From Nei ching in 2700 BCE, considered by many to be the oldest, if not the first medical book to document and discuss malaria symptoms, to Hippocrates, who made the connection between nearness of stagnant bodies of water and occurrence of fever, to 1913 in Nairobi when over 14, 000 malaria cases were reported, malaria remains a global threat in the 21st century especially in sub-Saharan Africa and Kenya is not spared.
Parts of Kenya report up to 725 malaria cases per 1,000 people. This requires urgent attention.
As we commemorate world malaria day 2021 amid a global Covid-19 pandemic, a day we highlight the efforts to control malaria and celebrate the gains that have been made, it’s also a time to reflect on our failures and seek solutions.
This is because we still live at risk from this preventable, treatable disease that costs a child’s life every two minutes.
Malaria is considered a public health problem with a population of 31 million people at risk. Interventions towards its prevention such as distribution of bed nets and spraying of houses with insecticides have been scaled up. Treatment is provided for free in public hospitals.
However, in the last two years, our systems have been tested by the Covid-19 pandemic that found us unprepared. We all got scared and quickly ignored the immediate threats around us and it was all systems go against Covid-19. Hospitals were closed, and for the few that operated, patients feared visiting them.
For the patients who presented sick with fever, the most common symptom in a person with malaria and Covid, it was assumed to be coronavirus until proven otherwise. This led to stigma as patients feared going to hospitals for fear of being driven to isolation by the men and women in white gowns. As if this was not enough, healthcare workers went on strike affecting the delivery of essential services in the country.
The number of malaria cases treated in our health facilities reduced from five million in 2019 to four million in 2020. However, at the community level, the cases managed by community health volunteers increased almost three-fold from 138, 769 in 2019 to 361,569 in 2020. This according to data in the Kenya Health Information Systems. This demonstrates the need for a strong community health system in the fight against malaria during this challenging period and the future. Similar observations in the role of community health volunteers in complementing hospital-based services in the fight against malaria in developing countries such as Kenya have been observed in recent studies.
To effectively control malaria, there is a call to action for more robust community participation and engagement in health matters. Currently, management of malaria by community health volunteers stands at 32 per cent coverage in the 10 malaria high-risk counties in the Western and Nyanza regions. This is expected to grow to 68 per cent by 2024, against the recommended coverage of 100 per cent, through increased investments in recruiting and training new health volunteers by the government and development partners.
Secondly, investing in local capacity of the affected population by using the community health volunteers as agents of change will contribute to improved knowledge and understanding of malaria intervention strategies. It is likely to bring about positive effects to the health of the local population with the greatest chance to produce fast, effective, and sustainable results.
Finally, the current malaria interventions should be scaled up to ensure everyone, especially those living in the most remote areas of our country and are at risk of malaria receive services equitably and this can be achieved through having a paid, motivated and capacitated pool of community health workers, residing in this communities who can provide promotive, preventive and curative services.
With the pandemic and its impact on the delivery of malaria services, the government, healthcare workers, non-state health actors are urged to sustain efforts to prevent, detect, and treat malaria among populations at risk. This will ensure the response to Covid-19 does not undermine the provision of life-saving services, and the gains already made in the fight against malaria.
Dr Donald Apat is the programme manager, Global Fund Project at Amref Health Africa in Kenya; Dr Bernard Langat is programme director, HIV, TB, Malaria, and NCDs at Amref Health Africa in Kenya