During the past two years, referrals for cases of severe malaria and malaria in pregnancy (MIP) to Isiolo District Hospital, Eastern Province, Kenya, have decreased by 60 percent and 50 percent respectively. These robust achievements have been attained through the efforts of the two Ministries of Health (Ministry of Public Health and Sanitation and Ministry of Medical Services) in conjunction with the AIDS, Population and Health, Integrated Assistance (APHIA II) Program in Eastern Province. In this program, which is supported by the U.S. Agency for International Development, Jhpiego leads a consortium of six organizations. Results are likely due to increased intermittent preventive treatment for pregnant women (IPTp) and the widespread distribution of insecticide-treated nets (ITNs) to pregnant women and children under five in the district. Health facilities in the district are far from each other and infrastructure is poor. The long rains from March to May contribute to seasonal outbreaks of malaria. The combination of challenging logistics and weather presents a difficult environment for health care workers as well as the pastoralist community in combating malaria.
Complications of MIP include intrauterine growth restriction resulting in low birth weight, preterm deliveries and infant deaths in significant numbers in this area. APHIA II Eastern has trained more than 90 service providers from Isiolo on focused antenatal care (ANC)/MIP, with special emphasis on Kenya’s policy on malaria prevention and control during pregnancy. The policy focuses on uptake of: 1) two doses of IPTp during ANC in the second and third trimesters, at least one month apart; 2) ITNs; and 3) effective case management of malaria illness and anemia during regular ANC visits at static sites or at regular mobile outreach sites for nomadic populations.
The district has seen an increase in the number of pregnant women receiving two doses of IPTp, from 1,839 in 2006 to 2,819 in 2009. The latter figure represents 92 percent of women who had registered for ANC. All of these women were also given an ITN.
Mothers in the maternal and child health/family planning clinic in the district hospital and a nearby health center attest to the positive change in their health following the APHIA II Eastern support. “I was afraid of losing my baby when a nurse told me that I had malaria during my last pregnancy; my friend had lost her pregnancy due to malaria and I thought the same could happen to me. But I thank God for the nurse because she knew my problem early and she gave me injections that healed me and saved my unborn baby’s life” said Amina, a pregnant mother at Isiolo District Hospital.
“It is so amazing that for the two years my child and I have been sleeping under an ITN, we have never fallen sick with malaria. Before we were supplied with the ITN during my last pregnancy, we were often at the health facility for malaria treatment. I wish all mothers could know how useful these mosquito nets are in preventing malaria! I am now convinced that if all people in malarial areas consistently sleep under ITNs, there will be very few malaria patients in the health facilities,” said Zuhura, a mother of a child under five at Kina Health Centre.
Mohamed Duba, the Isiolo District clinical officer in charge of the malaria program said, “APHIA II Eastern has done a lot in scaling up malaria training for a significant number of health care workers in the district. Resultantly, the nurses and clinical officers working in dispensaries and health centers are now able to effectively diagnose and treat uncomplicated malaria in time. They can also be able to identify complicated malaria, give supportive care and quickly refer to the main hospital.”
Duba further indicated that malaria drugs have been available to the lowest-level health facilities, and service providers have been equipped with better skills in administering them. Quinine, the drug of choice for treating malaria in pregnant women, is available at all facilities. Duba said that all mothers attending ANC also have access to IPT for malaria.
The Ministry of Public Health and Sanitation in conjunction with PSI and APHIA II Eastern has distributed ITNs to the vast majority of pregnant mothers in Isiolo District. They have also intensified health education and advocacy for use of the nets by all pregnant mothers and children under five. Mobile outreaches are conducted on a monthly basis. “During these outreaches in rural areas, re-treatment of ITNs is carried out,” said Duba. With APHIA II Eastern support, his team is working round the clock to count malaria out in Isiolo District.