Malaria deaths: When a health system betrays you

In the hilly, rugged terrain of Tiaty in Baringo County lies a small village cut off from modernity, hundreds of kilometres away from life as we know it. For villagers, small manyattas supported by sticks and sheds put up around thorny trees are what they call home.
During the day, in the sweltering heat, these hurriedly put up structures act as resting areas for the elderly. At night, they become ‘bedrooms’. Animal hides provide the comfort of a mattress. The men use ngechar (Pokot for small stool) as a pillow.
Without a way to hang a mosquito net at night, their only weapon against deadly malaria is, hopefully, their immunity. The lucky few who can afford the nets tie them on trees.
This is Gulel village where access to medical care is a nightmare. Its neighbour Kongor made the headlines last month after malaria killed eight people. Here, if you fall sick, you will have to brave a 100-kilometre journey to nearest hospital. There is no operational hospital in the vast Akoret division.
A poor mobile network and dilapidated, steep roads worsen the situation. The occasional motorcycle is a villager’s only chance of making it to the hospital. And it’s not cheap. One has to part with Sh6,500 as fare to seek treatment or die on the walk to hospital. It took the HealthyNation team about five hours to travel from the village to Chemolingot Sub-County Hospital.

DEADLY OUTBREAK
Malaria, a disease that should not be killing people due to the efforts that have gone into prevention and treatment, has found an easy target in the residents. For the last three years, outbreaks have claimed lives and left hundreds in hospitals.
Chebokisera Akorie, a mother of nine, has lived to tell the story, but not did not come out unscathed.
In 2017, when the disease killed more than 20 women and children, her eight-year-old son was among them. This year, in August, she lost her 11-year-old daughter to the illness. She recalls last month’s incident as if it happened yesterday. She left for the market only to come back and find her daughter with a high fever. She gave the girl the only medication she had in her house.
Asked what kind of drugs they were, Chebokisera tells HealthyNation she does not know. “All I know is that any drug can bring down a fever. My husband and I can’t read. Whatever medication we have is what we give,” she admits.
However, medicine and going to hospital are usually the last option. Chebokisera says whenever someone falls sick, there has to be a sacrifice to “rebuke the disease”. They slaughter a goat and smear the blood on the sick person. For good measure, residents tie a piece of goat skin around their wrists to “protect them from the bad omen”.
She lost her child on their way to hospital.

Chebokisera had not used a mosquito net for 10 years until last month when Baringo County health officials supplied them to the region after the outbreak. “I have seven children, but they only gave me one net. I share it with my lastborn. The rest just have to brave the mosquito bites at night,” she says.
And even then, the net cannot sufficiently cover them as she does not have a proper place to hang it. She hangs it on sticks and places stones on the net’s loose ends to seal the opening.

CULTURAL RITUALS
Our journey takes us to Kongor, a four-hour drive from Gulel, still within Tiaty.
An elderly man of about 70 says he lost a four-year-old son to malaria. He sits under a tree, where the family sleeps at night. “It’s only after the death of my son that I was given a net, which I still don’t know how to use. I can’t tie it onto a tree as the branches are far apart,” says Chepkoikat Akadasi, his wife.
The only time she makes a shelter using leaves, is when it rains. The area can go for years without rain.
The four-year-old had been left in his father’s care when his temperatures shot up and he started vomiting. After the cultural rituals, he got worse. He died on the way to hospital. “We expected it. He was very weak. I feel like the government has neglected us. We’ve been left on our own to die,” she says.
The situation of the two families paints a picture of a failing health system. There seems to be a cycle. A malaria outbreak occurs, health officials rush to the affected areas, distribute nets and before you know it, they have left. Things quickly go back to normal until another outbreak.
In Baringo, malaria accounts for 12 per cent of outpatient cases, higher than the national prevalence of eight per cent, according to the Health ministry.

