Environmental Risk Factors for Visceral Leishmaniasis: An Analysis of Housing Types and Behavioral Factors in Baringo County, Kenya

Katherine O’Brien Department of Public Health and Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts;
African Centre for Community Investment in Health, Nginyang, Kenya;

Search for other papers by Katherine O’Brien in
Current site
Google Scholar
PubMed
Close
,
Grace Kennedy Department of Public Health and Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts;
African Centre for Community Investment in Health, Nginyang, Kenya;

Search for other papers by Grace Kennedy in
Current site
Google Scholar
PubMed
Close
,
Hellen Nyakundi African Centre for Community Investment in Health, Nginyang, Kenya;

Search for other papers by Hellen Nyakundi in
Current site
Google Scholar
PubMed
Close
,
Mwatela Kitondo African Centre for Community Investment in Health, Nginyang, Kenya;

Search for other papers by Mwatela Kitondo in
Current site
Google Scholar
PubMed
Close
,
Valaria Pembee Chemolingot Sub-County Hospital, Chemolingot, Kenya;

Search for other papers by Valaria Pembee in
Current site
Google Scholar
PubMed
Close
,
Wilson Biwott Chemolingot Sub-County Hospital, Chemolingot, Kenya;

Search for other papers by Wilson Biwott in
Current site
Google Scholar
PubMed
Close
, and
Richard Wamai African Centre for Community Investment in Health, Nginyang, Kenya;
Department of Cultures, Societies, and Global Studies, College of Social Sciences and Humanities, Northeastern University, Boston, Massachusetts;
Integrated Initiative for Global Health, Northeastern University, Boston, Massachusetts;
Nigerian Institute of Medical Research, Lagos, Nigeria

Search for other papers by Richard Wamai in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

Visceral leishmaniasis (VL) is endemic in Baringo County, Kenya, and contributes significantly to the burden of disease in the region. Housing structures and other environmental risk factors contribute to transmission dynamics, but these have not been specifically studied in Baringo. The aim of this study was to increase understanding of VL transmission in the region through determining relationships between VL infection, housing, and other environmental factors. Data collection occurred from February 1 to May 31, 2023 at Chemolingot Sub-County Hospital and patients’ homesteads via questionnaires of primary VL patients being treated and VL follow-up patients who were still residing in the same house as when the infection occurred. Factors assessed were housing structures, proximity to vector breeding and resting sites, and prevention and control measure practices. A baseline assessment of housing types was conducted through direct ethnographic observation and used in the analysis. Forty-one patients were included in the study. A χ2 analysis and Fisher’s test were used to determine association between VL infection and housing materials, where VL patient housing data were compared with the regional baseline assessment. Significant associations with VL infection were found between mud and stick walls (P <0.001); mud walls (P <0.001); mud, stick, and grass combination walls (P = 0.02); and stick and grass walls (P <0.001). Behavior comparison showed that most VL-protective behaviors were practiced by follow-up patients after infection. Results showed an increased need for VL prevention focusing on environmental factors.

    • Supplemental Materials (PDF 12.573 KB)

Author Notes

Financial support: This project was funded in part by Northeastern University (Office of Undergraduate Research and Fellowships, Student Financial Services, Global Experience Office, Undergraduate Research Initiative, EJM Research Fund, Department of Public Health and Health Sciences, and Department of Cultures, Societies, and Global Studies), the African Centre for Community Investment in Health, and the Kenya National Research Fund.

Disclosure: This study was part of an ongoing NTD research program in Baringo County jointly approved by the institutional review boards (IRBs) at Northeastern University (IRB # 10-11-18) and University of Nairobi (P422/10/2011). Informed consent was obtained from all participants in the study using an IRB-approved consent form prior to the beginning of the questionnaire. Approved assent forms were used for children aged 10–17 years with the consent of a guardian. Guardians consented for individuals under the age of 10 years. In the case of illiteracy, fingerprints were used as a proxy for signature on consent and assent forms. Consenting and interviews were conducted in the Pokot language.

