Protecting communities to eliminate lymphatic filariasis in Kenya

Sixty-seven-year-old Nyashe Shee lives on picturesque Ndau Island, part of the Lamu archipelago off Kenya’s east coast. Despite the tranquillity of her surroundings, most of her adult life has been a struggle. At the age of 18, her legs began to swell and she developed lymphatic filariasis.

Lymphatic filariasis is transmitted by mosquitos carrying filarial worms (microscopic parasitic worms) which damage the lymphatic system as they mature. The diseases can cause lymphoedema (swelling of limbs) and hydrocele (swelling of the scrotum), often accompanied by toughening of the affected area’s skin. The disease affects people’s physical and mental well-being, quality of life and ability to work.

“Sometimes I get very high fevers and my body feels heavy,” says Shee. “I can’t go far or do much like I used to.”

Shee, along with many older residents, bear the brunt of the disease. Younger people have been protected by Kenya’s efforts to scale up the administration of medicines which treat and ultimately eliminate neglected tropical diseases like lymphatic filariasis.

Shee lives with her sister, nieces and nephews, who help care for her. “I used to collect firewood, but now I can’t manage. The only work I can still do is small chores around the house,” she says.

Kenya’s first mass drug administration took place in Kilifi County in 2002 and later expanded to other coastal counties, including Kwale, Tana River, Lamu and Mombasa.

While early campaigns were irregular, Kenya has run yearly campaigns since 2015, introducing a targeted and effective triple-drug therapy in the coastal sub-counties of Jomvu, Lamu East and Lamu West in 2018 and 2019.

These efforts have effectively stopped transmission of lymphatic filariasis and no microfilariae (immature larvae of the parasitic worms) have been detected in the population at risk in two recent lymphatic filariasis transmission surveys. Because some children in specific villages tested positive to antigen tests in Ndau Island and in Jomvu sub-county in Mombasa, two more mass drug administration rounds targeting these villages are being conducted as a precautionary measure in 2025 and 2026.

“I’m really happy about the medicine being given out in Ndau. It gives me hope that the children won’t have to suffer like I have,” says Shee.

Behind each mass drug administration is a carefully coordinated process. Health officials from the county Ministry of Health and the head nurse from the local dispensary count and record every tablet to ensure proper tracking and accountability. The medicines are then handed over to community health promoters, who administer them door-to-door during a timebound campaign.

During mass drug administration, community drug distributors record administration, refusals and any identified cases of lymphoedema or hydrocele.

This data is compiled at village level, aggregated by supervisors and Health Records Information Officers and transmitted to a central database where it is analysed by age and sex to monitor coverage.

Adlai Ismail, a Health Records and Information Officer from Kenya’s northeastern Garissa County now resides in Faza, a small town on Lamu Archipelago.

His work during mass drug administration is to coordinate data collection and participate in community education sessions on the purpose of the medicines and the risks of lymphatic filariasis.

"We also meet with people who have refused the medicine and we helped explain why the treatment is important,” says Ismail. “We assure them the medicine is safe and approved. Once they understand, they take it without hesitation.”

After a long day, the tide is low and the motorboat transporting Ismail cannot reach shore. So rather than wait hours for the tide to rise, he wades through the shallow water to reach home.

Commitment from all levels of local government and strong community mobilization has consistently pushed coverage of mass drug administration to well over the WHO-recommended 65% threshold.

It has also reduced the size of Kenya’s population who require mass drug administration from 4 million to just under 12 000 people who need focused treatment in a few selected villages.

Surveys conducted in 2021 show that infection rates have dropped from 0.5% to 0.2% in Lamu county and halved to 0.7% in Jomvu sub-county, demonstrating that Kenya is on track to achieve elimination of lymphatic filariasis by 2027.

For Ndau Island resident Fatouma Bwana, who received the medication from her nephew, Mustafa, a community drug distributor, the benefits are clear.

"I took the medicine to protect myself from getting this disease. It’s a good thing because these drugs are really helping us. They prevent the swelling, which we’ve seen affect many people here," she says.

Through WHO’s Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) in the African region, the Organization has supported Kenya to ensure consistent supply of essential medicines for mass drug administration and strengthen real-time data collection and monitoring at the community level.

Tools like ESPEN Collect, a free mobile platform, help health teams gather and analyse data on neglected tropical diseases and improving decision-making at the programme level. WHO also provides targeted technical assistance to embed interventions in primary health care systems.

Kenya’s 2023–2027 National Master Plan for NTD Elimination, developed with WHO support, further aligns national action with the global roadmap.

“WHO is proud to stand alongside Kenya’s Ministry of Health in efforts to eliminate lymphatic filariasis and other neglected tropical diseases, ensuring communities are healthier and better protected for the future,” says Dr Adiele Onyeze, Acting WHO Representative in Kenya.

"I’m happy the medicines are being given, especially to the young people. It will protect them from suffering like we have seen in the elder generation,” says 33-year-old Twahuru Dau, a mangrove farmer from Ndau Island.

"When fewer people have these diseases, it helps the whole community. More people will be able to go fishing or harvest mangroves and support their families,” he says.