AUTHOR=de Souza Dziedzom K. , Picado Albert , Bessell Paul R. , Liban Abduba , Wachira Davis , Mwiti Daniel , Matendechero Sultani H. , Bosch Mercedes , Ndung’u Joseph M. , Cruz Israel 

TITLE=Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County

JOURNAL=Frontiers in Tropical Diseases

VOLUME=Volume 2 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/tropical-diseases/articles/10.3389/fitd.2021.809757

DOI=10.3389/fitd.2021.809757

ISSN=2673-7515

ABSTRACT=Visceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD), that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD roadmap. However, improving access to VL diagnosis and treatment remains a major challenge in many VL endemic countries. Kenya is endemic for VL and is among the top six high disease burden countries in the world. In this work, we present the implementation of activities to improve access to diagnosis and the impacts in Marsabit county. We analyzed the data for the 2017 and 2019 outbreaks and assessed the importance of improving access and community sensitization to VL diagnosis.  
There was a sharp increase in the number of people tested from 2017 to 2019. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019 respectively. The data revealed a shift in the demographic structures of cases towards the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases were reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018, resulted in a decrease in the distance travelled by confirmed VL cases from 28.1km in 2017 to 10.8km in 2019. Modelling the impact of facility placement indicated the most optimal facility to provide VL diagnostic services and minimize the distance travelled by patients. Adding new facilities reduces the travel distance till a point where the addition of a new facility provides no additional impact. 
The results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment. Extending the activities in Kenya to other VL endemic countries in East Africa will contribute significantly towards the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.