Strides made but malaria still a primary disease in Kenya

In Catherine Okello’s home, frequent visits to the hospital due to malaria are now a thing of the past after two of her children were recently vaccinated. Catherine, a resident of Kisumu County says her children were initially frequent victims of the disease. “We used to spend a lot of time visiting hospitals as my children would always get sick of the mosquito disease, especially during rainy seasons, which created a good breeding ground for the insects,” she says.

So, when Community Health Volunteers (CHVs) visited their village to sensitise the community on the vaccine, she did not hesitate to go for it. Although only her twins who were below two years old at the time were to be vaccinated leaving out her six years old firstborn, she says the situation has never been better.  Akello, however, does not only credit her family’s relief from Malaria to just the vaccine, but also strictly adhering to prevention measures.  “It is difficult to have a young one sleep under a mosquito net during hot nights, which is characteristic with this region, but with the vaccine, their safety against malaria is guaranteed,” she says. Malaria has been a major problem in Africa with Kenya contributing to one per cent of the global malaria cases and three per cent of the deaths according to the World Malaria Report of 2020.

While the government declares a decline of malaria burden in Kenya in the last decade, data shows children are still vulnerable to the infection of the disease. Kenya National Bureau of Statistics 2021 report indicates 11,787 children were confirmed to have suffered from malaria in 2020 with the disease being among the second disease with the highest numbers of the patient suffering from it. However, with the introduction of the malaria vaccine in the Western and Nyanza region, tremendous changes in terms of confirmed cases have significantly declined.

Vaccine Success

 According to WHO, 2.3 million doses of the RTS,S vaccine have been administered in more than two years since the inception of the piloting project in three African countries including Kenya and more than 800,000 children of age between six months and two years have so far been inoculated.

In Kenya, 750,000 doses of vaccines have been administered with 275,000 Kenyan children receiving at least one of the four required doses while 45,000 are fully vaccinated. 

Dr Rose Jalang’o, the strategic information management and communication officer in the National Vaccine and Immunisation Programme at the Ministry of Health (MOH) says the reception of vaccines in the community has been beyond their expectations. 

She says, unlike other vaccines, which have faced a lot of resistance, the malaria vaccine has been the opposite with most parents embracing it. “With malaria, many parents have the experience of suffering from malaria, they are familiar with its pain. This might be one of the reasons they are not hesitant in accepting it unlike diseases they have no experience with,” she says. 

She also says the incorporation of the vaccine during the post-natal clinics makes sure the baby is vaccinated before attaining two years when most parents stop taking their children to clinics.

 And on the changes in terms of decline in malaria prevalence among the vaccine-targeted age group, Jalang’o says counties undertaking the piloting programme have recorded a remarkable decline of children being treated for malaria. 

She, however, attributes the decline to combined efforts of the jabs, usage of treated mosquito nets, as well as cleaning up of the environment, especially around areas likely to be mosquito breeding zones.

While the vaccine roll-out seems to be a success in the Western and Nyanza region, other counties prone to malaria are yet to be enrolled for the vaccine more than five months after WHO approved it for broader use.  The vaccine is currently being implemented in selected sub-counties of eight counties which initially had the burden of up to 20 per cent. The counties include, Kisumu, Kakamega, Vihiga, Bungoma, Busia, Homabay, Migori and Siaya.

But according to experts while the Western and Nyanza areas’ malaria are seasonal, the Coastal region is a malaria-endemic area because its transmission is intense throughout the year.

Dr Donald Apat, Programme Manager Global Fund Malaria Project, Amref Health Africa in Kenya says arid and semi-arid areas of northern and south-eastern parts of the country experience short periods of intense malaria transmission during the rainfall seasons hence referred to as seasonal transmission areas.

He says while cases in the vaccine-targeted areas are seemingly reducing, the numbers are increasing nationally, which is contrary to Kenya Malaria Strategy (KMS) 2019-2023 goal, which is to reduce malaria incidence and deaths by at least 75 per cent by 2023. 

The Kenya Malaria Indicator Survey (KMIS) of 2020, a survey conducted every three to five years to assess the coverage of key malaria interventions shows that nationally, the prevalence has reduced from eight per cent in 2015 to six per cent in 2020 while the mortality rate has declined from 2.2 per cent in 2018 to two per cent deaths per 100,000 population in 2020.

