NAIROBI, KENYA – Tracy Anyango, 4, recites her ABCs as she nibbles on potato crisps. She coughs occasionally, but covers her mouth at her mother’s instruction. Her runny nose attracts flies and she swats them away.
When Tracy told her mother, Jane Makokha, that she felt sick and did not want to go to school, Makokha says she thought her daughter was looking for an excuse to stay with her at home. But soon, Tracy began to vomit and complained of a headache. Makokha says she went to the local pharmacy in search of painkillers and antibiotics but nothing seemed to work.
Makokha took her daughter to the nearest health clinic for some tests, but they were inconclusive. “Several tests were done after some days, but bore no relief,” she says. “In fact, Tracy’s condition worsened because the medical staff missed the vital signs. It took me two weeks to discover that it was malaria.” When malaria is not treated immediately after onset it can progress and in Kenya, it often becomes fatal. Malaria symptoms -- fever, chills, headache and vomiting – typically appear seven days or more after the infected mosquito bite occurs. The World Health Organization, WHO, reports that malaria symptoms are often difficult to recognize in that they mirror symptoms of other common illnesses.
Despite Kenya’s metropolitan capital and stable international reputation, malaria remains the number one cause of death for children under five here, according to statistics from the Ministry of Health in Nairobi.
Globally, malaria impacts 247 million people, 212 million in Africa alone. According to the Global Malaria Action Plan, Kenya is among the top five countries affected by malaria, with 11.3 million cases reported in 2008. In response, a national strategy has been put into place to combat the disease, measures include increased distribution of mosquito nets and repellents. But efforts to create an affordable, effective vaccine have made little progress here. Despite a strategic plan on the national level, many say that on-the-ground implementation remains weak as a result of politics and bureaucratic waste. In 2007, political bickering resulted in the division of the Ministry of Health into two separate entities, resulting in increased costs and ineffective service delivery. The split even prevented Kenya from receiving funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria this year.
International Strategy Focuses on Prevention
Dr. Elizabeth Juma, head of the Division of Malaria Control, DOMC, says malaria is both preventable and curable. Despite the high death tolls, especially among children, Juma insists that Kenya is making progress in fighting the disease. She does, however, admit that malaria poses “an enormous health and economic burden in Kenya.”
In response, Juma created the Kenya National Malaria Strategy, which utilizes local and international resources in hopes of reducing two thirds of malaria-related deaths by 2017.
“The new National Malaria Strategy has been developed and invests in four core interventions,” Juma says. The strategy focuses on vector control, prompt and effective treatment, malaria prevention during pregnancy, and epidemic preparedness and response. International advocates are also creating social mobilization and communication programs to strengthen community awareness.
Reducing the impact of malaria would significantly advance Kenya’s efforts to achieve the Millennium Development Goals, agreed upon by every United Nations member state.
More han 10 of Africa’s most endemic countries –including Nigeria and the Democratic Republic of Congo– have implemented similar strategies and are reporting steep declines in new reported cases and a decline of more than 50 percent in malaria-related child deaths.
On the ground, prevention efforts here are focused on distribution of mosquito nets and repellents. Sarah Namalwa, a staff member in the paediatric ward at Busia District Hospital, says using nets and repellents are the best ways to prevent malaria transmission among children. Namalwa says she would like to see the national strategy employ other mosquito-control measures, including spraying insecticides inside homes and draining standing water in areas where mosquitoes lay their eggs.
What is missing, however, is an affordable, effective vaccine. Though Juma says many are in development, Kenyans do not yet have access to a malaria vaccine that provides a high-level of protection over a long period of time. A new study released this month, revealed new results in “needle-free” vaccines, or the use of preventative antibiotics that have yielded vaccine-like results in creating immunity to malaria.
The study, published in the journal Science Translation Medicine, revealed that a preventive treatment for malaria is possible with affordable, safe antibiotics that could yield strong results for people living in areas with “intense malaria transmission.”
The research, conducted by a multinational team of researchers from the Heidelberg University School of Medicine and the Max Planck Institute for Infection Biology in Germany, and the London School of Tropical Medicine and Hygiene, in conjunction with the KEMRI-Welcome Trust Research Program in Kenya, found that healthy mice infected with malaria parasites faired well with doses of preventative antibiotics. The mice developed a vaccine-like immunity against re-infection.
Dr. Steffen Borrman, co-author of the research, says, “An important follow-up of this work is the validation of our experimental approach by clinical trials in humans.” Borrman says they hope to test the preventive antibiotics in young children soon.
Political Bickering Decreased Quality of Care
Still, the reality of implementing Juma’s strategy has yet to be realized here.
Makokha says that if her sister had not insisted she take Tracy to a private hospital in Nairobi, her daughter would have died. Though the public health clinic nearby their home offers free malaria treatment for children under five, Makokha says the doctors misdiagnosed Tracy. “Services offered at most government health facilities remain quite basic, I presume because the budget has been slashed into two,” Makokha says.
After the contested election of 2007, the government announced that the Ministry of Health had been split into two separate entities. Initially, Kenyans were told the change would make services more accessible and the split was welcomed. Three years later, the split has resulted in duplicate bureaucratic expenses that have increased costs and weakened service delivery throughout Kenya. According to Namalwa, it has placed a huge burden on local medical staff and created additional costs for patients in thousands of rural communities across Africa.
“Money that should have been used to improve services is instead being used to maintain a parallel bureaucracy whose net effect is just to enrich individuals and massage the elephantine egos of ministers and their sidekicks,” Namalwa says.
Indeed, a visit to any of the offices in the ministry of Health will today find two heads, one representing the ministry of Medical Services and the other representing the Public Health and Sanitation Ministry.
In February, the Global Fund to Fights AIDS, Tuberculosis and Malaria, a worldwide public/private partnership that distributes aid and funds, denied Kenya’s application for $270 million on the ground that the two ministries headed by Professor Anyang’ Nyong’o, in Medical Services, and Beth Mugo, in Public Health, presented budgets that showed a clear overlap of roles and indicating that much of the requested money would be used bureaucratically. Kenya has appealed the decision.
Since its was created in 2002, the Global Fund has become the dominant financier of programs to fight malaria worldwide.
