MANDERA/WAJIR - An outbreak of dengue fever and a suspected outbreak of kala-azar in northern Kenya are drawing attention to the need for improved health services in some of the country's most remote communities.

Health officials report the dengue fever outbreak is taking place in Mandera District, along the Ethiopian and Somali borders. Local health workers say there have been some 300 cases since the outbreak began in January. Three suspected dengue deaths have been recorded, and there are fears that more cases have gone unreported.

"We can't term it as a big outbreak now, but we have sent a disease surveillance and response team there to help the facilities there and to also take specimen for further tests," said Ian Njeru, director of disease surveillance and response at the Ministry of Public Health and Sanitation. "Some 100 specimens we collected tested negative for malaria, and we have started to diagnose to see if they can be dengue fever infections."

"Most of the patients are seeking treatment in private clinics," said one official. "The district hospital is not treating the matter seriously. The poor are suffering, and they are the most affected."

A nurse at a government hospital told IRIN that they lacked the antibiotics and fluids needed to help manage the dengue outbreak.

"No intervention measures are in place now. No special team has been formed to deal with the dengue cases since an outbreak was reported mid-last month," she said. "An anaemic and expectant [mother] died at a clinic in town; she had both malaria and dengue. A police sergeant based in Elwak [a town in Mandera] died on 29 January, while another man who contracted the disease died in Mandera last week."

In 2011, an outbreak of dengue fever infected up to 5,000 people.

Kala-azar

Meanwhile, senior health officials have denied reports of an outbreak of kala-azar, a parasitic disease, in Wajir District, also in northern Kenya.

"Wajir south is prone to periodic, frequent cases of kala-azar. The last cases were reported late last year, [and] I am not aware of any fresh cases or new outbreak," Abdikadir Sheikh, the provincial director of public health and sanitation, told IRIN.

But officials at the not-for-profit Drugs for Neglected Diseases Initiative (DNDi) told IRIN they had received unconfirmed reports of possible new cases of the disease.

"We are set to send a fact-finding team to Habaswein [in] Wajir [because]the report obtained by our office is not confirmed. We have also heard that a man has died, but our mission is going out there to follow up and get a credible report," said Monique Wasunna, head of DNDi Africa.

The government says it has run out of kits to diagnose kala-azar.

"The diagnosis of kala-azar is not very easy because if you don't have microscopes to do it, then you need to have rapid diagnostic kits, which we don't have at the moment," Njeru said.

Kala-azar - also known as leishmaniasis - is transmitted by the bite of the sand fly. Without timely treatment, it has a mortality rate over 95 percent. Treatment requires daily injections of sodium stibogluconate for a month; patients must stay near a health facility for observation.

Inaction

The government has been faulted for doing little to curb these diseases.

"The number of the people affected [and the] remoteness of the locations hit by neglected disease like dengue fever and kala-azar is pathetic, painful. Many [of those] suffering are [the] poor," Daniel Agan, head of the Kenyan NGO Media for Environment Science and Health, told IRIN.

"Access and distance to health facilities are major challenge. They deserve to be assisted. The government has no reason to hide nor dispute the reports. The locals, the affected have been diagnosed; that is sufficient [proof]. The state must act, treat people and start mobile services in those in remote areas," he added.

In 2012, the government  launched guidelines for the treatment and prevention of kala-azar. The guidelines called for, among other things, the use of rapid diagnostic test kits, mobile test centres and the distribution of insecticide-treated mosquito nets in areas where the disease is most prevalent.

Kala-azar and dengue fever are on the World Health Organization's list of 17 neglected tropical diseases.

Source:  Integrated Regional Information Networks (http://www.irinnews.org )