Sick traditions: The cost of culture and poverty in Kakamega's anthrax crisis

Kakamega County Director Vetinary services officer Dr Christopher Kadenge vaccinates a cow at Ichina area Malava Sub county in Kakamega County on March 19,2025. [Benjamin Sakwa, Standard] Geoffrey Lumbasi took off when we arrived in his village, Luanda K in East Kabras Ward, Malava Sub County, Kakamega County, for an interview. It took a ward administrator nearly two hours to convince him that we meant no harm. By then, he had run over two kilometres away. Once he returned and calmed down, Lumbasi explained why he fled. "I was once admitted to the hospital, and the doctors mentioned amputating my hand. I feared you might be from the hospital," he said. It turns out, Lumbasi is one of seven people who fell ill after consuming meat from a cow that died of anthrax in the area and was later admitted to the hospital. On the fateful day, early in the morning, Lumbasi heard his neighbour shouting, 'Kuna nyama ya bure' (There's free meat). To Lumbasi, the offer seemed too good to be true, especially during these tough economic times. As he got up, he overheard a group nearby saying the meat came from a cow owned by Caudencia Soita, one that had died the night before. He quickly grabbed his long knife, rushed to Caudencia's homestead and began skinning and cutting up the dead cow. By the time they were through with skinning, the compound was packed with people, ready to get a share of the meat. Caudencia remembers that in less than 30 minutes, the entire cow was gone, including the head, intestines and legs. She says the cow had shown no prior signs of sickness. "The cow suddenly fell ill in the evening. We planned to call a veterinarian the following morning. Unfortunately, it died that night," she says, adding, "I informed the community to come collect the meat, since it is considered a curse to throw away a whole cow." Two days later, Lumbasi started feeling unwell, experiencing cold shivers, nausea, swollen hands and body itching. When his condition worsened, he was taken to Malava Sub-County hospital. At the hospital, doctors diagnosed him with anthrax, a potentially deadly disease caused by the spore-forming bacterium, Bacillus anthracis. Humans can contract it from infected animals or contaminated animal products. Anthrax spores The Centres for Disease Control and Prevention (CDC) states that anthrax can cause severe illness in both people and animals. "The bacteria that cause anthrax occur naturally in soil worldwide and people usually get anthrax from infected animals or contaminated animal products. People can breathe in anthrax spores, eat food or drink water contaminated with spores, or get spores in a cut or scrape in the skin," it says. Both domestic and wild animals, such as cattle, sheep, goats, antelopes and deer, can become infected by inhaling, ingesting or drinking spores present in contaminated soil, plants or water. Harris Kencey, the Disease Surveillance Officer, Malava Sub-County, confirms that seven people contracted cutaneous anthrax after consuming meat from a dead cow and were hospitalised. Luanda K, East Kabras and Shamoni of South Kabras were the two affected areas. In Shamoni, only livestock was affected and no human case was reported. According to the CDC, cutaneous anthrax occurs when anthrax spores enter a cut or scrape on the skin, usually when a person handles infected animals or contaminated animal products like wool, hides, or hair. "It mostly shows up on the head, neck, forearms and hands. It's the most common form of anthrax infection and it's also considered the least dangerous," it says. Kencey says the ward administrator alerted them about the disease and together with the veterinary department, they began investigations and discovered the first case in early January. "We found out, people who were affected had participated in slaughtering the animals and consuming the meat of the livestock that had died," he says. The county health team also joined in intervention efforts and provided treatment for those affected. Kencey explains, they have been collaborating closely with the veterinary department, conducting social mobilisation and educating the community through posters. In April, veterinarians carried out a vaccination campaign, targeting cattle, sheep and goats. "We have intensified community surveillance, assisted by health community workers. In case of any sudden animal death, we are prepared to respond and take necessary measures," Kencey explains. In Shinyalu, Boniface Misiko is yet to recover from anthrax infection. In February, a neighbour's cow died suddenly, and he asked him to help skin and distribute the meat within the community. "Five of us worked on the dead cow. Unfortunately, l was the only one who got sick and hospitalised. My hands swelled, and doctors almost amputated them," he remembers. Misiko says he had an open wound on his hand, caused by a thorn, which likely allowed the infection