KENYA: Social awareness key to malaria control efforts

KILIFI

Amina Nyamawi returned her mosquito net to the health centre as word spread across Karimbo village in the Kilifi district of Kenya's Coast province that the nets were linked to evil spirits.

"The chief convinced me the net was safe so I took it again, but my baby and I went to Mombasa where my husband lives so that we could try the net together," said Amina Nyamawi. "Nothing happened," she added.

Hundreds of villagers in Karimbo handed back their nets in September and October 2006 as rumours spread that the nets made strange noises at night, possibly from spirits, said Edgar Mshelle, coordinator of the Kenya Red Cross Society’s (KRCS) campaign against malaria in Kilifi and Kaloleni districts.

According to McDonald Nyinge, a volunteer with KRCS, the need for a social awareness campaign before the insecticide-treated bed nets were distributed to families with children under the age of five and pregnant mothers had been overlooked.

"It was an oversight. It was assumed that people would not see mosquito nets as a novelty and that they knew how to use them. Most of the people were in fact using the nets for the first time in their lives,"  said Nyinge.

Unfounded rumours

He said the unfounded rumours had slowed down the campaign, but the community had generally accepted the use of mosquito nets as a disease-control measure. There were still pockets of resistance, with traditional healers being accused of spreading falsehoods against the use of nets because they feared that reducing malaria incidence meant fewer patients to prey on and less income, Nyinge said.
According to figures provided by KRCS, malaria incidence among children under the age of five and pregnant women has been on a downward trend since the free distribution by the ministry of health of bed nets in September 2006. Chonyi Division, which includes Karimbo village, for example, had 2,136 recorded cases of malaria when the campaign started compared with 1,319 in May 2007, a reduction attributable to increased use of the nets.

Malaria toll

An estimated 20 million of Kenya's 32 million people live in malaria-prone areas, according to the ministry of health. The disease is one of the leading causes of morbidity and mortality, particularly among children younger than five. It is responsible for 30 percent of outpatient hospital attendance and 19 percent of all admissions. Malaria claims 34,000 Kenyan children, most of them younger than five, annually.

The nets being distributed in Kilifi are only available free of charge to children under the age of five and pregnant women, but during severe flooding in May, demand for nets rose because stagnant water has provided an ideal breeding ground for mosquitoes in a malaria-endemic region.

"I have no young children, but that does not mean I am immune to malaria," said Langi Mwagambo, 68, complaining that he could not afford 50 shillings to buy a net from a government health facility. He said would have to choose between spending the money on a meal and buying a mosquito net. "Have the elderly been abandoned to die of malaria?" he wondered.

According to Nyinge, malaria incidence in Kilifi could be cut further if the government and aid donors provided funds for free general distribution of nets, saying poverty was preventing people from acquiring their own nets.

In 2006, Kenya undertook to encourage the widespread use of insecticide-treated mosquito nets and provide free treatment in hospitals.

The national campaign, targeting 24 malaria-prone districts, seeks to distribute 1.7 million nets, according to the health ministry. Malaria-endemic areas include the Rift Valley, Eastern, Central and Coast provinces.

Crop losses

The combined effect of the late onset of the March-May long rains, poor distribution and flooding is expected to lead to a poor harvest of maize, the staple food in the coastal region, meaning that people will be forced to spend their meagre resources on food, leaving them with little for anything else, including mosquito nets.

"It is obvious the crop has failed. People planted early, but the rains came late and crops withered," said George Nyale, an agriculture officer in the district. "When the rains came they were too heavy and many fields were flooded," he added.
Water contamination after the floods is another problem for people who depend on wells.

Philip Jira, a villager in Kikambala division of Kilifi, said his family risked both malaria and water-borne disease after the floods. "I am a casual labourer earning just enough for food and shelter. We need help in the form of mosquito nets and water-treatment chemicals," he said.