Kenya: RDY & Poverty

— Last week, five-year-old Prisca Nyaboke was recovering from her third bout of malaria at a private clinic in Mathare North, Nairobi. The first-born of Michael and Joan Mariga had been diagnosed after two days of fever, vomiting and diarrhoea.
The diagnosis was made at a chemist's shop in Mathare North at a cost of Sh100 rather than at a clinic or hospital. In a sense, the child was lucky because her parents could afford the test. Millions of poor families cannot raise Sh100.
Indeed, in Kenya, 92 children under the age of five contract malaria every day. And as World Malaria Day is marked on Sunday, UN Secretary-General Ban Ki-Moon is urging governments to ensure effective and affordable protection and treatment to all people at risk of malaria.
Since 2000 when African leaders resolved to halve malaria deaths by this year, many plans have been developed. One was part of World Health Organisation's guidelines released last month, advising that accurate tests should be conducted before dispensing malaria drugs.
But in impoverished communities diagnostic testing is often unavailable. That is why the Prisca's mother went to the chemist. She thought that if they went to a public hospital, she would just be given drugs and sent home. Today, many Kenyans choose to self-medicate and hope for the best. Mrs Mariga said Mathare residents have few or no options.
"Buying malaria tablets from the retail shops without consulting a doctor has become normal in our area," she said as she tended to her kiosk in Mathare North. Mrs Mariga said many expectant women and those with children under five years of age cannot access treated mosquito nets.
"When I gave birth to my second-bornGilead five months ago, I was not issued with a treated mosquito net," she said. Her husband Michael Mariga said the high cost of mosquito nets has prevented him from obtaining more than two to protect all the five occupants in his house.
Their house help, Lilian Moraa, suffered from malaria last month. The children sleep under nets, but Mr Mariga said the nets were last treated six years ago. The Mariga family story brings into question the effectiveness of public health drives to reduce illness and deaths from malaria. For every success, there are multiple challenges.
Children are the most vulnerable to the disease, and public health prevention efforts seem to have helped. According to the 2008/2009 Kenya Demographic and Health Survey, mortality for under-five-year-olds declined by 36 per cent since 2003.
In many parts of the world, malaria parasites have developed resistance to a number of medicines, necessitating more stringent measures to deal with the disease, especially in rural areas. Inappropriate use of anti-malarial drugs has contributed to widespread resistance by the malaria parasite to commonly used drugs such as chloroquine, leading to rising rates of sickness and death.
Over the past decade, a new group of antimalarials known as artemesinin-based combination therapies or ACTs, has brought new hope in the fight against the disease. With about 250 days left to meet the 2010 target of universal insecticide -treated net (ITN) coverage for all at-risk populations and the halving of malaria cases and deaths, it is estimated that around 10 million Kenyans lack ITNs.
Dr Elizabeth Juma, who heads the Division of Malaria Control in the Ministry of Public Health, said access to malaria prevention and treatment should be seen as a fundamental right. Western and Nyanza provinces and parts of the Coast region are the most malaria-prone areas in Kenya.
Malaria prevalence in children under five years in Rift Valley and Nyanza is reported to be as high as 25 per cent. Dr R. Kiptui, an official in the Division of Malaria Control, said Nairobi Province is considered a low-risk area, hence the absence of an aggressive malaria campaign.
"Some of the cases in Nairobi are imported; they are found in persons who have travelled from upcountry," said Dr Kiptui. An indoor residual spraying campaign rolled out by the government two weeks ago targets more than a million homes in 32 areas. As the world marks Malaria Day, the Marigas hope activities related to the global campaign will one day reach their doorstep.
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