Assessment of a decentralization model in improving treatment and care of visceral leishmaniasis in Turkana County, Kenya: A mixed method study.

backgroundVisceral Leishmaniasis (VL) is a vector-borne disease caused by the protozoa Leishmania and transmitted by sandflies. Up to 60% of all VL cases worldwide occur in East Africa. Given its ranking as a main cause of death among the parasitic infections worldwide, VL constitutes a serious global health concern. In Turkana County, the Foundation for Innovative New Diagnostics has undertaken significant work in supporting the decentralization of access to diagnosis and treatment, expanding from six health facilities giving VL care in 2018 to twenty-two in 2022. This study sought to assess the decentralization of VL services in Turkana to inform policy at the county and national levels.

methodsThis was a mixed methods cross-sectional survey conducted in four selected health facilities within Turkana County, between November 2023 and February 2024. Quantitative data involved data abstraction from records of VL patients between January 2018 to December 2022. For the qualitative data, 13 in-depth interviews were conducted with VL patients, 16 key informant interviews (KIIs) with healthcare workers, and seven KIIs with the county health management team members. Descriptive analysis of the quantitative data and thematic analysis of qualitative data were performed to assess the decentralization model in improving VL treatment and care in Turkana County.

resultsThe community had low knowledge of VL signs and symptoms. The mean delay time since the onset of symptoms before seeking medical care was 46.9 days. This long delay was mainly attributed to the long distance to the health facilities and the high costs of accessing the treatment facilities. Majority of the patients sought traditional treatments first before visiting the health facilities. Further, health workers indicated that the decentralization model has led to accurate diagnosis of VL and improvement of the infrastructure within the health facilities.

conclusionThe study observed low awareness of VL disease among patients that contributed heavily to delayed time to diagnosis. This calls for revamped health education and awareness campaigns among the communities living in VL endemic areas to promote positive behaviour change for effective control and elimination of the disease.