Deadly parasite mimics malaria, quietly claiming lives undetected

What seems like a typical case of malaria — with symptoms such as fever, weight loss, fatigue, and an enlarged spleen — often misleads both patients and medics, delaying accurate diagnosis and treatment..

But hidden beneath this clinical disguise is leishmaniasis, a parasitic disease that’s slowly ravaging parts of Kenya’s arid and semi-arid counties — largely unnoticed, underfunded, and dangerously underestimated.

This deadly yet neglected disease continues to afflict thousands, quietly claiming lives in communities already battling poverty, hunger, and limited access to health care.

Spread by sandflies, the disease has taken root in at least 11 counties across Kenya and remains one of the country’s most persistent health threats.

“This is one of the most lethal parasitic diseases after malaria,” said Daniel Mwiti from the Ministry of Health’s Vector-Borne and Neglected Tropical Diseases Unit. “If left untreated, visceral leishmaniasis (VL), the most severe form, has a fatality rate of up to 95 per cent.”

By May this year, Kenya had already reported more than 1,400 cases of VL, largely due to an ongoing outbreak in Wajir County. This number is expected to surpass 1,500 cases by the end of the year.

Alarmingly, Kenya ranks among the top 10 countries globally with the highest burden of leishmaniasis.

Leishmaniasis thrives in hot, humid environments where the sand fly vector, commonly referred to as the “sweet-turtle,” breeds.

These conditions are prevalent in Kenya’s arid and semi-arid lands (ASALs), which make up about 80 per cent of the country’s landmass. The disease is now endemic in counties like Baringo, Isiolo, Marsabit, Turkana, Wajir, West Pokot, and most recently, Samburu.

“These regions are sparsely populated, and health facilities are few and far between,” Mwiti explained. “Patients often have to travel long distances to reach diagnostic and treatment centres, which are usually sub-county or county referral hospitals.”

Currently, there are only 43 facilities in the endemic counties capable of diagnosing and treating VL. Management of VL is complicated and resource-intensive, requiring hospitalisation for up to 17 days and continuous monitoring for drug toxicity and treatment progress. Many of the facilities lack advanced laboratory equipment necessary for effective treatment.

The path to treatment for VL patients is often fraught with delays. Many initially seek help from traditional healers, only turning to health facilities after symptoms worsen.

In newly affected areas like Samburu, health workers sometimes fail to recognise the disease due to low awareness and suspicion levels.

“Delayed diagnosis leads to complicated cases that require even more intensive care,” said Mwiti.

“Patients often arrive with anemia, malnutrition, and suppressed immunity, requiring blood transfusions and nutritional support in addition to VL treatment.”

According to a recent study published in the National Library of Medicine, the average delay between symptom onset and seeking medical attention in Turkana County was 46.9 days. Most patients cited long travel distances and high costs as barriers to timely treatment.

Treating VL is prohibitively expensive. First-line treatment—a combination of two drugs—costs over Sh77,700 per patient. The second-line option, using the drug AmBisome, can cost up to $1,725, Sh223,390 per patient, as 75 vials are typically needed, each costing Sh2,980.

Moreover, VL patients require extensive lab monitoring to check blood counts and organ function, but many facilities lack critical lab equipment such as hematology and clinical chemistry analysers. Equipping a single treatment centre with these machines can cost up to Sh62 million

“We also face frequent supply shortages,” Mwiti noted. “Kenya relies heavily on World Health Organisation donations for VL drugs, which are manufactured by only one global supplier.”

Despite the grim statistics, there have been promising developments.

The Ministry of Health, with support from organisations like The END Fund and the Foundation for Innovative New Diagnostics (FIND), has made strides in decentralising VL care.

In Turkana County, the number of VL treatment facilities grew from six in 2018 to 22 by 2022.

A mixed-method study assessing this model showed that decentralisation improved diagnosis accuracy, enhanced infrastructure, and brought care closer to the affected populations.

Health workers reported better capacity to manage cases, and patients could access treatment without travelling hundreds of kilometres.

“This model could be replicated across other counties,” said Wycliffe Omondi the head of vector borne and neglected tropical diseases programme at the Ministry of Health.

“But it requires robust support in terms of funding, staffing, equipment, and community education,” said Dr Omondi.

Efforts are underway to address the low public awareness of leishmaniasis. Community sensitisation campaigns are being rolled out alongside surveillance and outbreak response initiatives.

Training of health records officers has also improved data collection and analysis, leading to the development of risk and spot maps for more targeted interventions.

However, challenges persist. “Nomadic communities frequently move in search of water and pasture, making consistent follow-up difficult,” Mwiti explained.

“There’s also cross-border movement between Kenya and neighboring countries like Ethiopia and South Sudan, which complicates disease control.”

Climate change adds another layer of complexity. Recurrent droughts have led to widespread malnutrition, weakening immune systems and increasing susceptibility to VL.