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The monetary burden of cystic echinococcosis and its distribution based on gender and age in Turkana North District, Kenya.



􀁃􀁹􀁳􀁴􀁩􀁣􀀠􀁅􀁣􀁨􀁩􀁮􀁯􀁣􀁯􀁣􀁣􀁯􀁳􀁩􀁳􀀠􀀨􀁃􀁅􀀩􀀠􀁩􀁳􀀠􀁣􀁡􀁵􀁳􀁥􀁤􀀠􀁢􀁹􀀠􀁴􀁨􀁥􀀠􀁬􀁡􀁲􀁶􀁡􀁬􀀠􀁳􀁴􀁡􀁧􀁥􀀠􀁯􀁦􀀠􀁴􀁨􀁥􀀠 􀁴􀁡􀁰􀁥􀁷􀁯􀁲􀁭􀀠 􀁅􀁣􀁨􀁩􀁮􀁯􀁣􀁯􀁣􀁣􀁵􀁳􀀠 􀁧􀁲􀁡􀁮􀁵􀁬􀁯􀁳􀁵􀁳􀀮􀀠 􀁔􀁨􀁥􀀠 􀁤􀁩􀁳􀁥􀁡􀁳􀁥􀀠 􀁯􀁣􀁣􀁵􀁲􀁳􀀠 􀁷􀁯􀁲􀁬􀁤􀁷􀁩􀁤􀁥􀀬􀀠􀁡􀁮􀁤􀀠􀁩􀁳􀀠􀁥􀁮􀁤􀁥􀁭􀁩􀁣􀀠􀁩􀁮􀀠􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀠􀁡􀁮􀁤􀀠􀁍􀁡􀁡􀁳􀁡􀁩􀀠􀁡􀁲􀁥􀁡􀁳􀀬􀀠􀁋􀁥􀁮􀁹􀁡􀀮􀀠 􀁔􀁨􀁥􀀠􀁯􀁢􀁪􀁥􀁣􀁴􀁩􀁶􀁥􀀠􀁯􀁦􀀠􀁴􀁨􀁥􀀠􀁳􀁴􀁵􀁤􀁹􀀠􀁷􀁡􀁳􀀠􀁴􀁯􀀠􀁡􀁳􀁳􀁥􀁳􀁳􀀠􀁴􀁨􀁥􀀠􀁤􀁩􀁲􀁥􀁣􀁴􀀠􀁡􀁮􀁤􀀠􀁩􀁮􀁤􀁩􀁲􀁥􀁣􀁴􀀠 􀁭􀁯􀁮􀁥􀁴􀁡􀁲􀁹􀀠 􀁢􀁵􀁲􀁤􀁥􀁮􀀠 􀁯􀁦􀀠 􀁃􀁅􀀠 􀁩􀁮􀀠 􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀠 􀁎􀁯􀁲􀁴􀁨􀀠 􀁄􀁩􀁳􀁴􀁲􀁩􀁣􀁴􀀠 􀁯􀁦􀀠 􀁋􀁥􀁮􀁹􀁡􀀮􀀠 􀀠 􀀠 􀁔􀁨􀁩􀁳􀀠 􀁳􀁴􀁵􀁤􀁹􀀠 􀁩􀁮􀁶􀁯􀁬􀁶􀁥􀁤􀀠 􀁡􀀠 􀁲􀁥􀁴􀁲􀁯􀁳􀁰􀁥􀁣􀁴􀁩􀁶􀁥􀀠 􀁲􀁥􀁶􀁩􀁥􀁷􀀠 􀁯􀁦􀀠 􀁃􀁅􀀠 􀁰􀁡􀁴􀁩􀁥􀁮􀁴􀁳􀀧􀀠 􀁭􀁥􀁤􀁩􀁣􀁡􀁬􀀠 􀁲􀁥􀁣􀁯􀁲􀁤􀁳􀀠 􀁯􀁢􀁴􀁡􀁩􀁮􀁥􀁤􀀠 􀁦􀁲􀁯􀁭􀀠 􀁁􀁍􀁒􀁅􀁆􀀭􀁋􀁥􀁮􀁹􀁡􀀠 􀀨􀀱􀀹􀀹􀀱􀀭􀀲􀀰􀀱􀀱􀀩􀀬􀀠 􀁷􀁩􀁴􀁨􀀠􀁰􀁡􀁴􀁩􀁥􀁮􀁴􀁳􀀠􀁯􀁲􀁩􀁧􀁩􀁮􀁡􀁴􀁩􀁮􀁧􀀠􀁦􀁲􀁯􀁭􀀠􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀠􀁎􀁯􀁲􀁴􀁨􀀠􀁤􀁩􀁳􀁴􀁲􀁩􀁣􀁴􀀠􀁯􀁦􀀠􀁋􀁥􀁮􀁹􀁡􀀮􀀠 􀁄􀁡􀁴􀁡􀀠􀁯􀁢􀁴􀁡􀁩􀁮􀁥􀁤􀀠􀁷􀁥􀁲􀁥􀀠􀁵􀁳􀁥􀁤􀀠􀁴􀁯􀀠􀁣􀁡􀁬􀁣􀁵􀁬􀁡􀁴􀁥􀀠􀁃􀁅􀀭􀀠􀁡􀁳􀁳􀁯􀁣􀁩􀁡􀁴􀁥􀁤􀀠􀁤􀁩􀁲􀁥􀁣􀁴􀀠􀁣􀁯􀁳􀁴􀁳􀀮􀀠 