Current contact information: Katherine O’Brien and Grace Kennedy, Department of Public Health and Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, and African Centre for Community Investment in Health, Nginyang, Kenya, E-mails: obrien.kather@northeastern.edu and kennedy.gr@northeastern.edu. Hellen Nyakundi and Mwatela Kitondo, African Centre for Community Investment in Health, Nginyang, Kenya, E-mails: hmnyakundi@yahoo.com and mwatelar@yahoo.com. Valaria Pembee and Wilson Biwott, Chemolingot Sub-County Hospital, Chemolingot, Kenya, E-mails: valariapembee@gmail.com and wilsbiwott@yahoo.com. Richard Wamai, African Centre for Community Investment in Health, Nginyang, Kenya, Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, MA, Integrated Initiative for Global Health, Northeastern University, Boston, MA, and Nigerian Institute of Medical Research, Lagos, Nigeria, E-mail: r.wamai@northeastern.edu.

Address correspondence to Katherine O’Brien, Department of Public Health and Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115. E-mail: obrien.kather@northeastern.edu
  • 1.

    Mewara A, Gudisa R, Padhi BK, Kumar P, Sah R, Rodriguez-Morales AJ, 2022. Visceral leishmaniasis outbreak in Kenya: A setback to the elimination efforts. New Microbes New Infect 49–50: 101060.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    World Health Organization, 2023. Leishmaniasis. Available at: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis. Accessed November 1, 2023.

    • PubMed
    • Export Citation
  • 3.

    Wamai RG, Khan J, McGloin J, Ziaggi G, 2020. Visceral leishmaniasis: A global overview. J Glob Health Sci 2: e3.

  • 4.

    Bi K, Chen Y, Zhao S, Kuang Y, Wu CHJ, 2018. Current visceral leishmaniasis research: A research review to inspire future study. Biomed Res Int 2018: 9872095.

  • 5.

    Dahl EH et al., 2021. Control of visceral leishmaniasis in East Africa: Fragile progress, new threats. BMJ Glob Health 6: e006835.

  • 6.

    Ruiz-Postigo J, Jain S, Madjou S, 2023. Global leishmaniasis surveillance: 2022, assessing trends over the past 10 years. Wkly Epidemiol Rec 40: 471487.

  • 7.

    Republic of Kenya, 2019. 2019 Kenya Population and Housing Census. Nairobi, Kenya: Republic of Kenya.

  • 8.

    World Health Organization, 2024. Leishmaniasis County Profile – 2022. Geneva; Switzerland: WHO.

  • 9.

    Wamai R, Grifferty G, Obadina D, 2015. Assessing leishmaniasis in East Pokot Kenya: An epidemiological survey and community evaluation. Ann Glob Health 81: 135136.

  • 10.

    Schaefer KU, Kurtzhals JA, Gachihi GS, Muller AS, Kager PA, 1995. A prospective sero-epidemiological study of visceral leishmaniasis in Baringo District, Rift Valley Province, Kenya. Trans R Soc Trop Med Hyg 89: 471475.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ryan JR et al., 2006. Spatial clustering and epidemiological aspects of visceral leishmaniasis in two endemic villages, Baringo district, Kenya. Am J Trop Med Hyg 74: 308317.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Ministry of Health, 2021. The Kenya Strategic Plan for Control of Leishmaniasis: 2021–2025. Nairobi, Kenya: Ministry of Health.

  • 13.

    Hassaballa IB, Torto B, Sole CL, Tchouassi DP, 2021. Exploring the influence of different habitats and their volatile chemistry in modulating sand fly population structure in a leishmaniasis endemic foci, Kenya. PLoS Negl Trop Dis 15: e0009062.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    du Plessis L, 2005. The Culture and Environmental Ethic of the Pokot People of Laikipia. MA Thesis, University of Stellenbosch: Stellenbosch, South Africa.

  • 15.

    Vehrs HP, 2022. Pokot Pastoralism. Suffolk, United Kingdom: Boydell & Brewer.

  • 16.

