Effects and control of highland malaria epidemic in Uasin Gishu District, Kenya

East Afr Med J. 1994 Jan;71(1):2-8.

Abstract

This report documents the effects of malaria epidemic and how it was controlled in one highland district of Kenya. The effects of the epidemic are presented in terms of mortality, morbidity and school absenteeism; information is from routine and verbal reports. Treatment with chloroquine, amodiaquine and sulphonamide pyrimethamine combinations, limited vector control, and health education were used to control the epidemic. Hospital mortality per month increased by 8.6 times during the epidemic while morbidity went up by 3.7 times. Of the 103 deaths attributed to malaria, 64 (62.1%) occurred in hospital and 39 (37.9%) at home. Most of the home deaths (92.3%), occurred in areas that border the malaria endemic Lake Victoria Basin. The rate of pupil absenteeism ranged from 17.6% to 54.4% in primary schools. The policy implications of the report are discussed.

PIP: In Kenya, a physician conducted a study during the May-June 1990 malaria epidemic in the highlands of Uasin Gishu district to find areas for improvement in the surveillance and control of malaria epidemics. Deaths attributed to all causes and malaria-specific deaths per month rose by 2.2 and 8.6 times, respectively, during the epidemic. Malaria proportionate deaths peaked at 75%. Case fatality rates were not different from those of the periods before and after the epidemic. Most malaria-related deaths (62.1%) occurred in Eldoret District Hospital. Most mortality cases (92.3%) were from near the Turbo Rural Demonstration Health Centre. There were 3.7 times the number of patients with a primary clinical diagnosis of malaria in the hospital at the peak of the epidemic than there generally are. The proportion of primary school pupils absent ranged from 17.6% at Davis School to 54.4% at Kapkwis School. Children in the lower classes had a higher absenteeism rate than those in the higher classes (35-40% vs. 10-23%). One hospital, 8 health centers, and 33 dispensaries provided malaria treatment (chloroquine, amodiaquine, or sulfonamide combinations). During the 1st 7 days, 8 mobile teams treated 13,820 patients. They had to refer only 39 severe malaria cases to the hospital. 72.8% of the 674 blood smears examined in the field were positive for malaria parasites. Larvicides and insecticides were applied to manholes, septic tanks, cesspits, pit latrines, gully traps, water closets, soak pits, drinking water, and indoors at a university, college, prisons, and secondary boarding schools. Health education messages were delivered through all clinic sessions, schools, Barazas, and radio. The intervention team covered the affected areas in 14 days. The additional cost of controlling the epidemic totaled 1,833,609 KSHS.

MeSH terms

  • Absenteeism
  • Adolescent
  • Adult
  • Altitude*
  • Ambulatory Care / statistics & numerical data
  • Antimalarials / therapeutic use
  • Child
  • Cost of Illness
  • Disease Outbreaks*
  • Health Education
  • Health Policy
  • Humans
  • Kenya / epidemiology
  • Malaria / epidemiology*
  • Malaria / prevention & control*
  • Mosquito Control
  • Patient Admission / statistics & numerical data
  • Population Surveillance*
  • Seasons
  • Students

Substances

  • Antimalarials