Poor communities are hardest-hit by vector-borne diseases like leishmaniasis, and climate change could make things worse unless they get more help to adapt
BARINGO, Kenya (Thomson Reuters Foundation) - The strength of the wind blowing into Helen Chepkirilo’s home in Baringo County signals to her when the rains are about to fall or a looming drought beckons. Lately, however, she has learned that the winds can also herald disease.
Chepkirilo’s seven year-old-son, Kapoyon Richard, is being treated at the Kimalel health centre for visceral leishmaniasis, commonly known as kala-azar, after he was bitten by a sandfly, the host insect of the parasite that causes the disease.
According to the World Health Organizaton (WHO), kala-azar is fatal if left untreated. It is characterised by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. It is highly endemic in the Indian subcontinent and East Africa, with an estimated 200,000 to 400,000 new cases worldwide each year.
“The insects swarm at night and are easily blown into our house by the wind,” explained Chepkirilo. “Even when we sleep under a mosquito net, the sand flies still pass through the mesh and bite us.”
The 40-year-old mother of seven children is not the only one troubled by kala-azar in this arid, poverty-stricken region of Kenya. Hundreds died from the infection before medics discovered its prevalence in 2008, with many unable to reach a health facility early enough for diagnosis.
Nonetheless, the struggle with the disease has inspired this community’s creative edge. Chepkirilo is among a growing number of her kin in Loruatu village who are building smarter homes to ward off the sandfly threat, a vector associated with particular climate patterns.
Experts recently told Chepkirilo and her peers that the insect favours regions where daily temperatures alternate between extreme heat and cold. Sandflies prefer to breed when it is hot, but like feeding when temperatures are cooler, according to the Kenya Medical Research Institute.
The WHO describes leishmaniasis as “climate-sensitive”, nothing that it is strongly affected by changes in rainfall, temperature and humidity. Global warming and land degradation affect its epidemiology, and their impacts could cause it to spread to different areas or compromise people’s immunity, it adds.
OUT OF THE WIND, AWAY FROM ANTS
“We are encouraging (people) to build houses away from the wind’s path to stop the insects being blown inside,” said Mark Rotich, a health officer working on environmental control of sandflies in Baringo County’s Marigat town.
“Cheap, simple and environmentally friendly innovations also involve communities demolishing anthills where sandflies breed, to establish farming projects there,” Rotich added.
At Entebbes village, about 7 km outside Marigat town, 22-year-old Johannes Makoko is taking vector control in his stride.
He is among the villagers taking advantage of water from the county’s Perkerra River to establish fresh-produce farms in areas that have been infested with anthills.
In a region where livestock herding is the main economic activity, Makoko has made enemies for defying the traditional culture and social status of pastoralism. But he has no regrets.
“When the young boys are in the field herding livestock they get bitten by sandflies,” Rotich said. “Girls are also victims when they walk long distances to fetch water and gather firewood. That is why kala-azar is widespread among the young.”
KEEP COWS CLOSE BY
Medics are convinced that controlling the sources of vector-borne diseases is one of the most effective measures to reduce their burden. Yet researchers increasingly oppose the use of chemicals such as insecticides, which they say harm the environment.
At the Nairobi-based International Center for Insect Physiology and Ecology (ICIPE), scientists are working on four areas widely affected by climate change: human, plant, environmental and animal health.
Their focus is to try and come up with low-cost, green prevention tools to reduce the disease burden in marginalised areas, an approach known as Integrated Vector Management (IVM).
For instance, zooprophylaxis - the technique of deploying domestic animals like cattle to divert vectors away from people - is proving to be useful, says Clifford Mutero, a lead researcher at ICIPE.
“Certain vectors prefer to take their meals of blood from cows rather than from people. Cows do not suffer from diseases transmitted by these vectors, hence if the insects have parasites in them, the parasites will die if injected into the cattle by the flies,” Mutero explained.
In Chepkirilo’s village, older people such as Kepkong’en Biir say the practice of building livestock enclosures near homes is a long-held tradition. But the original goal was to protect herds from raiders, rather than people from insects.
The 60-year-old has now refined the practice, and has built an enclosure right around his home where his goats and cattle rest at night.
“I do this to keep my family safe from sand flies. Community health workers came to this village and showed us this method. I think it is working,” said Birr as he showed off a sun-bronzed brow which he said hadn’t been bitten for about a week.
POOR COMMUNITIES STRUGGLE TO ADAPT
Yet despite this kind of optimism, some doubt the adaptation measures will work without continued government engagement in poorer communities.
Jasmine Tibae, a community health worker, said there is widespread ignorance in rural Kenya, which she blames on poverty and illiteracy.
On top of that, poor infrastructure and limited government support make it difficult to sustain adaptation activities in marginalised communities, she said.
The WHO says leishmaniasis affects the poorest people on the planet, and is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of resources. It is also linked to environmental changes such as deforestation, building of dams, irrigation schemes and urbanisation.
Around 80 percent of Kenya’s terrain is arid and semi-arid land. In 2012, the government launched a climate change surveillance tool, called Threshold 21 (T21), to facilitate the planning of adaptation projects, especially in arid areas.
According to the Ministry of Environment and Mineral Resources, the objective of T21 is to strengthen institutions and provide leadership to address climate change risks and opportunities through a national approach.
Struggling Kenyans like Chepkirilo would be better served if T21 and other climate change programmes did more to support the rollout of adaptation measures in the most remote areas. But for now, a lack of decent roads, electricity and mobile phone networks is getting in the way, officials say.
Kagondu Njagi is a freelance contributor for the Thomson Reuters Foundation, based in Nairobi and writing on climate change issues.
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