􀁁􀀠􀁴􀁯􀁴􀁡􀁬􀀠􀁯􀁦􀀠􀀵􀀸􀀶􀀠􀁳􀁵􀁲􀁧􀁩􀁣􀁡􀁬􀀠􀁣􀁡􀁳􀁥􀁳􀀠􀁴􀁲􀁥􀁡􀁴􀁥􀁤􀀠􀁡􀁴􀀠􀁋􀁡􀁫􀁵􀁭􀁡􀀠􀁍􀁩􀁳􀁳􀁩􀁯􀁮􀀠􀁈􀁯􀁳􀁰􀁩􀁴􀁡􀁬􀀬􀀠 􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀬􀀠􀁋􀁥􀁮􀁹􀁡􀀠􀁷􀁥􀁲􀁥􀀠􀁥􀁶􀁡􀁬􀁵􀁡􀁴􀁥􀁤􀀮􀀠􀁔􀁨􀁥􀀠􀁲􀁡􀁴􀁩􀁯􀀠􀁯􀁦􀀠􀁩􀁮􀁦􀁥􀁣􀁴􀁩􀁯􀁮􀀠􀁩􀁮􀀠􀁭􀁡􀁬􀁥􀀠􀁴􀁯􀀠 􀁦􀁥􀁭􀁡􀁬􀁥􀀠􀁷􀁡􀁳􀀠􀀱􀀺􀀲􀀬􀀠􀁷􀁩􀁴􀁨􀀠􀁩􀁮􀁤􀁩􀁶􀁩􀁤􀁵􀁡􀁬􀁳􀀠􀁩􀁮􀀠􀁴􀁨􀁥􀀠􀀳􀀱􀀭􀀴􀀰􀀠􀁡􀁧􀁥􀀠􀁧􀁲􀁯􀁵􀁰􀁳􀀠􀁢􀁥􀁩􀁮􀁧􀀠 􀁭􀁯􀁳􀁴􀀠􀁰􀁲􀁥􀁶􀁡􀁬􀁥􀁮􀁴􀀮􀀠􀁔􀁨􀁥􀀠􀁡􀁶􀁥􀁲􀁡􀁧􀁥􀀠􀁤􀁩􀁲􀁥􀁣􀁴􀀠􀁣􀁯􀁳􀁴􀀠􀁯􀁦􀀠􀁃􀁅􀀠􀁳􀁵􀁲􀁧􀁩􀁣􀁡􀁬􀀠􀁴􀁲􀁥􀁡􀁴􀁭􀁥􀁮􀁴􀀠 􀁷􀁡􀁳􀀠􀁕􀁓􀀤􀀠􀀷􀀰􀀳􀀮􀀠􀁄􀁩􀁲􀁥􀁣􀁴􀀠􀁣􀁯􀁳􀁴􀀠􀁦􀁯􀁲􀀠􀀵􀀸􀀶􀀠􀁳􀁵􀁲􀁧􀁩􀁣􀁡􀁬􀀠􀁰􀁡􀁴􀁩􀁥􀁮􀁴􀁳􀀬􀀠􀁯􀁶􀁥􀁲􀀠􀁴􀁨􀁥􀀠􀀲􀀰􀀠 􀁹􀁥􀁡􀁲􀀠 􀁳􀁴􀁵􀁤􀁹􀀠 􀁰􀁥􀁲􀁩􀁯􀁤􀀠 􀁷􀁡􀁳􀀠 􀁕􀁓􀀤􀀠 􀀴􀀵􀀳􀀬􀀱􀀵􀀴􀀠 􀁷􀁩􀁴􀁨􀀠 􀁡􀁮􀀠 􀁡􀁶􀁥􀁲􀁡􀁧􀁥􀀠 􀁯􀁦􀀠 􀁕􀁓􀀤􀀠 􀀲􀀲􀀬􀀶􀀵􀀸􀀠􀁰􀁥􀁲􀀠􀁹􀁥􀁡􀁲􀀮􀀠􀁁􀁮􀁮􀁵􀁡􀁬􀀠􀁩􀁮􀁤􀁩􀁲􀁥􀁣􀁴􀀠􀁃􀁅􀀭􀁡􀁳􀁳􀁯􀁣􀁩􀁡􀁴􀁥􀁤􀀠􀁭􀁯􀁮􀁥􀁴􀁡􀁲􀁹􀀠􀁬􀁯􀁳􀁳􀁥􀁳􀀠 􀁡􀁳􀁳􀁯􀁣􀁩􀁡􀁴􀁥􀁤􀀠􀁷􀁩􀁴􀁨􀀠􀁬􀁯􀁳􀁴􀀠􀁥􀁣􀁯􀁮􀁯􀁭􀁩􀁣􀀠􀁯􀁰􀁰􀁯􀁲􀁴􀁵􀁮􀁩􀁴􀁩􀁥􀁳􀀠􀁡􀁭􀁯􀁵􀁮􀁴􀁥􀁤􀀠􀁴􀁯􀀠􀁕􀁓􀀤􀀠 􀀴􀀬􀀴􀀱􀀴􀀠􀁦􀁯􀁲􀀠􀁡􀀠􀁨􀁥􀁲􀁤􀁳􀁭􀁡􀁮􀀠􀁡􀁮􀁤􀀠􀁕􀁓􀀤􀀠􀀱􀀬􀀳􀀳􀀹􀀠􀁦􀁯􀁲􀀠􀁡􀀠􀁨􀁯􀁵􀁳􀁥􀀠􀁷􀁩􀁦􀁥􀀮􀀠􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀠 􀁣􀁯􀁭􀁭􀁵􀁮􀁩􀁴􀁹􀀠 􀁩􀁳􀀠 􀁡􀀠 􀁮􀁯􀁭􀁡􀁤􀁩􀁣􀀠 􀁰􀁡􀁳􀁴􀁯􀁲􀁡􀁬􀁩􀁳􀁴􀀠 􀁡􀁮􀁤􀀠 􀁴􀁨􀁥􀀠 􀁲􀁵􀁲􀁡􀁬􀀠 􀁔􀁵􀁲􀁫􀁡􀁮􀁡􀀠 􀁷􀁯􀁭􀁥􀁮􀀠􀁬􀁡􀁣􀁫􀀠􀁦􀁯􀁲􀁭􀁡􀁬􀀠􀁥􀁤􀁵􀁣􀁡􀁴􀁩􀁯􀁮􀀬􀀠􀁴􀁨􀁥􀁩􀁲􀀠􀁥􀁣􀁯􀁮􀁯􀁭􀁩􀁣􀀠􀁣􀁯􀁮􀁴􀁲􀁩􀁢􀁵􀁴􀁩􀁯􀁮􀀠􀁴􀁯􀀠􀁴􀁨􀁥􀀠 􀁦􀁡􀁭􀁩􀁬􀁹􀀠􀁡􀁮􀁤􀀠􀁣􀁯􀁭􀁭􀁵􀁮􀁩􀁴􀁹􀀠􀁷􀁡􀁳􀀠􀁥􀁶􀁡􀁬􀁵􀁡􀁴􀁥􀁤􀀠􀁯􀁮􀀠􀁴􀁨􀁥􀀠􀁢􀁡􀁳􀁩􀁳􀀠􀁯􀁦􀀠􀁥􀁣􀁯􀁮􀁯􀁭􀁩􀁣􀀠 􀁰􀁯􀁴􀁥􀁮􀁴􀁩􀁡􀁬􀀠􀁯􀁦􀀠􀁡􀀠􀁨􀁥􀁲􀁤􀁳􀁭􀁡􀁮􀀠􀁡􀁮􀁤􀀠􀁡􀀠􀁨􀁯􀁵􀁳􀁥􀁷􀁩􀁦􀁥􀀮􀀠􀁔􀁨􀁥􀀠􀁲􀁥􀁳􀁵􀁬􀁴􀁳􀀠􀁳􀁨􀁯􀁷􀀠􀁴􀁨􀁡􀁴􀀠 􀁃􀁅􀀠 􀁨􀁡􀁳􀀠 􀁡􀀠 􀁳􀁩􀁧􀁮􀁩􀁦􀁩􀁣􀁡􀁮􀁴􀀠 