    Ngure P, Nzau A, Kiare M, Waithima A, Bowen M, Ingonga J, Ngumbi P, 2017. From mud and stick-walled houses to corrugated iron sheet houses: A new strategy for preventing human-vector contact in Marigat Sub-County: A leishmaniasis-endemic area in Kenya. Ann Clin Cytol Pathol 3: 1083.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Boelaert M, Meheus F, Sanchez A, Singh SP, Vanlerberghe V, Picado A, Meessen B, Sundar S, 2009. The poorest of the poor: A poverty appraisal of households affected by visceral leishmaniasis in Bihar, India. Trop Med Int Health 14: 639644.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Ochola EA, Karanja DMS, Elliott SJ, 2021. The impact of neglected tropical diseases (NTDs) on health and wellbeing in sub-Saharan Africa (SSA): A case study of Kenya. PLoS Negl Trop Dis 15: e0009131.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Kasili S, Okindo EG, Kutima HL, Mutai JM, 2016. Socioeconomic impacts of leishmaniasis on households of Marigat Sub county, Baringo County of Kenya. J Trop Dis 4: 5.

  • 20.

    Grifferty G, Shirley H, McGloin J, Kahn J, Orriols A, Wamai R, 2021. Vulnerabilities to and the socioeconomic and psychosocial impacts of the leishmaniases: A review. Res Rep Trop Med 12: 135151.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Republic of Kenya and Baringo County Government, 2018. County Integrated Development Plan: 2018–2022. Kabernet, Baringo County, Kenya: Republic of Kenya and Baringo County Government.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    DebRoy S, Prosper O, Mishoe A, Mubayi A, 2017. Challenges in modeling complexity of neglected tropical diseases: A review of dynamics of visceral leishmaniasis in resource limited settings. Emerg Themes Epidemiol 14: 10.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Dulacha D et al., 2019. Epidemiological characteristics and factors associated with visceral leishmaniasis in Marsabit County, Northern Kenya. J Interval Epidemiol Public Health 2: 3.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Ketema H, Weldegebreal F, Gemechu A, Gobena T, 2022. Seroprevalence of visceral leishmaniasis and its associated factors among asymptomatic pastoral community of Dire District, Borena zone, Oromia Region, Ethiopia. Front Public Health 10: 917536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Malaviya P, Hasker E, Picado A, Mishra M, Van Geertruyden JP, Das ML, Boelaert M, Sundar S, 2014. Exposure to Phlebotomus argentipes (Diptera, Psychodidae, Phlebotominae) sand flies in rural areas of Bihar, India: The role of housing conditions. PLoS One 9: e106771.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kesari S, Bhunia GS, Kumar V, Jeyaram A, Ranjan A, Das P, 2010. Study of house-level risk factors associated in the transmission of Indian Kala-azar. Parasit Vectors 3: 94.

  • 27.

    Chastonay AHM, Chastonay OJ, 2022. Housing risk factors of four tropical neglected diseases: A brief review of the recent literature. Trop Med Infect Dis 7: 143.

  • 28.

    Kiptui EG, Kiprono SJ, Mengich GJ, 2021. Risk factors of visceral leishmaniasis among residents of Baringo County, Kenya. Int J Community Med Public Health 8: 52515257.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Wanzirah H et al., 2015. Mind the gap: House structure and the risk of malaria in Uganda. PLoS One 10: e0117396.

  • 30.

    Maziarz M et al., 2018. A cross-sectional study of asymptomatic Plasmodium falciparum infection burden and risk factors in general population children in 12 villages in northern Uganda. Malar J 17: 240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Jones CM, Welburn SC, 2021. Leishmaniasis beyond East Africa. Front Vet Sci 8: 618766.

  • 32.

    Calderon-Anyosa R, Galvez-Petzoldt C, Garcia PJ, Carcamo CP, 2018. Housing characteristics and leishmaniasis: A systematic review. Am J Trop Med Hyg 99: 15471554.

  • 33.

