Panafrican News Agency - November 28, 2001

With 90 percent of the global malaria deaths occurring in Africa, a vaccine - still elusive up now - may be the only solution to the problem.

According to Population Services International (PSI), an world NGO operating in Kenya, the disease which accounts for nine percent of the disease burden to Africans, and is responsible for one in four deaths for children below the age of five, kills an average of 30,000 Kenyan children every year.

In Kenya, PSI says, malaria claims 30,000 children under the age of five years, accounting for 40 percent of childhood illnesses, 30 percent of outpatient and 20 percent of inpatient attendance nationally. It is responsible for 13 percent of all deaths in public hospitals, and it is only second to HIV/AIDS as a killer disease.

Besides causing high mortality, malaria is an impediment to child growth and development. So, says PSI, in a report published this week, given malaria's extraordinary toll on children, its control must become a top priority of the child health agenda.

However, Kenya is yet to adhere to the Abuja Declaration that put malaria on the top of the agenda and required governments to set aside 23 percent of their national budgets to health issues.

Malaria is a disease caused by the protozoa parasite Plasmodium. Infection is usually transmitted by the bite of the female of the Anopheles mosquito species.

Plasmodium falciparum is the commonest parasite in Kenya and it accounts for 98 percent of the cases. It is associated with significant morbidity (illness) and mortality (deaths).

The disease is characterised clinically by chills, fever and profuse sweating. It tends to be particularly severe in infants, children and pregnant women.

In Kenya, the report says, malaria is largely endemic in some parts of the coastal and Lake Victoria regions of the country, including Coast, Nyanza and Western Provinces.

Some areas with high altitude - such as the Aberdares ranges and Mount Kenya - are malaria-free, it adds.

The disease is stable in areas situated at an altitude of 300 metres above sea level, where transmission is high throughout the year. Unstable malaria occurs in areas situated at altitudes ranging between 300-1,700 metres, where the disease is not endemic.

There are also some areas with seasonal malaria which include parts of Eastern Province (Machakos, Embu and Kitui) and Rift Valley (Marigat and Ngurumani in Kajiado).

Recently, a new form of the disease - characterised by outbreaks and labelled highland malaria - has emerged.

Over the years, various methods have been used in efforts to combat malaria. Most of them are still largely in use, with the most recent innovation being treated bednets and curtains, the report adds.

Malaria vaccines have also received a lot of attention as another possible form of intervention. However, presently, a malaria vaccine is not available and it may take five to 10 years before a vaccine for routine use can be expected.

The use of anti-malaria medicine to prevent disease - called chemoprophylaxis - is recommended for malaria prevention for all persons from non-endemic areas travelling in endemic areas.

This is an effective strategy for a limited time (ranging from a few weeks to a few years), but not for lifelong protection because of the high costs and the potential for development of drug resistance.

Reports that resistance against these drugs has reached the 50 percent level - way above the World Health Organisation's recommended threshold of 25 percent - show that there is need to provide alternatives.
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