􀁥􀁣􀁯􀁮􀁯􀁭􀁩􀁣􀀠 􀁢􀁵􀁲􀁤􀁥􀁮􀀠 􀁯􀁮􀀠 􀁩􀁮􀁤􀁩􀁶􀁩􀁤􀁵􀁡􀁬􀁳􀀠 􀁩􀁮􀀠 􀁴􀁨􀁩􀁳􀀠 􀁲􀁥􀁧􀁩􀁯􀁮􀀮􀀠􀁔􀁨􀁩􀁳􀀠􀁲􀁥􀁱􀁵􀁩􀁲􀁥􀁳􀀠􀁩􀁭􀁭􀁥􀁤􀁩􀁡􀁴􀁥􀀠􀁳􀁵􀁳􀁴􀁡􀁩􀁮􀁡􀁢􀁬􀁥􀀠􀁣􀁯􀁮􀁴􀁲􀁯􀁬􀀠􀁭􀁥􀁡􀁳􀁵􀁲􀁥􀁳􀀠􀁡􀁴􀀠 􀁴􀁨􀁥􀀠􀁤􀁥􀁦􀁩􀁮􀁩􀁴􀁩􀁶􀁥􀀠􀁡􀁮􀁤􀀠􀁩􀁮􀁴􀁥􀁲􀁭􀁥􀁤􀁩􀁡􀁴􀁥􀀠􀁨􀁯􀁳􀁴􀁳􀀧􀀠􀁬􀁥􀁶􀁥􀁬􀀠􀁴􀁯􀀠􀁲􀁥􀁤􀁵􀁣􀁥􀀠􀁴􀁨􀁥􀀠􀁢􀁵􀁲􀁤􀁥􀁮􀀠 􀁯􀁦􀀠􀁴􀁨􀁥􀀠􀁩􀁮􀁦􀁥􀁣􀁴􀁩􀁯􀁮􀀮
The monetary burden of cystic echinococcosis and its distribution
based on gender and age in Turkana North District, Kenya
Cystic Echinococcosis (CE) is caused by the larval stage of the
tapeworm Echinococcus granulosus. The disease occurs
worldwide, and is endemic in Turkana and Maasai areas, Kenya.
The objective of the study was to assess the direct and indirect
monetary burden of CE in Turkana North District of Kenya.
This study involved a retrospective review of CE patients'
medical records obtained from AMREF-Kenya (1991-2011),
with patients originating from Turkana North district of Kenya.
Data obtained were used to calculate CE- associated direct costs.
A total of 586 surgical cases treated at Kakuma Mission Hospital,
Turkana, Kenya were evaluated. The ratio of infection in male to
female was 1:2, with individuals in the 31-40 age groups being
most prevalent. The average direct cost of CE surgical treatment
was US$ 703. Direct cost for 586 surgical patients, over the 20
year study period was US$ 453,154 with an average of US$
22,658 per year. Annual indirect CE-associated monetary losses
associated with lost economic opportunities amounted to US$
4,414 for a herdsman and US$ 1,339 for a house wife. Turkana
community is a nomadic pastoralist and the rural Turkana
women lack formal education, their economic contribution to the
family and community was evaluated on the basis of economic
potential of a herdsman and a housewife. The results show that
CE has a significant economic burden on individuals in this
region. This requires immediate sustainable control measures at
the definitive and intermediate hosts' level to reduce the burden
of the infection.