to enter. Right now, he struggles; his left hand is weak and not functioning. Bramwel Wanyonyi Sifuna, Shinyalu Sub County Disease Surveillance Coordinator, says out of five people who assisted in flaying the animal, only one got affected and had serious symptoms. "We advised them to visit the nearest health facility and to inform us immediately if any symptoms appeared. So far, none of them has developed any signs of illness," Sifuna says. Sifuna, who also heads the public health department at the sub-county, adds, they have been sensitising the community about anthrax through public forums and barazas. Recurring cases These are not the first cases of anthrax in Kakamega County. Edwin Ambasu, the County Disease Surveillance Coordinator, says the region has experienced multiple anthrax outbreaks over the past five years, from 2020 to 2024, affecting both humans and animals. Records from this period highlight recurring cases of infection and underscore the need for sustained public health, veterinary and environmental interventions, as anthrax bacteria live in the soil and tend to thrive under certain weather conditions. Kakamega recorded anthrax outbreaks in nearly all its sub-counties. Only Mumias West remained free of any reported anthrax cases during this period. Ikolomani recorded the highest number of outbreaks, with four incidents and 29 people infected. Shinyalu followed with five outbreaks and 16 people affected. Malava had three outbreaks with six people affected, while Khwisero also had four outbreaks resulting in 14 human cases. Navakholo reported three outbreaks with nine people affected. Others are Mumias East, which reported one outbreak with one person affected, Matungu had two outbreaks affecting two people, Lugari experienced two outbreaks with 13 people affected, Likuyani had one outbreak with one person affected and Lurambi recorded two outbreaks with three people infected. There were several anthrax-related deaths during this period. In Ikolomani sub-county, four people died in 2022 and another in 2023. Additionally, in 2022, three people died from anthrax in Shinyalu sub-county. Butere sub-county has active cases, with three people treated. Ambasu assures the public that currently, the situation is under control because no new cases are being reported. But he cautions, several sub-counties, such as Shinyalu, Butere, Khwisero, and Malava, are still experiencing high transmission rates. He emphasises that in Kakamega, anthrax remains a common threat, much like other infectious and zoonotic diseases. Dr Victor Yamo, a veterinary surgeon and Executive Director of Global One Health Advocacy Alliance, describes anthrax as a highly fatal and infectious zoonotic disease caused by the bacterium, Bacillus anthracis. It primarily affects herbivorous animals such as cattle, goats, sheep and buffaloes. "In livestock-especially cattle, sheep and pigs, there is sudden death with little or no prior warning. But before death, affected animals may exhibit signs such as high fever, difficulty in breathing and blood oozing from body openings," he explains. Environmental factors Dr Yamo explains, anthrax outbreaks are heavily influenced by environmental factors, including soil characteristics, including pH, mineral content and availability of organic matter, along with rainfall patterns and temperature changes, particularly those linked to seasonal shifts. These factors, he notes, affect the survival and spread of the disease-causing bacterial spores in the environment, increasing the risk of infection in both animals and humans. "Human activities like farming, livestock management and waste disposal influence the environmental distribution of anthrax spores while high animal density and the movement of infected animals can facilitate the spread of the disease," he explains. Christopher Ngugi attends to one of his dairy cattle Kanguku village Muranga county. He is one of the anthrax victim which occurred in the county in February 2024. [Collins oduor, Standard] He adds, "Anthrax spores thrive in soils rich in organic matter and with pH levels above 6.0. Soil type, particularly clay and mineral composition, including elements like calcium and potassium also contribute to the persistence of spores in the environment." Dr Yamo highlights that rainfall patterns, especially prolonged dry periods following wet seasons, play a key role in the release of anthrax spores and potential outbreaks. "Abnormally high temperatures and thawing permafrost can also bring spores to the surface," he explains. To prevent anthrax in livestock, Dr Yamo recommends a comprehensive approach that includes vaccination, proper disposal of animal carcasses, quarantine of infected areas, strict hygiene and sanitation practices and enhanced disease surveillance. He says carcass disposal should be done through incineration or deep burial, with the addition of limestone, as the recommended alternative. He explains that in animals, anthrax is