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‘Never-say-die’ disease that stalks children

Evelyn Makena @evemake_g

It took two hospital visits, several days of uncertainty and a couple of blood tests before doctors eventually figured out what was bothering Elvanas Wafula Baraza.  The three-year-and-10-month old baby boy had malaria, a disease his mother, Emma Wamalwa, dreaded the most.

“I panicked on receiving the diagnosis. Eight months earlier, Elvanas had been diagnosed with sickle-cell anaemia and doctors had warned that contracting malaria would deal a blow to his already compromised immune system,” she says.

Emma had taken her son to Kiambu District Hospital twice within a week in January this year when he developed a persistent fever. During the first visit, tests ruled out the possibility of malaria and instead Elavanas was treated for an infection, but the fever only got worse as other symptoms such as vomiting started to manifest. He tested positive for severe malaria the second time and was immediately admitted.

His health had started improving after receiving three-day malaria injectables and Emma was optimistic of taking him home in Thindigua, Kiambu, where the family resides. But just as he started his oral treatment on the fourth day, he succumbed.

For the past few months since his loss, Emma admits to not only being filled with immense grief, but also intense regrets. After losing her father-in-law in December last year, Emma had to travel with her two children to Bungoma, a malaria-prone region for the burial.  “There is this nagging feeling that had I not gone with my son to Bungoma, things would have been different,” she adds.

It’s not the first time Emma had to deal with severe cases of malaria in her children. Taking swift action when her firstborn child, now eight, developed a severe fever saved him. “He was only three then and had just returned home after spending one month in Bungoma. He quickly got treated,” she says.

Children at risk

Children aged five years and below are at the greatest risk of contracting malaria. In 2017, they accounted for 266,000 (61 per cent) of all malaria deaths worldwide, according to the 2018 World Malaria report by the World Health Organisation (WHO). The global health body warns that a child dies every two minutes from a preventable and curable disease.

Mosquito transmitting malaria.

“When a child develops severe malaria, it may lead to developmental challenges, so they do not fulfil their full potential,” says Melanie Renshaw, Roll Back Malaria Partnership, the global platform for coordinated action against malaria.

Other groups that are highly vulnerable to malaria are pregnant women, patients with HIV/Aids, mobile populations and travellers.

The burden of the disease in the country is not homogenous with areas in the Coast region and Lake Victoria bearing the highest risk of the disease. Bungoma is one of the counties under the Lake region that’s classified as a malaria endemic zone.

Renshaw says Kenya has realised significant success in fighting malaria through the stratification approach, which ensures that programmes rely on available data on prevalence and resources are targeted to the problem areas for maximum impact.

Dr Waqo Ejersa, the head of the National Malaria Control Programme under the Ministry of Health, says malaria has remained a disease of public health importance, but there have been improvements in the management.

“Prevalence is currently at eight per cent, a drop from 10 per cent in 2010, with the Lake Victoria region posting 27 per cent, a drop from 38 per cent in 2010.  We have also seen a drop from 63 cases per 1,000 persons in 2016 to 40 cases per 1,000 persons currently,” he said adding that the outpatient attendance also dropped from 30 per cent in 2013 to 15 per cent in 2018.

National interventions

Interventions by the ministry include the use of long-lasting insecticidal nets that last over three years and provided to pregnant women and babies aged one and below.  There has also been improvement in the malaria rapid diagnostic and microscopic tests.

The resistance to insecticides, particularly pyrehroids, used in treating mosquito nets, has posed a challenge. The resistance to anti-malarial drugs like chloroquine and sulphur-based drugs saw the country switch to artemisinin-based combination therapies that have lower resistance.

“WHO has done some work to show that the nets are still effective even when mosquitos are resistant to insecticides since they act as a physical barrier. The organisation and its partners are looking at how to introduce combination of two insecticides on nets to cope with resistance,”  Renshaw says.

Decline in funding

However, poor surveillance of malaria has slowed down the progress. “If we look at the malaria prevalence, almost 75 per cent of the country has less than two per cent malaria prevalence, which means that we can easily move the country to elimination and eradication of the disease,” says Jared Oule, project manager, Global Fund Malaria, Kenya.

Scaling up domestic investments on surveillance, experts say, is key to eliminating malaria in Kenya, which does not rank among the 10 high burden malaria countries.

Global Fund remains the largest single source of malaria funding globally and Kenya specifically. Between 2012 and 2017, Kenya received approximately Sh16.6 billion from Global Fund, but the figure has since declined to Sh6.4 billion for the 2018-2021 funding round and is likely to decline further.

The funding focuses on priority malaria control interventions including vector control, monitoring supervision and operations research and social behaviour change communications.

“We are in constant dialogue with our donors to sustain funding since withdrawing the funds abruptly may water down the gains made so far. Locally, we are doing a lot of domestic resource mobilisation even to the county levels,” says Oule.

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