Insufficient Funding Frustrate Efforts to Equip Healthcare Workers with Diagnostic Skills on Leprosy

By Caroline Kaatana

Email, thecoastnewspaper@gmail.com

Leprosy is grouped as a rare disease with World Health organisation (WHO) indicates about 208,000 people having the Hansen’s disease (leprosy) globally with most cases found in Asia and Africa.

In the United States, some 100 people receive a leprosy diagnosis every year. The exact mechanism of transmission of leprosy is unknown.

However, the widely held belief is that the disease is transmitted by contact between cases of leprosy and healthy persons. 

Another possibility was transmission through respiratory route and through insects. In the 1980s the dreaded disease was declared eliminated.

Statistics from the Ministry of Health, however, indicates that cases of leprosy have recently been on the rise from 93 (2017), 110 (2018) to 154 in (2019).

But lack of awareness of the disease remains an obstacle to early diagnosis and treatment.

Although leprosy is no longer a major public health problem in the country, there is a significant loss of skills and knowledge by healthcare providers on how to deal with it.

This could be the reasons behind the rapidly falling number of cases recorded in the recent times.

Kwale County health executive member Dr Francis Gwama says lack of leprosy experts at the grassroots levels is causing the capture of incorrect data .

“The data collected on leprosy is not correct because our health care workers lack skills and knowledge diagnostic procedures.”

According to him there are consistent efforts to sensitise health workers on the disease although it is frustrated by lack of funding.

“We have partnered with different stakeholders to ensure our health workers get high skills to get the correct diagnosis data, though in a low motion because we have insufficient fund.”

The health boss is worried some leprosy patients are seeking the attention of witchdoctors believing it is based on either a curse or witchcraft.

“Leprosy patients do not show up in hospitals due to lack of awareness hence forcing them seek treatment from witchdoctors and unfortunately coming to our hospitals at very late stage.”

Statistics indicate that the Coast and Western regions have the highest numbers of leprosy cases from the 2022 report. In that breath, Kilifi and Kwale counties are the most affected in Coast region.

“Whenever health workers are trained to identify the disease and community sensitized to end stigma to leprosy patients ,the numbers tend to go up.”

Leprosy is an airborne disease caused by a bacterium known as mycobacterium leprae. It is spread by breathing in droplets from the cough or sneezes of an infected person.

It takes close contact with an infected person for a prolonged period of time to contract the disease. But if treated early, the disease, with an incubation period of up to 20 years, leaves no physical damage on patients.

At Msambweni Subcounty of Kwale County, there are several leprosy activities that have been crippled by lack of funds leaving patients to fend for themselves.

The few patients who get properly diagnosed are put on a free medication regime provided by WHO for free. This has been going on from 1995. 

In its early stages, leprosy manifests as a skin condition causing lighter patches that are numb when touched. Usually at this point, the patches are painless hence many patients are unlikely to seek health intervention.

Health workers often mistake the skin lesions with other dermatological conditions but if left untreated, the disease can cause severe limb deformities and irreversible nerve damage that prevents patients from feeling heat or pain.

Due to the numbness, patients often, end up injuring themselves and having wounds that necessitate amputation of their limbs.

There are concerns that Kenya, which is on the leprosy post-elimination phase, risks losing the gains if better surveillance of the disease is not put in place.

“Ideally, when there is a reported leprosy case, we send a community health worker to the family to see if there are other family members showing symptoms but with the funding gap, this is not being done.”

“We just treat those that come to health facilities and make no follow-up visits, which could mean that more leprosy cases may be out there,” Dr.Gwama noted.

The increased cases come at a time when the Ministry of Health launched the National Strategy Plan 2019-2023 to guide the elimination of TB and leprosy nationally. 

The plan indicates the ministry’s mission to reduce the proportion of people with leprosy diagnosed with a grade two disability to below five per cent by 2030.  

The strategy highlights the lack of political commitment in leprosy control, lack of data on patient management, weak provision of quality care and weak surveillance as obstacles to achieving a leprosy free nation.