two survivors at the camp for many years. One of the two last patients left in July 2019 while the other one passed on in November,” says Amakoye. 

The huge numbers of patients that flocked the facility subsided after WHO introduced multidrug therapy (MDT) that proved to be highly effective in 1982.

Previously, leprosy was treated through a single drug with treatment lasting many years.

With the MDT regimen, treatment lasts between six and 12 months depending on the severity of the disease. 

Amid these changes, Amakoye notes that leprosy is not a disease of the past as many would like to believe, but one that’s still afflicting the population to date.

The hospital, now under the county government, has since diversified its health services to even include a maternity wing, but still attends to leprosy patients.

The facility attends to walk in leprosy patients from neighbouring counties of Kakamega, Siaya, Kisumu and Migori. 

“Leprosy patients are no longer confined in the facility, but treated and sent home. We only admit serious cases with the last admission having been in November last year,” adds Amakoye. 

Busia county, where the hospital is located, had 14 reported leprosy cases in 2019 according to data by Ministry of Health’s National Tuberculosis, Leprosy and Lung Disease Department (NTLP). T

he Coast and Western region have the highest burden of leprosy as per the 2019 statistics.

Out of the 154 cases countrywide, the Coast has 86, with Kilifi and Kwale counties as the most affected. Western had 23 incidents.

Rhoda Pola, Programme Officer, NTLP, says increase in leprosy cases is due to heightened efforts to sensitise and train health workers on the disease.

“Whenever health workers are trained to identify the disease, the numbers tend to go up.

But when there are no activities related to the disease at health facilities, there is a tendency to miss cases,” says Pola, the focal point person on leprosy at the programme. 

Consistent efforts to sensitise health workers on the contagious bacterial infection have, however, been frustrated by lack of funding.

Though the disease is still existent, the government has made no financial allocation towards it for this year.

Most of the interventions are carried out when partner organisations step in to help.

Leprosy is airborne and is caused by a bacterium known as mycobacterium leprae. It is spread by breathing in droplets from the cough or sneezes of an infected person.

It takes close contact with an infected person for a prolonged period of time to contract the disease. If treated early, the disease with an incubation period of up to 20 years, leaves no physical damage on patients.

Before joining NTLP in 2018, Pola worked as a district TB and leprosy coordinator at Msambweni, where the disease burden is high.

She says that health workers poorly understand the disease and signs are easy to miss.

“Most healthcare workers do not know how leprosy manifests, thus high level of misdiagnosis.

I have heard of cases where patients reported to going from one witchdoctor to another because they felt they could not be treated at the hospital,” adds Pola. 

At Msambweni, there are several leprosy activities that have been crippled by lack of funding, leaving patients to fend for themselves.

The few patients who get properly diagnosed are put on free medication, provided by the WHO for free since 1995. 

In its early stages, leprosy manifests as a skin condition causing lighter patches that are numb when touched.

“Usually at this point, the patches are painless hence many patients are unlikely to seek health intervention.

Health workers often mistake the skin lesions with other dermatological conditions,” says Pola. 

But if left untreated, the disease can cause severe limb deformities and irreversible nerve damage that prevents patients from feeling heat or pain.

Due to the numbness, patients often, end up injuring themselves and having wounds that necessitate amputation of their limbs.

National strategy

There are concerns that Kenya, which is on the leprosy post-elimination phase, risks losing the gains if better surveillance of the disease is not put in place.

“Ideally, when there is a reported leprosy case, we send a community health worker to the family to see if there are other family members showing symptoms. But with the funding gap, this is not being done.

We just treat those that come to  health facilities and make no follow-up visits, which could mean that more leprosy cases may be out there,” adds Pola.

The increased cases come at a time when the Ministry of Health launched the National Strategy Plan 2019-2023 to guide the elimination of TB and leprosy nationally. 

The plan indicates the ministry’s mission to reduce the proportion of people with leprosy diagnosed with a grade two disability to below five per cent by 2030.  

The  strategy highlights the lack of political commitment in leprosy control, lack of data on patient management, weak provision of quality care and weak surveillance as obstacles to achieving a leprosy free nation.

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