primarily treated using antibiotics like penicillin and streptomycin, often accompanied by supportive therapies to aid recovery. Kenya's National Strategy for the Prevention and Control of Anthrax in Humans and Animals 2021-2036, aims to systematically reduce anthrax risk through sustained livestock vaccinations, enhanced surveillance, proper carcass disposal and public education. The anthrax experience has changed both Lumbasi's and Misiko's perspectives on meat. They blame community traditions and cultural beliefs for misleading them about the safety of eating meat from dead animals. "What l went through in the hospital because of meat, now, even when l see inspected and certified meat in the butchery, l develop goosebumps. I feel like I've lost trust on meat, entirely," Lumbasi says. Anthrax cases reported earlier this year, affecting both humans and animals, add to multiple recurring outbreaks that have occurred between 2020 and 2024, underscoring the need for sustained public health, veterinary and environmental interventions. Edwin Ambasu, the Kakamega County Disease Surveillance Coordinator, says the Department of Health Services is implementing resilience measures to combat anthrax as a zoonotic disease. "Several departments have come together under the One Health strategy. The county has established the Kakamega County One Health Unit, also known as COHU-Kakamega," Ambasu explains. Under COHU, he explains, several key initiatives have been implemented. These include the development of a One Health strategic plan, recognised as a legal document to guide and finance COHU activities, along with training and sensitisation of staff on anthrax, vaccination of animals, advocacy efforts and formation of Technical Working Groups to operationalise the One Health strategy. Other measures include a Memorandum of Understanding (MOU) between Health, Environment and Veterinary departments aimed at strengthening collaboration in the preparation, management and control of zoonotic diseases, antimicrobial resistance (AMR), food security, and climate change challenges in Kakamega County. A steering committee has also been established to guide legislation, policy framework and stakeholder engagement. He also highlights the need for behaviour change, particularly in communities with strong preference for meat, some of whom have been known to exhume animal carcasses. The county is working with stakeholders to promote responsible meat consumption, enforce meat industry regulations and implement the Meat Control Act. Other ongoing efforts include routine vaccination of animals, continued community sensitisation, active case finding of all notifiable diseases and timely reporting. Culture and traditions Ambasu explains that cultural beliefs and traditions are among the factors contributing to the spread of anthrax in some communities. For instance, there are communities that believe anthrax is caused by witchcraft, rather than recognising it as a disease. Other people believe that a carcass should not be buried with its skin, as doing so prevents farmers from ever successfully rearing animals again. This practice contributes to the spread of spores and increases environmental contamination. "In certain traditions, when a pregnant animal dies, it is considered mandatory to slaughter it and remove the unborn calf. This practice further exposes the environment to anthrax spores," Ambasu shares. Ambasu also points out that some community members believe that even if the meat from a dead animal is unsafe for eating, the hide or skin can still be used for other purposes. "This is a dangerous misconception, as the hide or skin can contain anthrax spores and is highly infectious," he warns. Ambasu further explains, the county faces its fair share of challenges in its efforts to control the spread of anthrax, including inadequate funding for disease management and surveillance, limited sensitisation of staff on anthrax, poor health-seeking behaviour among community members and a widespread tendency to consume meat from dead animals. Other challenges include hostility from community members toward public health interventions, lack of proper disposal facilities and necessary chemicals, and the absence of a county-specific anthrax control plan. Additionally, there is a shortage of both public health and vet officers to manage and control zoonotic diseases and quarantine measures are not fully enforced due to economic and political constraints. The county also faces a shortage of educational materials necessary for effective awareness campaigns. Ambasu notes that Kakamega is actively seeking collaborations and partnerships in key areas such as advocacy, financing and policy development and dissemination of regulations, all aimed at eradicating anthrax in the region.

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Sick traditions: The cost of culture and poverty in Kakamega's anthrax crisis

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