Research on Malaria in Moyale District

Malaria originates from Medieval Italian Mala aria which mean “bad air”; and the disease was formerly called Ague or Marsh fever due to its association with swamps and marshland, (Watkins, 2001). Scientific studies on Malaria made their first significant advance in 1880, when Charles Louis Alphonse Laveran a French army doctor working in the military hospital of Constantine in Algeria observed malaria plasmodium parasites inside the red blood cell of people suffering from Malaria.

Documentation of report on discovery of origin of Malaria, one of the deadliest diseases of humanity shows that Chimpanzees, native to equatorial Africa have been identified as the original source of the parasite that likely moved from them to humans via mosquitoes. Wolfe, (2009) identified several parasites from Chimpanzee that show Malarial jumped from animal to human. Malaria is transmitted by Anopheline mosquitoes the number and type of which determine the extent of transmission in a given area. The plasmodium falciparum accounts for the majority of infections and is most lethal.

Transmission is affected by climate and geography and often coincides with the rainy season. In WHO/UNICEF, (2005) report malaria is one of the most devastating global public health problems with more than one million deaths and approximately 300-500 million cases of malaria annually. WHO, (2010) report, Malaria is by far the world’s worse tropical parasitic disease, and kills more people than any other communicable disease. Several studies observed that malaria kills more than 3,000 children daily and is the single most important factor for mortality among children under the age of five.

Additionally, an estimated 25 million pregnant women are at risk of malaria. Malaria is endemic in a total of 101 countries and territories 45 countries in WHO’s African region, 21 in WHO’s American region, 4 in WHO’s European region, 14 in WHO’s Eastern Mediterrarian Region, 8 In WHO’s South – East Asia region, and 9 in WHO’s Western Pacific region, (report from global health council on impact of infectious diseases. ) WHO, (2007) report has shown that malaria has reached epidemic proportions in many regions of the world and continues to spread unchecked.

In many regions of developing countries malaria exacts an enormous toll in lives, medical costs, and in days of labor lost. According to Roll-Back Malaria (RBM), over 40 per cent of the World’s children live in malaria-endemic countries and 107 countries and territories are at risk of malaria transmission. Malaria causes 24 percent of under-five deaths in Equatorial Guinea (UNICEF 2008). Malaria is preventable, if adequate resources are invested in prevention. About 98 percent of Equatorial Guineans live in areas with endemic risk of malaria but only one percent of children under five sleeps under insecticide-treated nets.

This is far fewer than in other Countries with similar malaria risk. This suggests inadequate efforts to prevent malaria that would contribute to the realization of the right to health of both children and adults. Children under the age of five, pregnant women, and people living with HIV and AIDS are at highest risk for developing clinical malaria. More than 80 per cent of these cases occur in sub-Saharan Africa. WHO/RBM, (2004). Malaria is a primary cause of poverty, putting additional burdens on health systems and costing Africa an estimated 12 billion USDs in lost production every year.

The spread of the disease is fuelled by several factors: climate change, increasing population mobility, more frequent international transport, emergence of multi drug-resistant strains, and military and economic deterioration. Abuja summit in Nigeria in the year 2000, 44 African leaders reaffirmed their commitment to roll back malaria and set interim target for Africa. They challenged other world leaders to join them in recognizing the importance of tackling malaria as a disease of poverty.

Following the Abuja summit, Africa Malaria Day was declared as a day to celebrate on malaria and a subsequent UN resolution declared 2001-2010. Roll Back Malaria, especially in Africa, giving prominence to Malaria in United Nations Millennium Development Goals. The Africa Malaria report, released in the year 2003/Nairobi/Geneva/New York by the World Health Organization (WHO 2005), and the United Nations Children’s Fund (UNICEF), said the death toll from malaria remains outrageously high-with a child dying in every 30 seconds.

The report gives an African situation for the struggle against the diseases and highlights the urgent need to make effective anti-malarial treatment available to most at risk. “The roll back Malaria initiatives has made considerable progress since it was launched in 1998, but we need to increase to combat a devastating disease which is holding back the development of many African countries,” states Dr Gro Harlem Brundtland, Director-General of WHO. Nationally Malaria has been a serious public health problem in most Districts of Kenya and the leading cause of morbidity and mortality in Kenya.