Dr Apat, however, says the incidence of malaria increased from 82 per 1,000 population in 2018, 96 in 2019, and then 85 per 1,000 population in 2020  “It is clear, in Kenya, the use or uptake of malaria interventions is low, and we are not meeting our objectives of increasing the utilisation of appropriate malaria interventions in Kenya to at least 80 per cent,” he says. 

He says while other counties await the inclusion in the malaria vaccine roll-out, communities should start taking responsibility by utilising these interventions optimally, such as the usage of treated mosquito nets, the uptake of prevention medicine provided for pregnant women and so on.  “Kenya also needs to sustain its provision of malaria services. Occasionally, facilities run out of malaria commodities, such as test kits and medicines, making it possible for patients to seek alternative forms of treatment,” he says.

Vaccine administering expansion

East African countries recently launched a cross border malaria drive to eliminate the disease under the banner of Great Lakes region and will prioritise working and supporting community-led initiatives. The strategy will also involve distributing of mosquito nets, and indoor residual spraying among other malaria control interventions.

The East African Community (EAC) contributes a significant portion of the global malaria burden. In 2017, the East African nations contributed to 24.7 per cent of all reported malaria cases in the world and 10 per cent of deaths.

Statistics from the Ministry of Health show Kenya has over the last decade been able to reduce the burden of malaria by at least 50 per cent from a prevalence rate of 11 per cent in 2010 to six per cent in 2020. This means that the efforts made to eradicate the disease are effective enough to ensure that the world has zero infections.

However, even with this positive progress against Malaria and Neglected tropical diseases (NTDs), their progress has stalled in recent years and even reversed in some countries due to a plateauing of funding, rapidly increasing population and widespread insecticide resistance alongside the recent Covid-19 pandemic. This has disrupted health programmes, including essential services and supply chains that have put further strain on the fight against malaria. “Malaria has afflicted humanity for millennia, but in the past 20 years, we have made huge gains, saving many lives. Those gains are now at risk. Without accelerated action, we are in danger of seeing an immediate resurgence of malaria, particularly in Africa. But we have the tools and the strategy to prevent that – and, with new tools, to start to dream of a malaria-free world,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General at the first ever joint malaria and NTDs summit with Heads of State hosted in Kigali.

  To attain a healthier and safer world that is free from malaria and NTDs requires new investments, strategic partnerships across different sectors data-driven and tailored use of current tools and increased investment in disease surveillance and early warning systems.

“In times of financial hardship, we smashed through the target set in London in 2018. The Kigali Summit featured commitments of over US$4.5 billion (Sh535.6 billion), including a crucial statement of intent and significant support towards the Global Fund to Fight HIV/Aids, Tuberculosis and Malaria with over US$2.2 billion (Sh262.3 billion) pledged by malaria-endemic countries. These commitments build huge momentum towards the Global Fund’s replenishment conference where we must reach out US$18 billion (Sh2.1 trillion) funding goal,” explains Lilies Njanga, CEO, Malaria No More -UK.

Multiple interventions

In 2000, the world began the fight against malaria and by 2006, it was acceptable to use Artemisinin combined therapy. Also, the distribution of nets for mothers and children under the age of five years began. “At that time, we also started using effective insecticides and in 2010, we had a Kenya Malaria Indicator survey where malaria cases were as high as 20 per cent and in 2015 the statistics reduced to eight per cent,” says Dr Omar Ahmeddin, Head of National Malaria Control Programme with MOH.

Accounting for over half of global funding to end malaria, a fully replenished Global Fund is projected to enable countries and partners to reduce malaria deaths by 62 per cent, treat 550 million malaria cases, and eliminate malaria from six more countries by 2026. In addition, it is supposed to unlock the potential of a Zero Malaria world, helping to strengthen equitable health systems and improve the lives and futures of millions of people. “In addition to the innovation of new tools, we must invest in the country’s health systems and programmes needed to ensure these tools and resources target the right people and right places, at the right time. The Global Fund plays a critical role in delivering life-saving malaria services where they are needed most,” said Dr Corine Karema, Interim CEO of the RBM Partnership to End Malaria.

Some of the current interventions in the fight to end Malaria and NTDs, include the development of two new malaria vaccines in development. This also, includes the RTS,S vaccine which received WHO recommendation in October 2021 for widespread use among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. “The results of the promising Phase 2B trails for the R21 malaria vaccine, developed by Oxford University, with previous efficacy ratings at over 77 per cent,” explains Lilies. 

Article first published on https://www.pd.co.ke/third-eye/health/strides-made-but-malaria-still-primary-disease-in-kenya-143348/