Evaluation of malaria control in Kisumu municipality, Kenya: A case study
Abstract
A study was carried out from September, 1986 to
February, 1987 in Kisumu Municipality, Kisumu
District, Kenya; to evaluate the current antimalaria
activities and the present status of
malaria infection and transmission.
The study included an interview to the Municipal
Health Authorities both by questionnaire and person
to person,on the current antimalaria activities
and the distribution of personnel, health facilities
and budget allocation for malaria control. Records
were also looked at and compared with the information
from the interviews.
A KAP survey was conducted in three selected areas within
the 'C0uncil boundaries. These were Upper
Railways Estate in the main Kisumu town, Nyalenda
sub1ocation, a peri-urban slum, and Mkendwa sublocation
which is rural. A total of 316 households
were studied.
A Clinical and Parasitological survey was carried
out in the same study areas. 325 children aged 2-9
years were studied. An Entomological survey was
also carried out in the three study areas. All
female anopheline mosquitoes were dissected and
sporozoites looked for in their salivary glands.
Larvae were also collected and classified into
their species.
The results showed the following:
The current antimalaria activities in the municipal
Council were geared mainly to controlling the
mosquito vector and the parasite. Although
recommendations were made within the Council as
to how best to control the mosquito vector, these were
not implemented due to lack of funds and shortage of
staff. It was also observed that there had been
very little expansion of the Council's services since
1974 although the population of the Municipality was
growing fast. From the records, it was clear that
not all the budget allocated to malaria control was
used for that purpose. Health education to the
Municipal residents was lacking as one way to control
malaria. These findings are fully discussed.
From the KAP Survey, it was found that the general
knowledge of malaria diagnosis by symptoms and of
the mosquito as the vector was very high.
However, knowledge about prophylaxis against malaria
was poor. The majority of the people practised
correct protective measures against mosquitoes. The
attitude of the people was found to be that the
government or Council was responsible for their
health, and so it was up to the government/Council
to protect them against mosquitoes. The results
are presented in full and discussed.
In the Clinical and Parasitological survey, 118
children from Nyalenda, 102 children from upper
Railways Estate (URE) and 105 children from
Mkendwa, all aged 2-9 yrs were examined for
splenomegaly and by thick and thin blood smears
for malaria parasites. The overall spleen rate
was 'found to be 13.85% with an overqll parasite
rate of 21.53%. Differences were observed in
both parameters when each area was analysed
separately. The spleen rate for Nyalenda was
27.1% as compared to 5.9% and 4.8% for URE and
Mkendwa respectively. The parasite rate for
Nyalenda was 38.13% as compared to 13.72% and
10.48% for URE and Mkendwa respectively. The
differences here were thought to be due to the
fact that Mkendwa is situated on a hill about 8km
from the town. It is basically sandy and so does
not favour the breeding of the anopheline, mosquitoes.
URE is urban. The transmission rate is lower in
urban eco-systems due to free usage of drugs. Nyalenda
is an over crowded slum area with half of it falling
under marshy ground that favours the breeding of
mosquitoes. Further analysis is given and discussed.
In the Entomological survey, a total of 118 adult
mosquitoes were collected from 6 selected catching
stations in Nyalenda. 46.6% of these were found to
be A. gambiae S.l.i 16.1% were A. funestus and the
remaining 37.3% were cu1icines. The anopheline
density was 12 (Anophelines per house). No Anopheline
larvae were found. In Upper Railways Estate, a
total of 55 culicines were collected in the 4
selected catching stations. No larvae were collecteJ.
In Mkendwa, a total of 21 mosquitoes were collected
from the selected catching stations; of these 9.5%
were found to be A. gambiae s.l.; all in the 4th
stage of development. The total anopheline density
was 0.5 per house.
All Female anophelines were dissected and their
salivary glands examined. No sporozoites were
found in any of them. The results are presented
in detail and discussed.
Recommendations were made and these are:-
(a) Health education to the community
(b) Community Participation in form.. ulating, and
implementing control programmes;
(c) Intersectional cooperation in planning control
measures;
(d) A good information system for
i) Communication,
ii) Evaluation,
iii) Surveillance.
(e) Manpower development for research into new
methods of control.
Citation
Degree of Master of Public Health of the University Of NairobiPublisher
School of Medicine
Description
A dissertation submitted in partial
fulfillment for the award of the
Degree of Master of Public Health
of the University Of Nairobi