Received: 18.08.2014
Accepted: 12.10.2014
Available online: 30.11.2014
*Corresponding author:*Corresponding author:
1 2 3 1 1 1 1 1
J. Odero *, J. Magambo , E. Zeyhle , H. Kutima , L. Ndahi , F. Njonge , T. Mutwiri , H. Mbaya ,
4 4 1 5 6
C. Mbae , E. Mulinge , D. Kagendo , P. Kern , T. Romig
1. Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
2. Meru University of Science and Technology, Meru, Kenya
3. African Medical Research Foundation, Nairobi, Kenya
4. Kenya Medical Research Institute, Nairobi, Kenya
5. Ulm University Hospital, Ulm, Germany
6. University of Hohenheim, Stuttgart, Germany
Email :
Tel.: +254722908871
Asian Journal of Pharmaceutical and Health Sciences
Cystic echinococcosis, Echinococcus granulossus,
Economic burden, Turkana North District - Kenya.
Cystic Echinococcosis (CE) is a zoonotic disease caused
by the larval stage of Echinococcus granulosus. Dogs
and other canids are the definitive hosts while
livestock/humans are intermediate hosts [1]. The outcome of
infection in livestock and human is cyst development in the body
organs. Intermediate hosts are infected after ingesting E.
granulossus eggs passed in dog feces [2]
The parasite occurs worldwide and affects rural pastoral
societies [1]. It is widespread in Africa especially in countries
with extensive livestock economy [3-5]. Cystic Echinococcosis is
highly endemic in sub-Saharan Africa [6] In Kenya, there is a very
high prevalence of CE in two pastoral communities, the Turkana
and Masaai regions [7]. Transmission is most intense in livestock
raising regions where veterinary services are unsatisfactory and
offal from slaughtered animals is accessible to dogs [1] The adult
tapeworm is harmless to the dog, although in large numbers,
enteritis may occur [8].
Humans are infected with hydatid cysts after consuming eggs
of E. granulosus through contaminated food, water and soil, or
direct contact with dogs [9]. After an incubation period of 515
years, the cysts can cause life threatening illness [10]. Fatal
complications may arise secondary to rupture of the cyst leading
to anaphylactic reactions [11]. Morbidity depends on the number,
Asian J. Pharm. Hea. Sci. | Oct - Dec 2014 | Vol-4 | Issue-4
size, and developmentalstatus of the cysts, the involved organand
the location of the cysts within the organ, and the defense
mechanisms of the infected individual [12]. Recurrence may arise
following surgery on primary cysts [13]
In clinical cases, a predominance of women has been noted,
with women of childbearing age having the highest prevalence
[14-15]. Hydatid cysts can occur in all parts of the body; however,
hydatid cysts of the liver were most common, followed by
abdominal cysts, kidney, spleen, lung, and soft tissue [16].
Human CE-associated direct economic losses arise from
diagnosis procedures including ultrasound and various laboratory
tests, surgical or chemotherapeutic treatment, hospitalization and
convalescence, life impairment and fatalities. Livestock
associated indirect economic losses arise from decrease in carcass
weight, milk production and fertility rates and from increased
condemnation of viscera [17]. Monetary losses due to CE have
been estimated for Uruguay [18], Wales [19] and for a highly
endemic area of the Tibetan plateau [20-21]. Costs associated
with CE have a great impact on affected individuals, their
families, and the community [17].
Non-monetary burden of CE has been assessed for a highly
endemic region of China (Tibetan plateau) and globally using the
disability adjusted life year (DALY) [22]. An initial valuation of
the global burden of CE is estimated at >1 million DALYs lost,
which gives CE a greater impact than Onchocerciasis, Dengue
fever and Chagas disease. [17]. Recently, the World Health
Organization (WHO) included CE in a subgroup of selected
Neglected Tropical Diseases (NTDs) to be addressed within its
20082015 strategic plan for control of NTDs [23]. The WHO
recommends that the economic impact of zoonotic infections be
assessed before implementation of any control measure [24]
In Kenya there is no information on the economic significance
of CE in humans and livestock. Estimation of the economic
burden of CE in human and livestock is important and should be
part of any cost-benefit program for the control of this parasitic
zoonosis [17]. The main aim of this study was to estimate the
monetary burden of CE and its distribution by age and gender in
humans in Turkana North district, Kenya. This estimate will
provide public health policy makers with important information
to aid in the implementation of control measures at the region and
country levels. The study also evaluated the economic value of a
Turkana herdsman and housewife with a view of evaluating the
indirect CE associated economic loss in the study area.
