Lesson 1: Malaria in Kenya

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Malaria remains a serious public health problem world wide, but more so in sub-Saharan Africa. The grim reality is that in this region malaria kills over 2 million people, including one million young children, every year. Most of the deaths occur in infants, young children and pregnant women.

In Kenya, malaria is the leading cause of morbidity and mortality. It accounts for 30 % of all outpatient attendance, 19% of admissions into the hospitals inpatient, and 30 % of all deaths in children under 5 years of age. The disease tends to be severe in children under five years of age and in pregnant women, especially the first pregnancy. Recurrent epidemics of malaria occur in certain parts of the country, such as highland areas of Kisii and Trans-Nzoia districts, (See fig 1 for distribution of malaria in Kenya). Altogether, besides killing many people, malaria contributes greatly to low economic development since work and school time is lost as a result of illness and malaria related health costs are high.

Figure 6.1. Endemicity of malaria in Kenya.

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Having learned about the malaria situation in Kenya as a whole, you should now assess the malaria situation in your catchment area. Do the following activity.

If you are at a health unit, get the outpatient register and calculate the percentages of the 5 top health problems. Do the same with the inpatient register if your health unit admits for inpatient care. Or, when you are at home talk to a few families to find out the number of people who have been sick in the past 2 weeks and from what diseases.

Now write the top five diseases in each category in the spaces provided in the table below:

OPD Attendance Inpatient Admission Inpatient Deaths
1 1 1
2 2 2
3 3 3
4 4 4
5 5 5

What percentage of families said they were sick with malaria?

You now know that malaria is the leading cause of illness and death in this country. This is because, in Kenya, there are many environmental and social factors that facilitate the transmission of malaria. These factors include the:

  • Presence of the Anopheles mosquito which transmits the malaria parasites
  • Favourable climatic conditions: temperature, rainfall and humidity.
  • Socio-economic/development activities: deforestation, swamp reclamation, brick-making, irrigation schemes, fishing and construction works. All these favour mosquito breeding.
  • Migration of people from one area to another.
  • A reservoir of malaria infection.
  • Susceptible non immune and partially immune hosts.

In addition, certain behaviours of individuals and the community contribute to maintain the high rates of the disease. These behaviours include:

  • Late treatment seeking behaviour.
  • Non-compliance with treatment schedule.
  • Misuse of antimalarials.
  • Little or no preventive measures being instituted by the individuals, community and government.

It is evident that human activity has created, and continues to create, more breeding sites for mosquitoes and yet little or no preventive activities are being carried out. The availability of many brands of antimalarials in the market promotes self-medication. This has greatly encouraged late treatment seeking behaviour as well as misuse of antimalarials by the community and health workers. The previously recommended antimalarials (chloroquine, sulphadoxine, pyrimethamine, and quinine) have been used unjustifiably and indiscriminately. The effect of these practices is the emergence of sulphadoxine-pyrimethamine and chloroquine resistant strains of Plasmodium falciparum.

The interventions employed in the prevention of malaria in Kenya are:

  • Early diagnosis and prompt correct treatment.
  • Vector control including use of personal protective items.
  • Health education.
  • Early detection and proper control of malaria epidemics in areas where they occur.