The race between new drugs and new resistances has not stopped since then.... And in 1986, WHO's expert panel concluded that a magic solution could not be relied upon, and that furthermore, malaria patterns were determined by a variety of socioeconomic as well as biological, climatic and geographic factors. " (Banfield, 1998. p. 35)
The article refers as well to the impact of malaria on the people of Kenya "... where people in the Bomet district were dying at a rate of three or four a day..." (Banfield, 1998. p.35)
Another general study which includes informative data relative to the topic of this study is The Heavy Cost of Malaria and AIDS by De Giorgio (2000). This article refers to some significant economic aspects and to the way that the high rate of malaria infections is affecting the economy of Kenya, as well as other countries in the region. The cycle of increased infection and the negative financial impact is clearly illustrated in the following quotation.
Malaria is also devastating, accounting for 10% to 30% of all hospital admissions in Africa and causing 15% to 25% of all deaths of children under the age of five. The cost of prevention and treatment depletes private savings and far exceeds the financial reach of health budgets. Sick individuals produce less and earn less. Foreign investment and tourism are negatively affected. (De Giorgio, 2000, p. 23)
The above study also presents some important statistics with regard to estimated costs of the disease. "According to UNICEF, the total cost of malaria in sub-Saharan Africa exceeded $2bn in 1997. And a study by John Gallup and Jeffrey Sachs reckons that malaria wiped out $74bn from the economies of 31 African countries between 1980 and 1995." (De Giorgio, 2000, p. 23) The estimated cost to Kenya was$200 per person.
The implications of malaria also have variable effects on different sectors of the population. An article that investigates the issue of healthcare, as well as the effect of malaria on women in Kenya is Women's Health Issues in Kenya by Patel (1997).
As in other developing countries, the health status of women in Kenya is unacceptably low. Widespread mortality and morbidity among women from causes all of which have one thing in common - they are largely avoidable. Since women form slightly over 50 per cent of Kenya's total population, of almost 30 million people, it makes demographic sense to address the needs of their share of the population. (Patel, 1997)
The significance of the above lies in the fact that malaria is this region is rife as well as the increasing prevalence of HIV / AIDS, both of which have a profound effect on women's health issues.
The literature also provides a wide range of studies that show that previous conventional methods of fighting malaria have proven in general to be ineffective. This aspect is concisely outlined in an article entitled, When Disease Resists; Malaria's Toll Rises in Tropical Regions As Effectiveness of Chloroquine Falls Off by David Brown (1994.) This article refers to an aspect that has already been touched on; namely that the malaria parasite has become resistant to many previously effective agents. "...the microorganism that causes malaria had become resistant to chloroquine, the standard medicine used to prevent and treat the disease for the previous 40 years." (Brown,1994) The study also refers particularly to the Kenyan situation."... researchers in Kenya - where chloroquine has been useless for a decade - reported that more than 25% of malaria cases in a recent study were resistant to the two more modern and expensive antimalarial drugs, mefloquine and doxycycline." (Brown,1994) This again raises the central concern that modern drugs are proving to be less and less effective in the fight against malaria.
As can be deduced for the studies mentioned above, there is a desperate need for a method that will be more effective in the fight against malaria in the region - particularly in the light of the fact that modern drugs are proving to be less effective. In this regard there are a number of research studies which indicate that insecticide impregnated or treated nets can provide a possible solution.
A source that provides an extensive range of data on his aspect is The Africa Malaria Report - 2003.
This study provides relevant and insightful statistics that show the effectiveness of impregnated netting. For example, "Randomized controlled trials in African settings of different transmission intensities have shown that ITNs can reduce the number of under-5 deaths by around one-fifth...saving about 6 lives for every 1000 children aged 1-59 months protected each year. (The Africa Malaria Report - 2003)
Furthermore, the report also states that, " The incidence of clinical episodes of Plasmodium falciparum infection is reduced by 50% on average. When used by pregnant women, ITNs are also efficacious in reducing maternal anaemia, placental infection, and low birth weight "(The Africa Malaria Report - 2003)
The study presents statistical evidence of the reduction of deaths and mortality rates, particularly among young children as a result of the use of the impregnated nets.