REACHED PLATEAU PHASE
What prevents Baringo from reducing malaria cases like other parts of the country?
Dr Simon Kariuki, chief research officer at Kenya Medical Research Institute’s Centre for Global Health Research in Kisumu, says there is an upsurge of cases in places that were previously not malaria zones. He attributes this to changes in climate and a population that lacks natural immunity to the disease.
He is also concerned that counties which once enjoyed rapid declines have now stagnated. “In western Kenya, we reduced the cases from 80 to 40 per cent. However, for the last six years, the rate of decline has stagnated. This means the mechanisms we are using — the bed nets, antimalarials and insecticides — are no longer as strong as they used to be,” he says.
Asked why there is no hospital in the area, Baringo County’s Health minister Mary Panga says they can’t construct one due to the nomadic nature of the residents. “Even if we put up a facility, it will not help them. Our focus now is to establish mobile clinics in the far-flung areas,” she tells HealthyNation at her office in Kabarnet.
According to the ministry, 1,242 malaria cases were reported in Tiaty East and East Pokot sub-counties of Baringo County. Eight deaths were reported.

VACCINE LAUNCH
The county says it has distributed more than 13,000 insecticide-treated mosquito nets to the affected families. Among the worst affected areas are Gulel, Atirir, Chesawach, Kongor, Tayier, Kaghat, Chesotim, Lokis, Kapau, Kreze, Ng'aina, Tiaty, Kabarnet, Baringo North, Baringo South and Akoret.
But, she says the county government did not set aside funding because malaria is being managed by the national government. “Malarial drugs are being funded by a global fund which is being managed by the national government. We get the drugs and nets from the Kenya Medical Supplies Authority,” she says.
She, however, wonders why Baringo County has not been considered in the pilot for the recently launched malaria vaccine, saying a petition on this is underway.
Last week, Kenya became the third country after Malawi and Ghana to start the routine vaccination of infants against malaria using the world's first vaccine to combat a disease that kills 800 children globally every day.
The vaccine, RTS,S, targets the deadliest and most common form of the malaria parasite in Africa, where children under five account for two-thirds of all global deaths from the disease.
The vaccine will be given in phases across malaria-endemic parts of western Kenya near Lake Victoria. The Health ministry said 120,000 children were expected to be vaccinated under the pilot programme.
The disease kills more than 400,000 people around the world every year. Of these, about 290,000 are under five, most are in Africa, where more than 90 per cent of the world's malaria cases and deaths occur. In Kenya, up to 27 per cent of children under five have been infected with the disease.
As the war on malaria continues, Kenya has made strides in reducing the death rate among children and women through prevention and treatment. The ministry has so far distributed 30 million nets to areas with a high prevalence. It has also pumped Sh200 million into indoor spraying of homes to prevent the risk of infection.

GLOBAL GRANT
According to a Global Fund report released in November last year, Kenya is one of the organisation’s ‘high impact’ countries with active signed grants of $384 million (about Sh38 billion) from January 2018 to June 2021 in its efforts to eradicate malaria, HIV and tuberculosis.
The audit conducted between January 2016 and December 2017 to establish whether Global Fund grants are adequate and effective revealed approximately 14.9 million mosquito nets were distributed between 2017 and 2018. The country achieved a 47 per cent reduction in malaria incidence between 2015 and 2017.
With the Sh38 billion, the country committed an additional Sh13 billion to investments in these deadly diseases.
Dr Kariuki acknowledges that new treatments and mechanisms to fight the disease are needed more urgently than ever, and they are using genetic and chemical tools targeting the malaria parasite.
Already, he says, new drugs and vaccines are being tested on patients. Among them are two new drugs under trial: KAF 156 and Ivermectin, an old drug discovered in the 1980s and used to kill parasitic worms responsible for river blindness and elephantiasis.
A clinical trial in Kisumu suggests that unlike existing drugs that target the parasite to reduce the spread of malaria, Ivermectin can be used to kill mosquitoes.
“Already, we have found that one tablet of Ivermectin can kill mosquitoes for up to seven days. If we increase the dosage to one-and-a-half tablets or three, the drug’s killing effect goes up to 28 days,” says Dr Kariuki.
Also in Kisumu County are trials of a new antimalarial drug developed by Swiss pharmaceutical company Novartis, alongside Medicines for Malaria Venture. The medicine, known as KAF156, targets drug-resistant malaria and will be trialled in eight other countries in Africa and Asia.