Cokoye

NAIROBI, 11 October 2010 (IRIN) - Stigma has allowed a disfiguring microscopic worm to thrive in Kenya's coastal region, among other endemic regions, but if adequate funds were made available, the spread of lymphatic filariasis (LF), also known as elephantiasis, could easily be stopped in the east African country with the help of just a couple of pills a year.

Spread by mosquitoes, elephantiasis can cause severe swelling of the limbs, breasts, and scrotum as well as thickening and hardening of the skin.

Some three million people living in Kenya's Coast Province are "at risk", a category that includes those who may already have contracted the disease, whose symptoms can take decades to manifest themselves.

"In the larger Kilifi District alone, 460,000 cases have been reported over the years," Safari Ngowa, programme manager of MAP International, an international NGO that has helped elephantiasis patients in Kenya since 2008, told IRIN.

"A lot of these people perhaps do not know that they can get help at public hospitals," Ngowa said. "MAP International mostly conducts operations for those with swellings in their genitals and provides palliative care for those with swollen limbs."

Shanaz Sharif, director of public health and sanitation in Kenya's Ministry of Health, said: "Reluctance to come forward and seek treatment also complicates [compiling] figures for the disease. Some of the sufferers have lived with the condition so long they just don't come forward."

He said Kenya was committed to eradicating the disease but budgetary constraints had affected the mass administration of two drugs which, when taken annually for four or five years, halt the transmission of the infecting parasite. The World Health Organization's (WHO) Global Programme to Eliminate LF is leading this effort.

Mass drug administration

"There was a delay in conducting the mass drug administration (MDA) in 2009 but we did it early this year in the affected districts," Sharif said.

MDA began in Kenya in 2002 in Malindi District, where four rounds of the programme led to prevalence rates dropping from 21 percent to under 1 percent, according to Sammy Njenga of the Kenya Medical Research Institute.

"Scaling up [MDA] was supposed to happen every year but we have not been able to do this, or deliver drugs every year, because of financial constraints," he told IRIN, explaining that the issue was not so much the cost of the drugs themselves, but that of their delivery and correct administration in remote areas.

Njenga described LF as a "hidden disease" that had not been taken seriously by Kenya's health officials.

On a more positive note, he said studies had shown that while interrupting MDA in other countries had allowed prevalence to rise, this did not appear to be the case in Kenya.

According to WHO, there are other reasons why less than a third of those at risk of LF in Africa benefit from MDA.

Loa loa

"In over 10 LF-endemic countries in Central Africa, Loa loa, another parasitic disease, is also present. Because people with Loa loa infections are at risk of severe adverse reactions when given ivermectin, traditional MDA for LF cannot be implemented in these areas," Kazuyu Ichimori, who works with the programme to eliminate LF at WHO's Department of Control of Neglected Tropical Diseases, told IRIN in an emailed response to questions.

"This is one of the biggest challenges to scaling up the geographical coverage of MDA and research is ongoing to better map the specific areas of overlap and to determine alternative strategies to interrupt transmission," she added.

"The other major challenges are the 13 countries which have not begun MDA that are in conflict or post-conflict stages as well as logistical problems in implementing MDA (and achieving high coverage) in urban areas," she wrote.

A WHO strategic plan to eliminate the disease as a public health problem by 2020 discusses "potential of enhanced drug regimens and vector control as a complement or alternative to the traditional MDA approach," she added.

According to WHO figures, LF affects more than 120 million people worldwide, one-third of whom live in Africa. At least 40 million people around the world are seriously incapacitated and disfigured by the disease. It is endemic in 81 countries.

In 2009, WHO said the MDA programme targeted 496 million people and treated 385 million - a 77 percent coverage rate.