Turkana County lies within Kenya's ecological zone V, VI and
VII, classified as arid and semi arid lands, about 65% are very
arid. The economy of the county relies on indigenous livestock
breeds reared on free range production systems [25]. Turkana are
nomadic traditionalists, therefore the male gender at the age of ten
years and above herd livestock and the rural Turkana woman is
mainly a housewife, married off at 13-15 years. Literacy level is
very low in Turkana County [26] The main economic contribution
to the family and community of a male and female Turkana is
being a herdsman and housewife respectively. Due to CE
morbidity/mortality, the economic production of the affected
individuals will be reduced constituting the indirect CE
associated monetary loss.
The study was conducted using 20 years (1991-2011) of
retrospective data from CE patients' records from Kakuma
Mission Hospital, Turkana North District, Kenya. The CE
patients' records are kept by AMREF-Kenya which conducts
annual CE community ultrasound screening and treatment in the
area. Turkana North District is situated in North Western Kenya.
The county is hot and dry most of the year with an average rainfall
of approximately 300-400 mm. The mean temperature ranges
0 0
between 26 C -38 C (25).
A twenty year (1991-2011) retrospective medical records
review was conducted using data obtained from AMREF-Kenya.
Data were collected on a total of 586 CE patients surgically treated
in the Kakuma Mission Hospital. Ethical clearance to use the
medical data for research was granted by the Director AMREF-
The data collected included the year and date of diagnosis, the
type of surgical treatment and the patient's name, age and gender.
The location of cyst in the various body organs and the cost of
each type of surgical intervention were also recorded. The above
data were entered into an excel spread sheet for analysis.
Human CE-associated monetary loss was evaluated based on
direct and indirect costs. The direct costs included diagnosis,
laboratory charges and surgical treatment, hospitalization (bed
charges and food for an average of 10 days), personnel charges
(surgeon and anesthetist), logistical costs (flight, fuel) and follow-
up costs. The direct CE-associated economic loss per year was
estimated by computing the product of the number of CE patients
treated per year and the estimated cost/procedure for CE patients
treated at Kakuma Mission Hospital, Turkana. Unreported and
non healthcare seeking CE cases were given an additional factor
of 10% of the total economic loss per year to capture the overall
direct CE-associated cost. This group comprised of asymptomatic
CE cases that are not aware about the infection and terminal cases
that remain at home. The additional factor of 10% was based on
the percentage of the total number of positive CE cases scheduled
for surgical operation at Kakuma Mission Hospital, Turkana,
Two parameters were used to estimate the indirect CE
associated economic loss in Turkana North district, Kenya.
Economic contribution in monetary value of a healthy herdsman
or a housewife in Turkana community of Kenya was used to
estimate the CE associated indirect loss in human.
A total of 586 patients were operated during the period
reviewed (1991-2011). Patients' ages ranges from ˂1-70 years.
The middle age groups, 21-30 years, 31-40 years and 41-50 years
were the most highly infected, making up 19%, 20% and 18% of
the cases respectively. The older age groups, 51-60 years and 61-
70 years made up 8% and 1% of the cases respectively. The
youngest age group, ˂1-10 years made up 16% of the cases.
Table 1 shows the cost of diagnosis and surgical treatment of
Asian J. Pharm. Hea. Sci. | Oct - Dec 2014 | Vol-4 | Issue-4
Table 1. Estimated cost for Cystic Echinococcosis treatment procedure per patient
Fig. 1. Distribution of Cystic Echinococcosis by gender
Asian J. Pharm. Hea. Sci. | Oct - Dec 2014 | Vol-4 | Issue-4
an individual CE patient in Kakuma Mission Hospital, Turkana,
Kenya. The parameters were used to evaluate the direct CE
associated economic loss. A total of 12 CE patients were operated
during a 5 day visit by AMREF-Kenya personnel. The patients
were admitted for an average of 10 days. However those with post
operative complications were considered for hospitalization for
more days. Diesel was used for transportation of CE patients in
remote locations to the hospital. The overall cost of diagnosis and
surgery for a CE patient at Kakuma Mission Hospital was
estimated at an average of US$ 703.
