Academic journal article Bulletin of the World Health Organization

Malaria Control in Bungoma District, Kenya: A Survey of Home Treatment of Children with Fever, Bednet Use and Attendance at Antenatal Clinics

Academic journal article Bulletin of the World Health Organization

Malaria Control in Bungoma District, Kenya: A Survey of Home Treatment of Children with Fever, Bednet Use and Attendance at Antenatal Clinics

Article excerpt

Voir page 1021 le resume en francais. En la pagina 1022 figura un resumen en espafiol.


WHO estimates that at least 1.5 million deaths are attributable to malaria each year (1), two-thirds of which occur among children under the age of 5 years living in sub-Saharan Africa. In western Kenya, intense malaria transmission occurs throughout the year and there are high levels of chloroquine resistance (2). A community survey conducted 130 km south of Bungoma District in Western Province revealed prevalences of Plasmodium falciparum parasitaemia in non-symptomatic children as high as 95% and 51% during the high and low transmission seasons, respectively (3). Malaria is the most frequently diagnosed condition in outpatients at health facilities in Bungoma District. It is the principal cause of death at the district hospital (4) and is a major contributor to the province's high mortality rate among children aged under 5 years, estimated to be 110 deaths per 1000 live births (5).

We conducted a household survey in order to obtain data that would provide a basis for designing and evaluating interventions to be introduced through the Bungoma District Malaria Initiative. The goal of this initiative, and of the Africa Integrated Malaria Initiative of which it is part, is to demonstrate the effectiveness of model, district-level malaria control programmes in reducing mortality and severe morbidity among children under the age of 5 years (6). The strategies used to achieve this goal involve improving case management of malaria in health facilities and households, providing intermittent presumptive malaria treatment or chemoprophylaxis during pregnancy, and achieving widespread distribution and use of insecticide-treated bednets. The survey provided an opportunity to collect baseline data on and to characterize the management of febrile children in the specified age group. Information was gathered on: home care practices and health facility utilization; the sources, availability and use of antimalarial drugs in the community; carers' knowledge of the cause and prevention of malaria; the use of bednets by children under 5 years of age; the utilization of antenatal care by pregnant women.

The population of Bungoma District is approximately 670 000, 80% of whom live in rural areas. Children under 5 years of age constitute 20% of the population (7). The Luhya are the predominant ethnic group. The villages consist of homesteads, usually inhabited by a male elder, his sons and their families. Each homestead is made up of several households. A household is defined by the District Statistical Office as a person or group of people living under one roof or on one homestead who share the same source of income. Over a quarter of the married women in Western Province are in polygynous unions (5). Co-wives typically live in separate houses but may be part of the same household.

There are 5 hospitals and 28 registered governmental and nongovernmental health facilities in the district. An unknown number of nonregistered health care providers work in small private clinics or in their own homes. Community health workers, traditional birth attendants, traditional healers and drug sellers are present. Drug sellers and pharmacists can provide antimalarial drugs without prior consultation with a clinician.

Reliable microscopic diagnosis of malaria is not available in most governmental health facilities in the district. Children under 5 years of age with fever or a history of fever are regarded as having malaria, in accordance with WHO guidelines for areas where the disease is endemic and microscopic diagnosis is unavailable. Also consistent with WHO recommendations is the national policy that pregnant women living in areas of endemicity should receive antimalarial chemoprophylaxis or presumptive intermittent therapy in order to reduce the risk of placental parasitaemia (7, 8). At the time of our survey, the nationally recommended drug for first-line treatment against malaria was chloroquine, and the recommended regimen for chemoprophylaxis during pregnancy involved its weekly administration. …

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