Malaria N° 9 - Subject N° 17

NATIONAL PROGRAMME AGAINST MALARIA, KENYAN EXPERIENCE
J.H. Ouma

SUMMARY
Malaria contributes the highest morbidity and mortality of all infectious diseases in Kenya accounting for 30% of out-patient illness; although its distribution is not uniform throughout the country Mortality among children is high, UNICEF estimates that about 25,000 children die of malaria each year, the actual number of deaths is unknown as most of them occur at home. It is estimated that unprotected children may have about two to five attacks of malaria and adult ten to twenty days disability, due to the disease per year. About half of untreated severe malaria cases are likely to die and only a minority of these cases present in hospitals; while almost 10% of survivors are left with varying degrees of mental impairment.

The predominant malaria species in Kenya is Plasmodium falciparum, accounting for at least 90% of malaria infections. The rest of the species include P. malariae, P. vivax and P. ovale. The principal malaria vectors are Anopheles gambia complex and Anopheles funestus. The distribution of malaria and its vectors follow rainfall pattern.

The malaria problem in Kenya can be summarised as follows:

• Approximately 20 Million people are exposed to stable malaria transmission, including 3.5 Million children aged below five years of which 26,000 die each year (72 children each day) from direct consequences of infection. Over 145,000 children will develop severe complications of the disease.
• Pregnant women, particularly primigravida and second gravid women living in stable malaria areas have increased risks of severe anaemia directly to malaria and a higher incidence of low-birth weight babies. Over 6,000 primigravida women develop severe, malaria-induced anaemia each year.
• Since the 1980's epidemic (unstable) malaria has been increasing in frequency and severity among densely populated and economically important areas of Kenya's Western Highlands. The 1997/98 El Nino rains led to devastating epidemics in the arid areas of N. E. Province. Approximately 8.5 Million Kenyans are at risk of epidemics.
• Kenya has been recognised as the epicentre for chloroquine resistance across the continent. Chloroquine is no longer effective in the management of up to over 60% of clinical episodes across the country and has been replaced as first line drug by sulphadoxine-pyrimethamine (SP) which itself already shows evidence of reduced sensitivity in several parts of the country.
• Tourist industry, our number one foreign exchange earner is suffering because of the malaria risk.

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