Figure 1 shows the distribution of CE by gender in the study
area. The female gender had the highest CE infection proportion
with a male: female infection ratio of 1:2. This phenomenon is
significant considering the prevailing epidemiological factors,
the female gender have a close contact with the definitive host
The indirect monetary losses due to CE infection in Turkana
community were based on the lost economic opportunities by an
infected herdsman or a house wife who cannot perform his/her
daily activities due to CE morbidity, mortality or reduced quality
of life after a surgical operation.
The figures used in Table 2 were assumptions based on the
existing environmental conditions prevailing in Turkana,
indigenous livestock breeds reared and the average market prices
of the various livestock species sold in good body condition. The
average individual herd or flock size represent the total number of
various livestock species owned by a single household in Turkana
community of Kenya. The total monetary loss by an individual
herdsman per year due to CE in Turkana community was
estimated as the equivalent of the total monetary values of the
calves, lambs, kids and number of adult animals sold per year.
Turkana women are generally housewives without any form
of formal employment due to low education levels [27]. Their
main contribution to the family and community include giving
birth and caring of children, drawing water from the river for
domestic use, fetching firewood and building of traditional huts.
The provisions of these services/activities to the family are
negatively affected due to CE morbidity and/or mortality.In the
current study the economic value of a housewife in Turkana
community was estimated by converting these services
performed by a healthy housewife in Turkana community into
monetary values by making assumptions based on existing cost of
Table 2. Estimated herd/flock size, and livestock values in monetary terms in Turkana, Kenya
Table 3. Daily activities performed by a healthy Turkana woman and estimated monetary value per year
Asian J. Pharm. Hea. Sci. | Oct - Dec 2014 | Vol-4 | Issue-4
Table 4. Direct economic loss due to Cystic Echinococcosis in human in Turkana North district, 1991-2011
these services/activities in an urban settlement within Turkana
County of Kenya. Currently there are no uniformly acceptable
costs of such services in the rural parts of Kenya. Giving birth
and caring of children was equated with the cost of hiring a house
help in Lodwar town in Turkana County. The cost of hiring a
house help in Kenya is US$ 63/month translating to US$
756/year. This is based on the Minimum Consolidated Wages by
Region and Occupation in Kenya [28] Drawing of water from
rivers for domestic use was equated with the value of a 20 litre
container of water in Lodwar town in Turkana County. Assuming
that one woman can manage 4, 20 litre containers daily using a
donkey as means of transport from a river. The cost of a 20 litre
container of water was assumed to cost US$ 0.24. The county is
usually dry most of the year and the women normally walk long
distances to fetch water. Fetching firewood was equated with the
value of a bundle of firewood in Lodwar town in Turkana County.
Firewood is the source of energy used by low income residents
living in low class estates within Lodwar town. One bundle was
assumed to cost US$ 0.6 and each household consumes a bundle
to prepare meals daily. Building of traditional homesteads was
equated with the cost of building materials of traditional huts and
labor within one homestead. The total cost was divided by the
approximate number of married women in one homestead in
Turkana community of Kenya to estimate the economic
contribution in monetary value by a single married woman.
Assuming each homestead has an average of 15 huts built of
locally available materials with approximately 9 healthy married
women per single homestead building the huts. The average cost
of building one hut is approximately US$ 59, cost of local
materials and labour.
Asian J. Pharm. Hea. Sci. | Oct - Dec 2014 | Vol-4 | Issue-4
The overall monetary value of the activities performed by
healthy Turkana women constituted the economic opportunity
lost by CE infected women due to its morbidity and/or mortality.
Table 4 shows the total direct economic loss due CE per year
during the period under review, the number of CE patients
operated/year multiplied by the total cost of surgically treating
one CE patient in Kakuma Mission Hospital, Kenya (Table 1). An
additional factor of 10% of the direct economic loss/year was
included to represent the unreported and non healthcare seeking
CE cases. The total CE associated direct economic loss for the 20
years (1991-2011) under review was US$ 453,154 with an
average of US$ 22,658 /year.
