Malaria interventions coverage

I. Epidemiological background

Parasite (Plasmodium) types	The most common species is P. falciparum, accounting for 80% of all malaria infections. P. malariae and P. ovale account for 10% and 8%, respectively, while P. vivax is rarely seen.
Main vector (mosquito) types	The principal vectors of malaria parasites in Kenya are members of the Anopheles gambiae complex and An. funestus. The species of An. gambiae complex found in Kenya are An. gambiae s.s., An. arabiensis, which are usually predominant during and after the rains and An. merus, which is mainly restricted to the coastal strip. An. funestus exist in low densities throughout the year.
Total population	34,652,581 (2007)
Population at risk	24,256,807 (2007)
~ 70% of the Population lives in areas at risk of malaria
Pregnant women at risk of malaria	1,386,103 (2007)
Children under five at risk of malaria	3,555,495 (2007)
Estimated malaria episodes	8,200,000 (2007)
Number of households in 16 epidemic districts	1,521,774 (2007)
Number of reported clinical malaria / fever cases	3,592,313 (2006)
Child under 5 mortality (per 1000)	13.6 (2000)*
Infant mortality (per 1000)	78 (2005)*

* Source of the data: WHO statistics 2007

II. Current Policy and Strategy

Case management

In 2004, the Government of Kenya adopted the use of Artemisinin-based Combination Therapy (ACT) as first line treatment for uncomplicated malaria. Quinine is recommended for uncomplicated falciparum malaria in pregnancy and children below five kilograms. It is also the drug of choice for severe and complicated malaria. Parenteral artemether and artesunate are recommended for pre-referral treatment in peripheral health facilities. In addition, parasitological diagnosis (microscopy) starting at health centres in map categories 2- 4 with scaling up countrywide and similarly for RDTs, starting in map category 1 areas) is now required for all age groups above 5 years. The ACTs, having been newly introduced, are supported by the following services: development of diagnostic capacity through strengthened laboratory services to improve quality of care, establishing a pharmaco-vigilance system to ensure drug safety among clients, therapeutic efficacy testing to determine levels of sensitivity.

Prevention

Vector control by use of insecticides treated nets (ITNs) and indoor residual spraying Management of malaria and anaemia in pregnancy: Pregnant women living in malaria endemic areas should get at least 2 doses of IPT, Epidemic preparedness and response. This strategy involves predicting, containing epidemics, and establishing an early warning system for epidemics. IRS is carried out in highland malaria epidemic-prone areas. The strategy is to spray over 80% of the households in malaria epidemic-prone district to minimise transmission. The IRS strategy is currently being implemented in these 16 malaria epidemic-prone districts.

Information, Education and Communication

Links to international initiatives Abuja declaration Roll Back Malaria Partnership Millennium Development Goals

III. Primary interventions: Outcomes and impact

[+] Anti-malaria drug avalaibility and use

Source: The evidence - base on milestone achievements of the Kenyan National Malaria Strategy and RBM Abuja declaration 2001-2006 DOMC & WT April 2007)

[+] ITN Coverage in Kenya 2002-2006

Source: MoH post campaign Survey Oct 06

ITN Use by household (Wealth Quintile)

Source: MICS 2000, DHS 2003

IV. Challenges and Priority support needs (2008 - 2010)

Challenges Poor Documentation (M&E) at all levels; process, outcome and impact Poor Reporting and accounting of funds particularly at the periphery Can we Sustain our achievements? Dependency on donor funding is a big challenge Timely implementation of planned activities Business plan is foundation of malaria control programme but takes 'time' to institutionalize Sustainable & adequate financing requires maintenance of effective partnerships Coordinated Technical support from WHO is invaluable: e.g. coordination, BCC, logistics, policy, leverage more funds (TA) Strong government leadership - context matters National steering committees for lobbying and good political will

Support needs (TA and Finance) Documentation (M&E) at all levels; process, outcome and impact- support needed Support in resolving Global fund round 2 Support in round 8 proposal Support in community based fever management Improvement of diagnostics To fill gap left for failure of round 7

V. Key RBM Partners in Kenya

• The National government
• WHO
• DFID
• UNICEF
• The Global Fund
• World Bank Booster Program
• US agencies: PMI, USAID(MSH), CDC
• PSI
• Red Cross
• Private companies
• NGOs
• Research and academic institutions

Source: NMCP Kenya

For questions, contact Ms Nadia Lasri, RBM Partnership facilitation
Dr James Banda, RBM Partnership facilitation Coordinator,
Dr Willis Akwale, National Malaria Control Programme Manager

RESOURCES & LINKS:

National Malaria Strategy 2001-2010

Division of Malaria Control, Ministry of Health, Kenya
Kenya Malaria Information Service (KMIS)
East African Network for Monitoring Antimalarial Treatment (EANMAT)

Surveys:
MICS 2000
DHS 2005

Malaria treatment protocols:
WHO Global AMDP database

Malaria contry profiles
PMI
World Malaria report 2005
WHO/AFRO

Online publications:
PubMed

Maps:
MARA/ARMA Kenya maps