Kenya still faces a heavy malaria burden despite years of control efforts, with a new World Health Organisation report warning that millions remain exposed and funding remains far too thin to sustain the fight.
Released on Monday, November 20, 2018, the report says 34.86 million Kenyans — about 68 per cent of the population — are still at risk of contracting the disease. The WHO also put the country’s malaria cases at 7.96 million in 2017, a drop of 360,000 from the previous year.
That decline reflects progress, but the disease remains deeply entrenched in parts of the country. Kenya Malaria Indicator Survey data shows national prevalence at about eight per cent, down from 11 per cent in 2010. In Western Kenya, one of the hardest-hit regions, prevalence stands at 27 per cent, compared with 38 per cent in 2010.
Even with those gains, malaria is still a major public health problem. The Economic Survey 2018 lists it as the second biggest cause of illness in Kenya after respiratory diseases. Deaths rose by 9.7 per cent to 17,553 in 2017, with pregnant women and children under five among the most affected.
Funding remains one of the biggest obstacles. For years, malaria programmes have depended heavily on external support, and the WHO figures show that pattern continuing. The Global Fund was the largest contributor in 2017, putting in Sh6 billion, followed by USAid at Sh3.5 billion and the UK at Sh240 million. By contrast, the Kenyan government allocated only Sh100 million to the fight.
Roll Back Malaria research cited in the report says Kenya will need about $427,860,536, or Sh42.8 billion, between 2018 and 2020 to respond properly to the disease. The same body has estimated that malaria costs the country about $109 million, or Sh10.9 billion, every year. When productivity losses linked to malaria deaths are included, that figure rises to $250.7 million, or Sh25 billion.
The funding gap is not limited to the national level. As at April 2018, only Busia and Kwale counties had set aside specific budget lines for malaria control, with allocations of Sh10 million and Sh5 million respectively.
The WHO continues to recommend insecticide-treated bed nets, indoor residual spraying, destruction of breeding sites and environmental management such as draining stagnant water and filling depressions that collect water. It says treated nets can cut transmission by 50 per cent.
For pregnant women, doctors also prescribe monthly preventive doses to reduce the risk of complications. For patients already infected, the emphasis is on prompt diagnosis and treatment with recommended antimalarial drugs, including ACTs.
Ministry of Health data shows about 15 million insecticide-treated nets were distributed to residents in 23 malaria-prone counties. Indoor residual spraying reached 1.8 million people in Migori and Homa Bay counties, while the ministry planned to extend the exercise to Kisumu County in 2019.
Coverage, however, remains uneven. Five in 10 children under five and four in 10 pregnant women still do not sleep under treated mosquito nets, even though about 53 per cent of Kenyans do.
Mid-2018, the government brought in vector control experts from Cuba to support malaria control in endemic regions and stepped up the use of bio larvicides at breeding sites. Waqo Ejersa, head of the National Malaria Control Programme at the Ministry of Health, said earlier that Cuban doctors would oversee spraying of stagnant water bodies in eight counties around Lake Victoria, where malaria prevalence is high.
The Lake Victoria region has a prevalence rate of about 50 per cent, while parts of the coastal region stand at about 20 per cent. The government is also preparing to roll out a WHO-backed infant malaria vaccine, RTS,S, for children between six months and two years. Officials say the vaccine is expected to help reduce prevalence in endemic areas, including the Coast and Lake Victoria, to below 20 per cent.
The Health ministry says the mix of interventions offers communities more protection and should reduce the overall disease burden. Still, the ministry reports that only 69 per cent of health workers in public facilities have been trained on malaria diagnosis and treatment, while just 83 per cent of those institutions have first-line medicines in stock.
Those gaps, together with weak county financing and continued reliance on donors, show how far Kenya still has to go before malaria is brought under control.
