Chronic shortage of funding thwarts Kenya’s dengue control efforts
Until an outbreak at the Kenyan coast, dengue fever had been a disease that scientists did not lose sleep about. A 2011 outbreak in Mandera, in Kenya’s North Eastern area, that left over 5,000 people infected shifted the conversation: scientists are now asking for funding for research and interventions.
Dr. Stephen Munga, the director of the Centre for Global Health Research (CGHR) in Kisumu in Kenya’s western area said: “Because it has not been an issue in Kenya, funding has generally not been good for neglected tropical diseases, not just dengue fever alone, but now there is an urgent need for basic science to understand the disease as well as improve surveillance”.
Since the first reported case of dengue in Kenya in 1982, rapid urbanisation, poor urban planning and the destruction of habitat for farming or housing have been implicated as the drivers of the other large scale outbreaks that have followed on the Kenyan coast, on the Northern Frontier and in western Kenya.
The presence of lots of arboviruses in Kenya has not made the situation any easier. It has been noted that the outbreaks in Mombasa, on Kenya’s coast, have coincided with the rainy season, which provides optimum breeding environments for the Aedes aegypti mosquito that is responsible for transmission.
These changes have altered the ecology of dengue fever and now scientists are paying attention, albeit with the challenges of being in a severely underfunded health system whose resources are focused on the big killers: malaria, HIV and tuberculosis.
Dr. Munga’s CGHR is one of the few in the East African region that hosts ongoing studies— mostly donor funded— about dengue fever. Dr. Munga told the International Society for Neglected Tropical Diseases that the little money available for dengue mostly goes into clinical trials and programmatic work because “interventions for diseases like dengue are known, there is some good knowledge about what works and what does not”.
Entomologist Dr. Bryson Ndenga, also based at CGHR, has been carrying out research to establish the prevalence of the disease in western Kenya. In the middle of his study, he made a startling observation: more than 90 per cent of the children in the area tested positive for another mosquito-spread disease (malaria) but did not show any signs of sickness. Dr. Ndenga said: “So I wondered, when they do get sick, since malaria and dengue fever have symptoms that mimic each other, how can it be certain whether they are sick of malaria or dengue fever?” Dr.
Ndenga also noted that the suspicion index in healthcare workers for dengue fever is so low that when patients presented the usual symptoms of headache and fever malaria would be the most likely provisional diagnosis. Worse, most hospitals do not have the diagnostic capacity to test for dengue fever, and often rely on research institutions such as the Kenya Medical Research Institute (KEMRI) for tests.
While much attention has been drawn to the impact of dengue in Asia, the full extent and burden of dengue remains grossly understudied throughout Kenya as well as Africa, and a convergence of resources, advocacy and research will be urgently needed to close these gaps and improve significantly public health throughout the continent.
Verah Okeyo is a global health reporter, working in Kenya's Daily Nation newspaper. Her interests lie in maternal and child health, neglected and tropical diseases and other infectious diseases. Verah holds an MSC in Global Media and Communications from the London School of Economics and Political Science, and researches on the nexus between media, research and policy.