Malaria Epidemic Preparedness and Response

Introduction

Malaria Epidemics in Kenya Malaria epidemics usually occur in the western highlands and the arid and semi-arid regions in Kenya. The epidemics are characterized by high morbidity and mortality and are associated with unusual climatic conditions, mainly high rainfall and temperatures that are suitable for vector breeding. Malaria epidemic preparedness and response (EPR) remains a priority in disease surveillance and response, with the main objective of reducing morbidity and mortality during epidemics through early detection and response

Malaria Epidemics in Kenya

Malaria EPR is one of the strategies under the surveillance objective of the Kenya Malaria Strategy (2019–2023) (MOH, 2019). The Surveillance, Monitoring, Evaluation, and Operational Research unit in the DNMP is responsible for the development of guidelines, manuals, tools, training, and planning for EPR in Kenya. The Division of Disease Surveillance and Response (DDSR) is nationally responsible for surveillance and response for all epidemic-prone diseases. Malaria EPR is geared towards preparedness and timely and effective response to avoid occurrence of malaria epidemics, thus reducing excess morbidity and mortality.

A total of 127 sub-counties spread across 26 counties in the western highlands and seasonal transmission zones of Kenya are classified as malaria epidemic-prone areas (MOH, 2016) as indicated in Figure 1 on the left.

Objective of EPR

EPR is positioned as strategy 2 within the objective 5 i.e.  Surveillance, Monitoring, and operational research object in the Kenya Malaria Strategy 2019-2023

Aim of EPR

To prepare and respond to malaria epidemics in epidemic prone areas in Kenya. Strategies of EPR include:
1) Epidemic preparedness

Activities: Preparedness activities should be stratified by level of care due to their different roles and responsibilities. The broad preparedness activities include the following:

  • Developing and updating EPR plans. These outline what should be done in the event of an epidemic and should detail the resources that would be required.
  • Building capacity on epidemic detection and response. All health workers should be trained on how to set and monitor thresholds to detect an epidemic and how to initiate response measures.
  • Coordinating epidemic control measures. Increases in numbers and the risk of progression to severe disease or death in an epidemic situation require the coordination of the different players to ensure prompt and effective management of resources and treatment of cases as well as to meet the heightened surveillance needs.
  • Providing strategic emergency supplies for malaria epidemics. Ensuring adequate supply of antimalarial commodities is critical for effective case management and prevention of onward transmission
2) Epidemic prevention

The purpose of epidemic prevention is to avert or reduce excess morbidity and prevent mortality due to malaria. The main approach for malaria prevention is timely vector control and effective case management. When an epidemic is predicted, the following should be done:

  • Undertake active monitoring of malaria cases (line listing) and trends to identify transmission foci.
  • Undertake entomological surveys. § Undertake focalized IRS one month before onset of the outbreak in high-risk areas based on surveillance data. There should be a coverage of at least 80 percent of the identified foci
  • Ensure adequate stock of malaria commodities
  • Undertake community sensitization on the use of mosquito nets and early treatment seeking behavior (within 24 hours of onset of fever)
3) Epidemic response

Epidemic response depends on the stage at which the epidemic is detected. The aim of response is to reduce transmission and mortality by treating those who are infected and preventing new infections (WHO, 2018). A rapid assessment should be conducted to confirm that an unusual increase in the number of fever cases is due to malaria. Rapid assessment can be conducted at different phases, as follows: To assess preparedness for a predicted epidemic (pre-epidemic phase), to confirm a suspected epidemic (epidemic phase), or at the end of an epidemic to assess response (post-epidemic phase), Rapid Assessment and Confirmation of Epidemic. The sub-county MOH should convene a sub-county rapid response team to carry out a rapid assessment of the situation. The rapid assessment team should comprise a clinician, an epidemiologist/disease surveillance officer, an entomologist, and a trained laboratory officer to verify cases in the field. The purpose of the rapid assessment is to:

  • Verify the source of information § Confirm the outbreak
  • Determine the extent of the epidemic
  • Establish the approximate population at risk of the epidemic
  • Define the type and extent of interventions
  • Identify priority activities

Response Activities The aim of malaria epidemic response is to reduce transmission and mortality by treating those who are infected and preventing new infections. Access to early diagnosis and effective treatment of all malaria patients will minimize mortality. Response activities include the following:

  • Case management- Strengthening Malaria Case Management During Epidemics
  • Advocacy, community mobilization, and health education
  • Strengthening Vector Control Activities During Epidemics by deployment of appropriate and feasible Vector control interventions
  • Strengthening Malaria Surveillance during active Epidemics
  • Effective coordination of Epidemic Response activities
4) Monitoring Malaria Epidemic Preparedness and Response

Monitoring and evaluation is an integral component of enhancing the tracking of input, process, and output indicators effective for management (prevention and containment) of malaria epidemics. Monitoring of ongoing malaria epidemic preparedness and response activities should be implemented at community, health facility, sub-county, county, and national levels. Process indicators should be measured to ensure that all activities are implemented as planned and to identify problems and challenges faced during the implementation. The indicators for malaria EPR should be monitored to ensure that all activities are implemented as planned. Challenges faced during the implementation should be identified and appropriate remedies applied. Table 5 shows the indicators for malaria EPR as stated in the Kenya Malaria.

Achievement so far and challenges