EVALUATION OF THE RE-EMERGENCE OF LEPTOSPIROSIS AND ITS IMPACT ON PUBLIC HEALTH STRATEGIES IN BUNGOMA COUNTY, KENYA

Abstract

Leptospirosis is an important re-emerging but neglected zoonosis with a worldwide distribution and it has socio-economic and public health implications. Leptospirosis is caused by the bacteria of the genus Leptospira. Humans get infected through direct or indirect contact with the urine of infected animals or the environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Lack of pathognomonic signs of the disease in both livestock and humans coupled with lack of laboratory confirmation makes diagnosis a challenge. The most notable outbreak of Leptospirosis in Kenya occurred in Bungoma County in 2004 and is listed as one of the major public health disasters in Kenya. The study was carried out between January and June 2017 with the overall objective being to evaluate the impact of the re-emergence of Leptospirosis on Public Health strategies in Bungoma County, Kenya. A cross sectional design was employed in the study. The four specific objectives of the study were to determine the seroprevalence of Leptospirosis in cattle, determine the risk factors for re-emergence of Leptospirosis, examine the knowledge, attitude and practices (KAP) associated with Leptospirosis amongst the local community and to evaluate the impact of Leptospirosis outbreak on public health strategies in Bungoma County. In the study, a total of 400 households were identified using systematic random sampling in Kimilili and Mt Elgon sub-counties, Bungoma County. Two hundred (200) blood serum samples from cattle were collected in the five wards and one slaughterhouse and tested for Leptospirosis using Enzyme Linked Immunosorbent Assay (ELISA). The risk factors considered were; rainfall patterns, livestock management practices (grazing and watering system), home slaughter of livestock, consumption of un-inspected meat, rodent infestation in homes, and frequency of contact of livestock keepers with veterinary extension staff. In the third specific objective, a validated questionnaire was administered to the head of household to assess the knowledge, attitude and practices in the study area. In the fourth specific objective, the public health strategies for the management of Leptospirosis were evaluated. The study established the Leptospirosis seroprevalence in cattle in Kimilili and Mt Elgon sub-counties, Bungoma County is 16%. The seroprevalence of Leptospirosis in the study area by wards is as follows; 10.7% in Kibingei, 12.5% in Kimilili, 17.6 in Maeni, 16.7% in Kamukuywa and 15.6% in Kaptama. The study demonstrated that there are circulating antibodies of Leptospirosis in cattle in Bungoma County with the highest seroprevalence reported at Kimilili slaughterhouse (21.0%). The study showed that the risk factors for Leptospirosis in Kimilili and Mt Elgon include the close association of the community and their livestock, rodent infestation, slaughter of livestock in non-designated areas, low contact of the population with veterinary staff and poor knowledge about Leptospirosis. This study identified the knowledge gaps, cultural beliefs and practices that exacerbate disease or pose barriers to Leptospirosis control strategies. This information is critical in designing targeted awareness campaigns among the communities and providing baseline information for planning and implementing Leptospirosis control strategies in Bungoma County. The findings of this study are important in informing the implementation of appropriate and timely preparedness strategies for addressing public health emergencies such as Leptospirosis.