{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T13:29:16Z","timestamp":1785590956401,"version":"3.56.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["RIA2020S-3301"],"award-info":[{"award-number":["RIA2020S-3301"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Visceral Leishmaniasis (VL) is a vector-borne disease caused by the protozoa <jats:italic>Leishmania<\/jats:italic> 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The 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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323990","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T17:58:57Z","timestamp":1747763937000},"page":"e0323990","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessment of a decentralization model in improving treatment and care of visceral leishmaniasis in Turkana County, Kenya: A mixed method study"],"prefix":"10.1371","volume":"20","author":[{"given":"Jane","family":"Mbui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Macharia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Maranga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2647-1359","authenticated-orcid":true,"given":"Collins","family":"Okoyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"pone.0323990.ref001","first-page":"776","volume":"104","author":"NE Aronson","journal-title":"Hunter\u2019s Tropical Medicine and Emerging Infectious Diseases"},{"key":"pone.0323990.ref002","doi-asserted-by":"crossref","DOI":"10.1038\/nrmicro1766","article-title":"Evaluation of rapid diagnostic tests: visceral leishmaniasis","volume":"5","author":"M Boelaert","year":"2007","journal-title":"Nat Rev Microbiol"},{"issue":"1","key":"pone.0323990.ref003","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.idc.2018.10.005","article-title":"Visceral leishmaniasis: recent advances in diagnostics and treatment regimens","volume":"33","author":"J van G","year":"2019","journal-title":"Infect Dis Clin North Am"},{"issue":"1","key":"pone.0323990.ref004","doi-asserted-by":"crossref","DOI":"10.35500\/jghs.2020.2.e3","article-title":"Visceral leishmaniasis: a global overview","volume":"2","author":"RG Wamai","year":"2020","journal-title":"J Glob Health Sci"},{"key":"pone.0323990.ref005","first-page":"0","author":"World Health Organization.","year":"2020"},{"key":"pone.0323990.ref006","first-page":"265","article-title":"Global leishmaniasis surveillance, 2017\u22122018, and first report on five additional indicators","volume":"25","author":"WHO","year":"2020","journal-title":"Wkly Epidemiol Rec"},{"issue":"11","key":"pone.0323990.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002543","article-title":"Risk factors for visceral Leishmaniasis among residents and migrants in Kafta-Humera, Ethiopia","volume":"7","author":"D Argaw","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0323990.ref008","unstructured":"Republic of Kenya, Ministry of Health, The Strategic Plan for control of Leishmaniasis 2021\u20132025."},{"key":"pone.0323990.ref009","first-page":"1095","article-title":"Leishmaniasis.","volume-title":"Tropical infectious diseases: principles, pathogens and practice","author":"S Jeronimo","year":"2006"},{"issue":"10","key":"pone.0323990.ref010","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.apjtm.2016.06.021","article-title":"Worldwide risk factors in leishmaniasis","volume":"9","author":"A Oryan","year":"2016","journal-title":"Asian Pac J Trop Med"},{"issue":"4","key":"pone.0323990.ref011","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4269\/ajtmh.2011.10-0321","article-title":"Who is a typical patient with visceral leishmaniasis? Characterizing the demographic and nutritional profile of patients in Brazil, East Africa, and South Asia","volume":"84","author":"MO Harhay","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0323990.ref012","volume-title":"Prevention, diagnosis and treatment of visceral leishmaniasis (kala-azar) in Kenya, National guidelines for health workers","year":"2017"},{"issue":"12","key":"pone.0323990.ref013","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(21)00392-2","article-title":"Towards the elimination of visceral leishmaniasis as a public health problem in east Africa: reflections on an enhanced control strategy and a call for action","volume":"9","author":"J Alvar","year":"2021","journal-title":"Lancet Glob Health"},{"key":"pone.0323990.ref014","doi-asserted-by":"crossref","DOI":"10.4324\/9780203495735","volume-title":"Understanding communication research methods: A theoretical and practical approach","author":"SM Croucher","year":"2014"},{"issue":"2","key":"pone.0323990.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5455\/209302\/ijtmph.","article-title":"A descriptive survey on Knowledge, Attitude, Practices and Beliefs (KAPBs) on Kala-azar among the Residents of Marigat Sub-County, Baringo County","volume":"6","author":"M Kiarie","year":"2016","journal-title":"Int J Trop Med Public Health"},{"issue":"11","key":"pone.0323990.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006778","article-title":"Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study","volume":"12","author":"RM Coulborn","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pone.0323990.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0306067","article-title":"Visceral leishmaniasis follow-up and treatment outcomes in Tiaty East and West sub-counties, Kenya: Cure, relapse, and Post Kala-azar Dermal Leishmaniasis","volume":"19","author":"GC Kennedy","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0323990.ref018","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s41182-023-00549-1","article-title":"Follow-up assessment of visceral leishmaniasis treated patients and the impact of COVID-19 on control services in Nepal","volume":"51","author":"AB Joshi","year":"2023","journal-title":"Trop Med Health"},{"key":"pone.0323990.ref019","article-title":"Moving from control to elimination of Visceral Leishmaniasis in East Africa","volume":"3","author":"LK Makau-Barasa","year":"2022","journal-title":"Front Trop Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T17:59:06Z","timestamp":1747763946000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323990"}},"subtitle":[],"editor":[{"given":"Mehdi","family":"Bamorovat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323990","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]}}}