What counties can do to curtail malaria outbreaks

In the past 15 years, Kenya has made great strides in preventing and controlling malaria by issuing insecticide-treated bed nets, spraying homes with insecticides and through widespread diagnostic testing.

These efforts have resulted in a significant drop in transmission rates, but the progress has not been uniform.

OUTBREAKS

Counties in the west and along the Rift Valley are still plagued by serious seasonal cases of the deadly disease.

Outbreaks are common in the wet season running from March to June, then again from October to December.

In years with high rainfall, it also rains in January and February as has been the case this year. As a result, in February, the arid counties of Baringo, West Pokot and Marsabit experienced an outbreak and hundreds of people were hospitalised.

Most of the patients were children under the age of five. The outbreak followed a similar one in October last year where in less than a week, more than 400 people were hospitalised and at least 10 died of malaria.

In Baringo, malaria accounts for 12 per cent of outpatient cases, higher than the national prevalence of eight per cent.

CHALLENGES

What is preventing Baringo County from reducing its malaria caseload like other parts of the country? A number of factors are at play.

These include weak health systems in arid and semi-arid areas, where health facilities are sparsely distributed. On average, patients walk more than 15 kilometres to the nearest facility.

The facilities are also understaffed with inadequate medical equipment and insufficient anti-malarial drugs. The road networks are also poor.

To add salt to injury, ongoing community conflicts get in the way, as nurses regularly flee medical facilities, leaving nobody in charge.

The environment also poses a challenge because the number of mosquito larvae breeding sites increase in the wet months.

Herding, the main economic activity in Baringo, also contributes to higher rates of malaria, because the Anopheles arabiensis, one of the mosquitoes that spreads malaria in the region, feeds on humans as well as livestock.

Therefore, high livestock densities in an area where herders converge in communal grazing lands translate into more people being bitten.

In the dry season, the vector is sustained by permanent habitats like swamps and drainage canals from these swamps.

During the rainy season, the breeding sites increase when seasonal rivers and manmade habitats such as pan dams, concrete tanks, ditches and trenches get filled up with water.

SOLUTIONS

Living conditions are also a challenge. Most of the houses have thatched roofs and don’t have adequate screens on the doors and windows. This means that mosquitoes can enter easily.

Tackling these challenges requires the resources of both national and county governments.

Firstly, the national government needs to improve security so that medical staff aren’t forced to flee for their safety.

Secondly, the county governments need to provide adequate supplies of anti-malarials as well as enough diagnostic equipment.

They also need to increase their distribution of insecticide-treated bed nets to reach more than the 52 per cent of the population living in malaria risk zones that is currently covered.

They should also introduce targeted larvae control by filling up unnecessary ditches and trenches, draining stagnant water and applying larvicides in irrigation canals to reduce the vector population.

The governments should also boost public health education and awareness by encouraging pregnant women to take antimalarial drugs during pregnancy and encouraging more residents to sleep under insecticide treated nets as well as avoid unnecessary exposure to mosquito bites.

County governments should encourage residents to shift to concrete houses with sealable windows and deploy mobile clinics and ambulances to ferry patients from far-flung parts to health centres for treatment.

This piece first appeared in The Conversation