With more than 70% of the Kenya’s population living in areas where malaria is transmitted, Malaria is responsible for approximately 30% of out-patient visits (requiring more than eight million out-patient treatments each year), and 19% of all hospital admissions. At least 14,000 children are hospitalized annually for malaria, and there are an estimated 34,000 deaths among children under-five each year. Annually, an estimated six thousand pregnant women suffer from malaria-associated anemia, and four thousand babies are born with low birth weight as a result of maternal anemia, report from government health facility in 2007.

Economically, it is estimated that 170 million working days are lost each year because of malaria illness. Culture and poor access to health facilities lead to increase in cases of malaria. The main thing peculiar with children under 5 years is that many cannot sleep under net due to incapability of their parent especially in rural areas, because of the few wages they hardly get from their casual work. Most children again play outside in the grasses or near drainage where mosquito’s breeds thus are exposed to mosquito bites.

In local situation Malaria is the highest causes death of many people in the region of Moyale and districts of North Eastern province bordering Moyale district from east. Malaria claims the life of 1,500 in the year 1998 and out of that 45 death in Wajir district (Daily Nation, Thursday, February 1998). Sololo Mission Hospital reported the admission of 67 people. Out of 67people, 25 children of less than five years were reported cases of malaria (SMH/1999). 1. 2 problem articulation/ statement: Malaria is World’s most important parasite infectious disease.

Over 2 billion people are at risk between 300 and 500 million episodes and over 1 million deaths annually, WHO, (2005). Over 90% of malaria burden are in sub-Saharan Africa. Malaria is one of the planets deadliest diseases and one of the leading causes of sickness and death in the developing world. Documentation also show that Malaria affect child cognitive, physical development and leads to poor school attendance. Malaria also leads to malnutrition and anemic condition in children. More so it also affects adult’s ability to make a living and care for their families.

At country level malaria affects trade, tourism and foreign direct investment and there is significant correlation between malaria and poverty. An average GDP in malaria’s countries is five times lower than in non-malaria’s countries 1. 3 Objectives of the study To establish factors that lead to high prevalence of Malaria in children under five years in Obbu Division, Moyale District. 1. 4 Specific objectives: 1. To determine socio-demographic factors contributing to Malaria prevalence among the under five children in Obbu division. 2. To establish the level of knowledge on Malaria, among caregivers of children under five in Obbu Division. .

Research questions 1. What are the main factors contributing to high prevalence of Malaria among the under five children in Obbu division? 2. What is the knowledge level of care givers of children under five years about the risk factors of late treatment and prevention of Malaria? 3. To what extent the level of knowledge on Malaria, among caregivers of children under five in Obbu Division? 1. 6. Hypothesis/assumption There were no factors that contribute to prevalence of malaria in children less than five years in Obbu Division of Solol District 1. 7 Justification of the study.

Malaria outbreak in mid July 2012, number of cases diagnosed were 82, and 8 out of 10 reported death were children under five (Malaria/SMH/ 20012/3). The prevalence was precipitated by illiteracy, migration lifestyle of pastoralists’ community and uncontrolled border intermingling and refugees from neighboring countries like Ethiopia and Somali as revealed by the study of Diseases Outbreak Management Unit-DOMU (2002). Socio demographic factors and knowledge about the diseases control and prevention attracted a lot of concern that call for research in these factors.

Obbu division has few documentation of the study, so this will be helpful to academia as it will be used as document of references for a researcher in the same area of study. The government or other stakeholders will benefit from the findings and may take intervention measures for instance the Ministry of public health to educate people on the better prevention methods. The findings of the study will be used by people of the study area to plan for the prevention of the malaria, since it is preventable at every household. 1. 8 Scope of the study

To investigate main factors contributing to high prevalence of Malaria among children less than five years of age in Obbu division of Moyale district. . 1. 9 Limitations 1. Data collection during interview was difficult due to migration of the population but the settlement around the centre of each four location was targeted. 2. Cost of getting trained research assistant was challenging. 3. The study was limited to factors contributing to prevalence of malaria in children less than five years of age. 2. 0 CHAPTER TWO: LITERATURE REVIEW 2. 1. 0 Origin of malaria.

