Good tidings come early this year

Life for the ordinary Kenyan family today is hard hit by the economic crunch, skyrocketing food prices, unemployment and other looming challenges.

This has meant that many families have had to make do without some basic necessities – sometimes at the expense of their health.

Although a semblance of normalcy has returned to the country following the post-election violence that erupted after last Christmas, Kenyans can still use all the good news they can get.

So where matters of health are concerned, what could be more heartening in this festive season than news that Kenya is winning a major battle in the war against malaria?

According to recent research from the Ministry of Public Health, Kenya has been able to reduce the numbers of child deaths from malaria by 44 per cent, thanks to combined strategies in the fight against malaria employed over the last five years.

This resounding decline in child deaths, at a time when 80 per cent of the Kenyan population faces the malaria threat is no mean feat. Each day, malaria kills 92 Kenyan children, for a total of 34,000 deaths annually.

Decreasing Kenya’s estimated 34,000 childhood malaria deaths by 44 per cent equals 14,960 children who may get to see a new year dawn.

And officials give most of the credit for this reduction to one simple, low cost intervention: the Insecticide Treated Net, or ITN.

Dr Elizabeth Juma, programme director of the National Malaria Control Programme (NMCP), says four key districts accounted for the bulk of Kenya’s dramatic decrease in child malaria deaths: Bondo, Kwale, Makueni and Kisii.

“Data that has been collected over the last 20 years shows that between 2004 and 2006, the coverage with ITNs increased from 7 per cent to 67 per cent,” she says. Within this period, child deaths attributable to malaria also declined by 44 per cent.

She adds: “This puts forth a strong case for the increased use of ITNs; put in another way, for every 1000 nets we distribute, we can prevent 7 deaths.”

Over the past five years, the Government and other stakeholders such as the Population Services International (PSI) distributed three million treated nets annually to children and pregnant women in various parts of the country.

Nationwide, the number of children sleeping under a treated net increased from 5 per cent to 52 per cent during the same period.

Dr Juma suggests that these gains point to another possible milestone in the future. She predicts that Kenya could completely eliminate childhood malaria mortality by combining intervention strategies like the use of ITNs with education about why they should be used consistently.

Other interventions include indoor residual spraying, as well as providing access to diagnosis and appropriate treatment within 24 hours of onset fever.

She says many lives are lost because Kenyans adopt a ‘wait and see’ attitude when they fall ill instead of going to hospital immediately.

The most vulnerable population for malaria infection comprises children under five years of age and expectant mothers.

This is because the immune systems of young children are not fully developed, and pregnant women have compromised immune systems.

Unlike adults who may have developed malaria previously, children have little resistance. In regions where malaria is an epidemic, there is a high rate of child mortality attributable to the disease.

Kenya is divided into three major malaria epidemic zones: “There are endemic regions like Nyanza, Western and Coast provinces where malaria occurs all year round,” says Dr Juma.

“There are also regions where malaria is transmitted seasonally like the lowlands of Nyanza, Rift Valley, and some parts of Eastern and Central provinces after the rainy season, and the arid areas of North Rift, Eastern and North-Eastern provinces when it rains heavily.

“Then there are some areas where malaria has not yet been documented, as in a few areas of Central Province,” she says.

Burden of malaria

Dr Juma says the burden of malaria is felt most heavily in areas where the disease is transmitted all year round – more young children fall ill and die “It is also in these areas that the impact of interventions will be felt most,” she adds.

Malaria cases in Nairobi are unique because numbers are relatively high, yet it is not a malaria-prone region.

In fact, most mosquitoes in Nairobi do not carry malaria. Dr Ayub Manya, a medical epidemiologist at the Kenyatta National Hospital, says this is because Nairobi is a convergence point for many travellers from different regions across the country.

Some travellers import malaria from epidemic regions and when the mosquitoes bite these carriers of the parasite, the disease is easily transmitted when they move on to bite a healthy person who may be nearby.

Dr Daniel Nguku of the Nairobi City Council Public Health Department adds that recent climatic changes have created a favourable environment for mosquitoes to flourish, thus fuelling the higher incidence of malaria infection.

“Mosquito populations increase with a rise in temperatures (between 18 and 30 degrees Celcius). And this is not in Nairobi alone; many other parts of the country have been affected,” says Dr Nguku.

Interestingly, railway transport has contributed to incidences of malaria infection in Nairobi. Dr Manya says trains often carry mosquitoes from other parts of the country to Nairobi.

This has contributed to higher numbers of malaria cases in communities living next to railway lines. “Some time back I was involved in a study in communities living along the railway line in Kibera and the data confirmed these findings,” he says.