Randomized controlled trials showed an overall under-5 mortality reduction of 17% in communities provided with ITNs compared with communities not provided with ITNs. The impact was similar across a range of malaria endemicities. Impact derives not only from a reduction in malaria deaths, but also from reductions in child deaths due to other causes that are associated with, or exacerbated by, malaria, such as acute respiratory infection, low birth weight, and malnutrition. " (The Africa Malaria Report - 2003)
There is also evidence that these statistics may be conservative. This is due to the fact that impregnated nets have an indirect impact on the prevalence of infection. This in effect means that even households without nets are protected to a certain extent.
The efficacy of ITNs, because the impact of reduced mosquito burden extends to households and communities without nets, which reduces the apparent difference between study areas with nets and study areas without nets. The protection afforded to non-users in the vicinity is difficult to quantify, but it appears to extend over several hundred metres. From observed reductions in parasite prevalences, it has recently been estimated that, in the long-term, widespread use of ITNs - if regularly retreated - will massively reduce malaria transmission. (The Africa Malaria Report - 2003)
Another valuable study which expands on the above findings with particular reference to Western Kenya, is EFFECT OF SUSTAINED INSECTICIDE-TREATED BED NET USE ON ALL-CAUSE CHILD MORTALITY IN AN AREA OF INTENSE PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA, by Eisele et al. (2005).
This study "...present results from a study conducted in western Kenya where all-cause child mortality was assessed among a population with high levels of sustained insecticide-treated bed net (ITN) use for up to six years.." (Eisele et al. 2005)
The study found that in Western Kenya the introduction of impregnated netting was correlated with a "...significant reductions in all-cause mortality among infants 1-11 months old..." (Eisele et al. 2005)
However it is also important to note that "...there was no difference in the rate of all-cause mortality among children 12-59 months old with ITNs for 2-4 years, compared historically with children from villages without ITNs, after controlling for seasonality and underlying child mortality across calendar years..." (Eisele et al. 2005) main finding of the study is that impregnated nets are very effective in the reduction of mortality rates due it malaria.
Insecticide-treated bed nets (ITNs) have been associated with substantial reductions in malaria transmission. Accordingly, community-randomized controlled trials conducted across a range of malaria transmission settings in sub-Saharan Africa have shown ITNs and insecticide-treated curtains (ITCs) to be associated with up to a 30% reduction in all-cause child mortality over the first 1-2 years of the trials. (Eisele et al. 2005)
At the same time the study also found that that there a number of concomitant and complex issues which should be taken into account in ascertaining the effectiveness of impregnated bed netting. One of these is the issue that impregnated nets may adversely affect the immunity levels in older children. "However, there has been some concern that sustained use of ITNs may increase mortality rates in older children as a result of a delayed acquisition of natural immunity to malaria, especially within areas of intense, perennial malaria transmission." (Eisele et al. 2005)
The statistical findings of the study tend to confirm that assertion.
There was no increase in the proportion of child deaths at older ages (12-59 months old) of all child deaths within villages with ITNs for 5-6 years (48.1%) compared historically with villages without ITNs (47.9%), after controlling for seasonality (AHR = 1.03, P = 0.834). We find no evidence that sustained ITN use increased the risk of mortality in older children in this area of…
Challenges in the response of public health in this area includes the following:
1) a lack of medical records or documentation of predeparture therapy;
2) Limited Medicaid reimbursement for therapy and follow-up care due to the lack of documentation;
3) Difficulty in securing the appropriate treatment since Malarone is not on the FDOH.
A formulary; and 4) Initial difficulty in locating a Kirundi interpreter for the interviews. (Epi Update, 2008)
VI. BARRIERS and MISCONCEPTIONS