History Of Malaria Control in Kenya Malaria control activities were undertaken on a large scale in Kenya between 1955 and 1974 with the advent of DDT as a residual insecticide and a number of antimalarial drugs such as chloroquine and pyrimethamine. These efforts were hampered by a number of factors, among them: • The development of insecticide resistant vectors • Parasite resistance to antimalarial drugs • Inadequate national resources for sustaining vertically organized malaria control programmes • Attitudes of the local population towards malaria control • A high degree of malaria endemicity encountered in most areas of the country. In 1978 the World Health Organization assembly approved a malaria control strategy based on the principles of primary health care (PHC). According to the PHC approach, large vertical malaria control programmes were replaced by community based programmes integrating other aspects of PHC with active community participation. It has was accepted that malaria eradication is not a feasible option for many parts of sub-Saharan Africa, such as Kenya, and emphasis was placed on control strategies which could be effective in reducing morbidity and mortality and which could be sustainable with available local resources. After the malaria eradication era of 1955-1974, the Kenyan government re-oriented its malaria control strategies. The country adopted prompt diagnosis and adequate treatment of the disease as the basis for malaria control, with the aim of preventing morbidity and mortality due to malaria. The emergence of drug-resistant P. falciparum, particularly to chloroquine, made this method difficult, since treatment has to be done with more expensive or more toxic antimalarial drugs. Thus in 1998, the country changed her treatment policy from chloroquine to SP and in 2006 the country changed its policy to AL which was more effective. In realizing that malaria is becoming increasingly difficult to manage, and following WHO recommendations for tropical countries affected by malaria to formulate their own malaria control strategies, the government of Kenya launched a five year National Plan of Action for Malaria Control in 1994. The main goal of the plan was to develop an infrastructure that would ensure access to malaria prevention and curative services to those at risk, with the aim of substantially reducing illness and death. The specific objectives of the plan, among others, were to improve and sustain services within the community for reducing malaria morbidity and mortality and to co-ordinate and focus the malaria control efforts of Ministries, divisions, international agencies and the private sector in recognizing malaria as a national health problem. National malaria Control program was further strengthened by the interest generated by the Global communities, with the introduction of Roll back malaria initiative by World Health Organization (RBM). In line with RBM movement which was started in 1998 and in-order to co-ordinate partners, the Kenyan Government created Division of Malaria Control within the Ministry of Health a commitment to reducing the malaria burden in Kenya. In 1999 an office was built with support from DFID to house the NMCP.
In April 2000 during the African Heads of State Summit, The President committed the Government of Kenya to an intensive effort in support of The Abuja Declaration of April 2000 at the "Roll Back Malaria" The RBM set a ten-year target to realise tangible differences in malaria control and prevention in Africa. As a response to this challenge Kenya developed The National Malaria Strategy 2001–2010 (MOH, 2001b) in 2001 which was designed to create an enabling environment for implementing malaria control by:
• Focusing national commitment on malaria control. • Coordinating stakeholders and efforts. • Strengthening partnerships. • Integrating systems for malaria control. • Advocating for the allocation of priority resources to malaria control. • Designing national guidelines for malaria control.
The development of NMS 2001–2010 was followed by the development of a costed malaria business plan in 2003.
In March to June 2009 Malaria Programme Performance Review (MPR) was conducted which highlighted programmatic strengths, weaknesses and gaps to address. In line with recommendations from MPR, The National Malaria Strategy (NMS) 2009–2017 was developed through a multistakeholder, multisector participatory approach. This strategy was developed in line with the Government’s first Medium-Term Plan of Kenya Vision 2030 and the Millennium Development Goals, as well as Roll Back Malaria partnership goals and targets for malaria control. Alongside the strategy DOMC developed Kenya Malaria Monitoring and Evaluation Plan 2009-2017 to monitor progress of malaria control program.
During the same period, the DOMC unveiled its vision of “A malaria free Kenya”, mission and core values. This crystallized the Division’s overall mandate, which is the planning and coordination of inputs and activities for malaria control activities at all levels.
In April 2010 DOMC developed the first ever comprehensive Malaria policy which articulated policy issue on malaria control in Kenya
In 2013 mid-term DOMC under took a review of the Kenya NMS 2009-2017 which identified areas of the Malaria strategic plan (MSP) that needed revision and drafting costing of the revised Kenya Malaria Strategic Plan 2014-2018 (KMSP) and the Kenya Monitoring and
Definition of Malaria Malaria is a parasitic disease caused by an obligate intracellular protozoan of the genus Plasmodium. The disease is systemic, acute and sometimes severe. It is usually characterized by shivering, chills alternating with fever, headache and nausea and sometimes vomiting. After an interval free of fever, the cycle is repeated either daily or every third day depending on the species of the malaria parasite. Malaria is the one of the leading causes of morbidity and mortality in Kenya, accounting for 15% of all out-patient attendance in the country's health facilities admissions (DHIS 2015). However there has been a steady decline of malaria cases in the last five years (DHIS 2015). In Kenya the distribution of malaria is not uniform, due to geographical differences in altitude, rainfall and humidity. These geographical factors influence the transmission patterns as they determine the vector densities and intensity of biting. The higher the ambient temperature, the shorter the sporogonic cycle of the parasite in the mosquito, hence the shorter the duration of the gonotrophic cycle.
Plasmodium species All four species of human Plasmodium: P. falciparum, P. malariae, P. ovale and P. vivax occur in Kenya. P. falciparum which causes the severest form of the disease accounts for 98 percent of all malaria infections. 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. They are among the most efficient vectors in the world as they feed predominantly on humans. In Kenya these malaria vectors are susceptible to all pyrethroid insecticides, although a decrease in susceptibility to permethrin was reported from an area of insecticide treated bed nets in western Kenya round, 1994). Several studies carried out on malaria vectors in Kenya have shown that they are indoor feeders, preferring mainly human blood, apart from An. arabiensis which prefer animals and some feed out door. They also rest indoors after feeding. The biting activities for most Anophelines occur between 20.00 and 06.00 hours, with a peak biting rate from midnight to 04.00 hours when most people are in bed, and as such they are susceptible to insecticide treated bed nets. Based on these known biological characteristics, the Kenyan Government has promoted use of insecticide treated bed nets as the main malaria control intervention measure.