Evaluation of malaria control in Kisumu municipality, Kenya: A case study
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.