The history of malaria replete with a number of theories about its aetiology, the earliest theory was the Miasmatic. This theory postulated that swamp air contained chemicals which had been freed from rotting wood. This air was what was responsible for causing malaria (Ransford 1983). It was because of this theory that double storey buildings were preferred during the early days of the colonial period as it was believed that miasma did not rise above ground level (Ransford 1983) and that the miasma was thought to spread horizontally (King and King 1992).

Ransford and Friedson claim that Africans were the ones who first recognized the link between mosquitoes and malaria (Ransford 1983; Friedson 1996) and in the West it was only known later through the pioneering works of Patrick Mason, Ronald Ross, Grassi and others around the 1890s. 2. 1. 1 Prevalence of Malaria. There are 300-500 million clinical cases of Malaria each year resulting in 1. 5 to 2. 7 million deaths (WHO, 2005).

Global viral forecasting initiative and standard university, made the discovery published in the Aug. 2009 proceedings of the National academy of sciences Wolfe, (2009). Malaria in most countries of Western Pacific and Regional Organizations has significantly declined in the period 1992 to 2000. There is widespread consensus that the change to Artemisinin Based Combination (ACT) in Vietnam was a significant factor in the 98% drop in malaria mortality between 1992 and 2002. The geographical area affected by malaria has shrunk considerably over the past 50 years, but control is becoming more difficult and gains are being eroded.

Increased risk of the disease is linked with changes in land use linked to activities like road building, mining, logging and Agricultural and irrigation projects, particularly in “frontier” areas like the rain forests. Other causes of its spread include global climatic change, disintegration of health services, armed conflicts and mass movements of refugees. According to citation from the August 97 issue of the American magazine the Atlantic Monthly entitled “Resurgence of a Deadly Disease” by Ellen Rippel Shell.

Early success in controlling infectious diseases has bred arrogance and a belief in whopping big solutions. The emergence of multi-drug resistant strains of parasite is also exacerbating the situation. Via the explosion of easy international travel, imported cases of malaria are now more frequently registered in developed countries. Malaria is now re-emerging in areas where it was previously under control or eradicated for instance, in the central Asian and in Korea. Late 1980s, it was noted at several international meetings that the malaria situation getting worse. Figure1. PHOTO OF MOSQUITO THAT TRASMIT MALARIA.

Malaria impacts globally. Malaria characteristic varies with geographical location. Malaria is endemic in a total of 101 countries and territories 45 countries in WHO’s African region, 21 in WHO’s American region, 4 in WHO’s European region, 14 in WHO’s Eastern Mediterrarian Region, 8 In WHO’s South – East Asia region, and 9 in WHO’s Western Pacific region (Noor et al. ,2002). Environmental factors such as temperature, influences Malaria prevalence in endemic areas and the disease is more frequent in rural areas than in urban areas (Noor et al. 2010). In malaria endemic parts of the world, a change in risk of malaria can be the unintended result of economic activity or Agricultural policy that changes the use of land for example creation of dams, irrigation schemes, commercial tree cropping and deforestation. In today’s international world, the phenomenon of “airport malaria”, or the importing of malaria by international travelers, is becoming common place. The United Kingdom for example registered 2364 cases of malaria in 1997 and among them are 1134 children, all of them imported by travelers (UNICEF,2009).

Documentation of Malaria situation analysis for Zambia (May 2000), show that malaria, particularly that caused by plasmodium falciparum, is an important public health problem in the country. Incidence of the disease has steadily rise from 1976 through 1999, to the point where it is now estimated that the incidence rate, from facility-based data, stands at 331 per 1000 population (Munthali,A. 2001). This is obviously an underestimate as many malaria cases occur at community levels which do not get reported to the formal health system.

As expected, those most affected by the disease in Zambia include children under the age of five years. The clinical management of malaria in Zambia was complicated in recent years by a growing resistance to the first line treatment. The clinical failure rate ranges between 24% and 52%, levels beyond which an examination of formal change in drug policy is recommended by international health bodies such as the WHO. Studies on Knowledge, attitudes and practices (KAP) find that, although malaria is widely recognized, there remain many misconceptions about the disease.