This is the first study on the assessment of the monetary
burden of CE in humans in Kenya. The analyses were done using
CE patients' data from Turkana North district, which is a CE
endemic region in Kenya. Studies that estimate the burden of a
disease at a regional level provide data that enable decision
makers to prioritize allocation of limited resources in developing
countries like Kenya [29] Similar studies have been done in
several countries such as Uruguay [18], Wales [19] The results of
this study from a single CE endemic region, Turkana, Kenya is
significant and can be used to direct CE control programs in the
entire country. However, direct comparison of data is difficult due
to lack of standard methods for estimating the costs of the
infection and the differences among countries in terms of human
and animal population sizes, disease prevalence, inherent socio
economic patterns, and period of evaluation [30].
The findings of this study show that the overall monetary
burden of CE in the Turkana North district of Kenya is high. The
average annual direct economic cost of US$ 22,658 per year for
patients treated in a single health facility in Turkana County
clearly confirms that CE is a zoonotic parasitic infection with a
high economic burden in the study site. The cost of CE diagnosis,
surgical treatment and hospitalization of the patients at Kakuma
Mission Hospital is catered for by AMREF- Kenya. The
government of Kenya through the ministry of health does not have
a specific budget for the diagnosis, treatment and control of CE
and patients have to shoulder the whole burden in the absence of
volunteer financiers such as AMREF- Kenya.
Indirect costs for this study included all the opportunities that
were lost as a result of CE-associated morbidity and/or mortality.
Morbidity leads to disability [31] and most likely a reduction in
quality of life in CE patients [32]. Indirect CE-associated
monetary loss were estimated based on the lost economic
opportunities of an infected herdsman and a housewife in the
Turkana community, with lost-opportunity costs corresponding to
the productive time lost due to an infected person working less
efficiently than someone who is uninfected [30].
The monetary value of the young animals born and the culled
animals sold per year constitute the economic contribution of a
herdsman to his family and community in general. In the Turkana
community, women are less educated and are usually married at
an early age. Their daily activities include caring for children,
drawing water from the rivers for domestic use, fetching
firewood, and building traditional homesteads [27]. These
activities when converted into monetary values constitute the
DISTRICT, 1991-2011
economic contribution of a local Turkana woman to her family
and community. The assumptions were made based on the cost of
goods and services in the main town of Lodwar in Turkana
County.Findings from this study show a significant annual
indirect CE associated monetary loss by an individual herdsman
(US$ 4,414) and a housewife (US$ 1,339) in Turkana due to CE.
Kenya's Gross Domestic Product (GDP) is estimated at US$ 40.7
billion with a per capita GDP of US$ 943 [33]. The CE associated
monetary loss by an individual herdsman and housewife in
Turkana community compared to the country's per capita GDP
confirms the economic burden of this zoonotic disease within the
study site. From the results of this study, both males and females
are at risk of contracting and developing CE with a male to female
infection ratio of 1:2. French [34] studied the age-sex distribution
of 355 Turkana hydatid patients and obtained similar results. He
related the trend to the close contact between women and dogs
during child rearing when the dogs are used as nurse maids to
clean babies' faeces or vomit.The higher number of female cases
can also be due to the fact that the female members of the
community are normally within the homesteads during CE mass
screening and if they test positive will subsequently booked for
treatment at the Kakuma Mission Hospital. The men are often out
of the homesteads grazing livestock and are not fully captured
during CE screening. The middle age groups, 21-30 and 31- 40
made up the highest proportion of cases, which could be
associated with close contact with the definitive host (dogs) in the
study site. Turkana, men are known to herd their livestock with
dogs and the women get close contact with dogs while child
Cystic Echinococcosis not only causes monetary losses, but
also can cause social problems including stigmatization, divorce
and creating a burden on the family members caring for a
terminally ill CE patient. The family of a terminally CE patient
suffer psychological stress due to the care required at this
moment, this increase the overall indirect CE burden. The poverty
level of Turkana County stands at 94.3% according to Kenya
integrated household survey [35], CE therefore is a contributing
factor to the high poverty index in the study area.
This study confirms a significant direct and indirect CE
associated monetary burden and social problems within the study
area and hence a parasitic zoonotic disease of public health
importance in the region. The study therefore recommends
comprehensive public health education on the CE risk factors and
effective control measures to reduce the its associated monetary
burden considering the existing epidemiological information
within the study site.
The authors are grateful to the German DFG and the Cystic
Echinococcosis Sub-Saharan Africa Research initiative
(CESSARi) Kenya for funding the Research project and Prof
Christine Budke who read the manuscript and offered technical
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