Kenyan communities fight back against malaria

Over the past two decades malaria has become a growing problem in the highlands of western Kenya. In the Gusii highlands, malaria is now responsible for 33 percent of deaths and more than 60 percent of deaths in children under five.

Prompt and appropriate responses to malaria are critical for its effective management. Delays can lead to costly complications and even death. A swift response with appropriate treatment depends on many factors including cost of treatment and recognition of the danger signs of malaria. Many people choose, at first, to treat themselves at home with antimalarial drugs, sometimes incorrectly, leading to delays in accessing appropriate treatment.

To tackle this problem a number of malaria intervention programmes are running in Gusii. A baseline survey by Merlin, an international NGO, showed that community members were less likely to mention malaria danger signs than in areas where malaria is endemic. In response, Merlin started a programme in Gusii to help local people recognise signs of malaria and decide whether these are dangerous. The programme also focused on antimalarials and malaria prevention, such as the use of bed nets.

An evaluation of the programme reveals it was effective:

• The proportion of people who correctly used sulfadoxine-pyrimethamine (SP) antimalarial drugs increased from 21 percent to 91 percent.
• The proportion of individuals using antipyretics to control fever increased from 31 percent during the baseline survey to under 48 percent. Correct use of antipyretics increased from 40 percent to 74 percent over the same period.
• Mothers reported that 80 percent of children were examined for malaria at the local health centre, compared to only 29 percent in the baseline survey.
• About 60 percent of the community recognised fever as a key sign of malaria (an increase from 55 percent reported during the baseline survey). However, it is important to note that in this area, there are other health conditions, such as typhoid fever, that mask the use of fever as a key sign for malaria. Gusii is unlike other areas where over-identification of fever and malaria is common.

These findings show that there is potential to enhance the capacity of communities and local health services to deal with changing malaria patterns. This can be achieved through providing customised information to communities, which is sensitive to local conditions. By helping communities to recognise and respond to malaria, the impact of the disease can be promptly and effectively managed.

However, with malaria parasites' growing resistance to many antimalarial drugs, the Kenyan government has shifted its policy to the more effective artemisinin combination therapy (ACT). The drawback is its high cost which is likely to discourage people from accessing appropriate treatment unless it is subsidised.

Isaac K. Nyamongo
Institute of African Studies, University of Nairobi, P.O. Box 30197, Nairobi, Kenya
inyamongo@uonbi.ac.ke

John Muturi
Merlin-Kisii, P.O. Box 44, Kisii, Kenya
kisii@merlin.org.uk

See also

'Health care switching behaviour of patients in a Kenyan rural community', Social Science and Medicine 54(3), pages 377-386, by Isaac K. Nyamongo, 2002

'Home case management for malaria: an ethnographic study of lay people's classification of drugs', Tropical Medicine and International Health 4(11), pages 736-743, by Isaac K. Nyamongo, 1999

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