    Younis LG, Kroeger A, Joshi AB, Das ML, Omer M, Singh VK, Gurung CK, Banjara MR, 2020. Housing structure including the surrounding environment as a risk factor for visceral leishmaniasis transmission in Nepal. PLoS Negl Trop Dis 14: e0008132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Kolaczinski JH, Reithinger R, Worku DT, Ocheng A, Kasimiro J, Kabatereine N, Brooker S, 2008. Risk factors of visceral leishmaniasis in East Africa: A case-control study in Pokot territory of Kenya and Uganda. Int J Epidemiol 37: 344352.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Valero NNH, Uriarte M, 2020. Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: A systematic review. Parasitol Res 119: 365384.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Argaw D, Mulugeta A, Herrero M, Nombela N, Teklu T, Tefera T, Belew Z, Alvar J, Bern C, 2013. Risk factors for visceral leishmaniasis among residents and migrants in Kafta-Humera, Ethiopia. PLoS Negl Trop Dis 7: e2543.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Philipo Gwandi M, Odongo AO, Kirira PG, Jeruto E, 2022. Risk factors associated with leishmaniasis among residents of rural Marigat Sub-County, Baringo County - Kenya. Int J Trop Dis Health 43: 111.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Lotukoi JA, Kutima HL, Anjili C, Wanzala P, 2017. Exposure factors associated with visceral leishmaniasis (kala-azar) in Loima Sub-County of Turkana County, Kenya. Am J Lab Med 2: 144155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Abdullahi B, Mutiso J, Maloba F, Macharia J, Riongoita M, Gicheru M, 2022. Climate change and environmental influence on prevalence of visceral leishmaniasis in West Pokot County, Kenya. J Trop Med 2022: 16.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Shirley H, Grifferty G, Yates EF, Raykar N, Wamai R, McClain CD, 2022. The connection between climate change, surgical care and neglected tropical diseases. Ann Glob Health 88: 68.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Grifferty G, Shirley H, O’Brien K, 2023. The leishmaniases in Kenya: A scoping review. PLoS Negl Trop Dis 17: e001358.

  • 42.

    Baringo County Government, 2018. County Population Density and Distribution .Kabarnet, Baringo County, Kenya: Baringo County Government.

  • 43.

    Shirley H, Wamai R, 2022. A narrative review of Kenya’s surgical capacity using the Lancet Commission on Global Surgery’s indicator framework. Glob Health Sci Pract 10: e2100500.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Saunders B, Sim J, Kingstone T, Shula B, Waterfield J, Bartlam B, Burroughs H, Jinks C, 2018. Saturation in qualitative research: Exploring its conceptualization and operationalization. Qual Quant 52: 18931907.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Sinha PK et al., 2006. Visceral leishmaniasis (kala-azar)| the Bihar (India) perspective. J Infect 53: 6064.

  • 46.

    Yared S, Deribe K, Gebreselassie A, Lemma W, Akililu E, Kirstein OD, Balkew M, Warburg A, Gebre-Michael T, Hailu A, 2014. Risk factors of visceral leishmaniasis: A case control study in north-western Ethiopia. Parasit Vectors 7: 470.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Jeihooni AK, Harsini PA, Kashfi SM, Rakhshani T, 2019. Effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniasis among housewives. Cad Saude Publica 35: e00158818.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Srinivasan R, Ahmad T, Raghavan V, Kaushik M, Pathak R, 2018. Positive influence of behavior change communication on knowledge, attitudes, and practices for visceral leishmaniasis/kala-azar in India. Glob Health Sci Pract 6: 192209.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Alizadeh G, Shahnazi H, Hassanzadeh A, 2021. Application of BASNEF model in students training regarding cutaneous leishmaniasis prevention behaviors: A school-base quasi experimental study. BMC Infect Dis 21: 1164.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Ghodsi M, Maheri M, Joveini H, Rakhshani MH, Mehri A, 2019. Designing and evaluating educational intervention to improve preventive behavior against cutaneous leishmaniasis in endemic areas in Iran. Osong Public Health Res Perspect 10: 253262.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Bengtson M, Bharadwaj M, Bosch AT, Nyakundi H, Matoke-Muhia D, Dekker C, Diehl JC, 2020. Matching development of point-of-care diagnostic tests to the local context: A case study of visceral leishmaniasis in Kenya and Uganda. Glob Health Sci Pract 8: 549565.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    World Health Organization, 2010. Control of the Leishmaniases: WHO Technical Report Series, 949, Geneva, 22–26 March 2010. Geneva, Switzerland: WHO.

Past two years Past Year Past 30 Days
Abstract Views 789 789 120
Full Text Views 50 50 31
PDF Downloads 52 52 26
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save