However, there is no need to fear that Nairobi could become a malaria region because its high altitude and cool climate are unfavourable for mosquitoes to reproduce quickly.

In addition, mosquitoes usually thrive in clean stagnant water, which Dr Manya explains is not abundantly available in Nairobi.

“Although the environment is relatively clean, most stagnant water contains sewerage waste in which mosquitoes can hardly survive,” he says.

There is hope that malaria is likely to be eradicated sooner rather than later, if the government and other key stakeholders involved in the big fight against the disease continue in the same stride.

“But before then, we have to move from control – where we reduce the transmission and illness to a certain level – to elimination.

“Only after a certain period of elimination can we be certified as malaria-free or as having eradicated malaria. We need to work towards this goal with our neighbours, as Kenya is not an island,” Dr Juma explains.

These gains in the fight against malaria have come not without challenges. Health officials say inadequate resources continue to cripple efforts in Kenya.

In August this year, the Assistant Minister for Public Health, Dr James Gesami, warned of a likely increase in malaria deaths if the Sh4 billion budget deficit allocated for the fight against malaria was not sealed.

Unfortunately, Kenya has just been locked out of the Global Fund due to allegations of unaccountability with regards to previous funding.

But Dr Juma says that amid these challenges, the positive gains are largely attributed to the Global Fund. Intervention strategies involved in malaria control are very expensive.

One ITN costs USD5 (Sh390) and on average, she says, each household needs about three nets. Spraying is also expensive, costing about Sh1,000 per house.

“Spraying in the highlands is done once a year, but in endemic areas, it is done twice a year,” she explains.

In terms of medication, Kenya needs about 1.2 million doses every month. This translates to 15 million doses a year at USD6 (Sh468) per dose.

“There are also other logistics involved such as transportation, storage and distribution. All these work towards making the intervention process more expensive, as they add to the total budget of the Ministry of Public Health, and that is only one disease. The donors have done a good thing,” Dr Juma says.

Another big challenge has been changing people’s behaviour and attitudes, especially regarding usage of ITNs.

“We can equip the public with the interventions against malaria, but we also need to continue educating Kenyans on their importance, especially why they need to make use of ITNs,” she says.

Still, compared to neighbouring Uganda and Tanzania, the malaria burden in Kenya is light. This is due to Kenya’s relatively smaller malaria endemic area.

“As a result, we have achieved more impact nationally with the little interventions done. However, our neighbours have also reported similar achievements.

“Zanzibar, for instance, is moving towards malaria elimination. The island has dramatically reduced malaria transmission to almost nil in the past five years using a combination of strategies since it is small and sparsely populated,” she says.

And it appears that more malaria breakthroughs are in store for East Africa. A new study released recently in the Malaria Journal states that majority of the people who are put on malaria treatment are not even suffering from the disease.

In the study, most of the people prescribed an expensive drug combination against malaria at Mto wa Mbu in Tanzania, an area considered as hyper-endemic with the disease, were in fact free of the parasite.

In Nairobi, Dr Willis Akwale, a senior official in the Ministry of Public Health, recently said that many people are dying of malaria because of wrong medication.

More information

Addressing this issue, Dr Manya says research is currently ongoing in Kilifi and Kisumu that would establish the effectiveness of malaria drugs and yield more information about fake or generic drugs.

In addition, the Government is working on ways to subsidise the cost of anti-malaria drugs to make them more available to a wider population.

In June this year, fake and ineffective mono-therapy drugs were uncovered in the local market, creating a major setback to the three-year-old national policy on malaria.

So what would be a good Christmas gift if you are looking to do your bit for society in this season of giving? Perhaps an ITN to help protect a child from being infected with malaria.

Treated nets cost about Sh600, but there are cheaper options retailing at about Sh350. Long-lasting ITNs last five years and should not be washed more than 21 times, and then only using bar soap.

“We recommend bar soap because it is mild. Detergents might compromise the effectiveness of the chemical used in treating the net,” says Dr Manya.

But there are non-long-lasting ITNs whose treatment has a shorter lifespan – about three years. “The material in these nets wears out within three years,” Dr Manya explains.

She adds that the long-lasting ITNs are made of polyester and factory-treated, whereas the cheaper non-long-lasting ITNs are retailed together with the chemical for domestic treatment.

There are plans by the Government to subsidise the cost of the long-lasting ITNs. “The Government is importing the nets in untreated form since they acquire the chemical for free.

“They then contract a company to treat them industrially. This would cut down the cost of the nets,” says Dr Manya.

Unlike Kenya, Tanzania is mass-producing ITNs, which have penetrated our local market. There are hopes that soon, long-lasting ITNs would be easily accessible to all Kenyans.