MALARIA PREVENTION

Malaria Epidemic and its Prevention in Kenya

Malaria Epidemic and its Prevention in Kenya

Introduction

Human malaria parasites are transmitted by mosquitoes of the genus Anopheles and their geographic distribution is the result of a complex interaction of biogeography, including biotic (e.g. competition and dispersal) and abiotic factors (e.g. climate and topography) that can vary in both time and space.

Malaria is a leading cause of death in children under the age of five years in sub-Saharan Africa (Rowe et al, 2006). The Roll-Back Malaria (RBM) initiative is working to improve prevention efforts in affected countries, through insecticide treated nets (ITNs), indoor residual spraying (IRS) of pesticides, and intermittent preventive treatment (IPT) for pregnant women (WHO: World Malaria Report, 2005). RBM also focuses on intervention efforts via effective anti-malarial regimens like artemesinin- based combination therapy (ACT), pre-empting epidemics in epidemic-prone areas, and improving home management of the disease. Rapid, effective treatment response with ACT is currently the most effective treatment option in sub-Saharan Africa, considering the cur- rent state of anti-malarial drug resistance with chloroquine and sulphadoxine-pyrimethamine (Coleman et al, 2004), and artemether-lumefantrine is the now first-line treatment for malaria in Kenya (National Malaria Treatment Guidelines, 2006). Since many individuals in sub- Saharan Africa choose to treat malaria without visiting a medical facility, appropriate home management of malaria is vital to effective treatment of malaria.

A rapid treatment response is essential for effective home management. To this end, an understanding of treatment seeking behaviour enables communities and the formal health care system to design interventions that cater to a specific population (Lindblade et al, 2000). Unlike the inhabitants of areas of high endemicity, populations in highland East Africa are prone to large-scale malaria epidemics and generally lack protective immunity. All age groups are prone to severe malaria and death (Deressa, 2007). Despite the resulting high case fatality rates characteristic of epidemics, malaria treatment- seeking patterns in epidemic-prone areas of Africa are not well studied, particularly among adults. Limited information on treatment-seeking behaviour and antimalarial use hinders the evaluation and implementation of effective malaria prevention and treatment programmes [Yeung et al, 2005). Some research efforts have pinpointed the need to train drug retailers about appropriate dosages and drug regimens, thus increasing adherence to national recommendations in the community (Marsh et al, 2004).

Background

In sub-Saharan Africa, Plasmodium falciparum malaria is primarily transmitted by mosquito species belonging to the Anopheles gambiae and Anopheles funestus complexes (Coetzee et al, 2000, Coetzee et al, 2004, Gillies et al, 1968, Hay et al, 2005). The intensity of malaria transmission is heterogeneous across the continent, and influenced by mosquito species' compositions, vector competence, and underlying demographic and environmental factors (Kelly-Hope, McKenzie, 2009). High levels of transmission frequently occur where both An. gambiae sensu lato and An. funestus are present, as they tend to exploit different breeding habitats and peak at different times, thereby prolonging the transmission period. Generally, Anopheles gambiae s.l. is most abundant during the rainy season, and An. funestus is predominant at the end of the rains and beginning ...