In Ethiopia a total of 6,214,132 malaria case were diagnosed, treated microscopically or clinically during the year 1995-2000 with an annual average of 1,242,826. The number of malaria cases showed steepy increases from 816,114 in 1995/6 to 2,020,308 in 1998/9. Much of sub-Saharan Africa is exposed to stable, endemic P. falciparum transmission leading to high burdens of morbidity and mortality among children (Murray& Lopez 1997; Snow et al, 1999). In addition the continent has witnessed several devastating malaria epidemic during the early 1930’s in South Africa (Le Sueur et al. 1993) 1958 in Ethiopia (Fontaine et al,1961), and 1986 in Madagascar (Mouchet,1998).

These outbreaks in transmission followed clearly identifiable changes in climate favoring vector and parasite proliferation and were among non-immune populations. Various estimates from these epidemics indicate that between 1% and 14% of the respective populations died. Many factors can influence the ability of parasites and vectors to coexist long enough to result in continued transmission. Several reviews have described the effects on transmission of environmental change, changes in Agriculture and forestry practices and an-made construction (Hackett, 1949; Lindsay & Birley, 1996; Lindsay & Martens, 1998; Mouchet et al 1998). Global warming and other climatic events such as “El – Nino” also play their role in increasing risk of diseases. The diseases has now spread to highlands areas of Africa for instance, while El – Nino events have an impact on Malaria because the associated weather disturbances influence vector breeding sites, and hence transmission of the disease. African children remained unprotected by an insecticide treated mosquito net in 2007 (Noor et al. , 2010).

Documentation of Randomized control trials conducted in Kenya, Gambia and Ghana (UNICEF 2001) show about 30 percent of child death could be avoided if children sleep under bed nets regularly treated with recommended insecticide such as pyrethroids which will remain effective for 6 to 12 months. Malaria kills an African child every 30 seconds, and remains one of the most important threats to the health of pregnant woman and their newborns,” Bellamy, (1998). Anderson, (1943) reported that other soldiers contacted the disease in Sudan, Ethiopia and Somali due to high way which connect Nairobi to Addis Ababa in Ethiopia.

Weekend Malaria, which happens when city dwellers in Africa return to their rural settings, is becoming an increasing problem. Africa child under five years of age are chronic victims, suffering an average of six bouts a year. Fatally afflicted children often die less than 72 hours after developing symptoms. In those children who survive, Malaria also drains vital nutrients from them, impairing their physical and intellectual development. Malaria sickness is also one of the principal reasons for poor school attendance in Kenya.

UNICEF recognizes that malaria is one of the five major causes of mortality in children less than five years. 2. 1. 3 Malaria in Kenya. Malaria in Kenya has reached endemic in arid and semi arid region of North Eastern, Rift Valley and Eastern province. In Rift Valley it’s common in Baringo, Pokot and Laikipia. In Wajir one of the neighboring district in North Eastern province, Medicine Sans Frontiere, MSF (1998) reported that between January and March 1998 the mobile clinics in the town of Wajir treated over 20,000 cases of malaria among an estimated population of 60,00.

This represents an absolute minimum attack rate of 33 per 1,000 populations for three months. Consultation data from Merlin (1998), suggest equal attack rates between children less than 5 and the population aged greater than five years. In Eastern Province high Malaria cases have been documented in Kitui, Machakos, Tharaka, Isiolo and Moyale district. Moyale district is a potential focus for diseases because of presence of vector habitats and intermingling of people due to border movements. All the key clinical features of Malaria including; intermittent fever and weight loss in the background of malnutrition was evidenced.

Since the area borders the town of the neighboring countries which often experience outbreak, there has been need of capacity building of care givers and mothers through campaign on behavior and attitudinal changes. Figure 1. 2: MAP OF KENYA SHOWING MALARIA ENDEMIC AREA [pic] 2. 1. 4 Moyale district- Obbu division In mid July 2012 a suspected outbreak of Malaria was reported in Obbu division of Moyale district. The report by investigation team comprising of clinicians, Epidemiologist and Parasitologists established a total of 82 suspected cases.

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