Malaria Health Promotion Plan

Though Malaria has been eradicated in some parts of the world, especially developed countries, it remains a significant public health concern across the globe. According to the World Health Organisation (WHO) (2017), there were 212 million malaria cases and 429,000 malaria deaths globally in 2015 alone. Though the incidence of malaria morbidity and mortality has reduced over the years, these statistics are undoubtedly troubling. Developing countries bear the greatest burden of malaria (Shretta, Avancena & Hatefi, 2016). More specifically, Africa has a disproportionately high prevalence of malaria, with estimates indicating that approximately 90% of all malaria cases and 92% of all malaria mortalities across the globe occur in the continent (WHO, 2017). Over 70% of malaria cases in Africa occur in only 13 countries, mostly in the sub-Saharan region, with infants, children below 5 years, expectant women, and HIV/AIDS patients being at a greater risk compared to the rest of the population (WHO, 2017).
Kenya is one of the countries in sub-Saharan Africa where the problem of malaria is prevalent. The country is currently grappling with a malaria crisis that has claimed more than 50 lives in less than a month (Obi, 2017). One of the most affected areas in the country is Marsabit County, an administrative region located in the northern part of the country. This paper provides a health promotion plan for this poverty-stricken community. Based on the MAP-IT framework, the plan specifically describes an intervention for addressing the ongoing malaria crisis, purposely highlighting the stakeholders involved, the objective of the intervention, strategies for addressing the problem, as well as implementation and evaluation issues.
Community Characteristics and the Malaria Crisis
With an area covering approximately 66,000 square kilometres, Marsabit County is the largest county in Kenya. Geographically, the county is situated in northern Kenya, and borders Lake Turkana to the west. Marsabit is one of the poorest counties in Kenya, meaning that access to healthcare remains a perennial problem. The county is characterised by an arid climate, deplorable housing, a disproportionately high level of illiteracy, little economic activity, poor transport infrastructure, as well as an acute shortage of healthcare facilities and personnel.
Marsabit County has been one of the most affected counties in the wake of the ongoing malaria outbreak in Kenya. Reports indicate that the outbreak has led to 26 deaths and more than 1,300 cases of malaria in the county (Obi, 2017). The outbreak has coincided with the short rains. Most of the affected areas have received heavy downpours, including Marsabit, offering an ideal breeding ground for mosquitoes. The problem has further been compounded by an ongoing healthcare workers’ strike that has lasted several months. In Kenya, healthcare workers’ strikes affect the poor far more than the rest of the population. Similar to most developing countries, the poor in Kenya are mainly dependent on public health facilities as majority of them cannot afford private healthcare services. Being one of the poorest counties in Kenya, Marsabit has been significantly affected by the strike, which has without a doubt made access to malaria treatment difficult for majority of the residents.
Health Promotion Plan
Malaria is a preventable and curable disease. Addressing the disease requires a proper understanding of its causes and risk factors. Generally, the malaria virus is transmitted to humans by the female Anopheles mosquito (Shretta, Avancena & Hatefi, 2016). The magnitude of transmission is dependent on, among other factors, the characteristics of the parasite, the human host (e.g. low immunity), and the environment (e.g. temperature, humidity, and rainfall patterns) (WHO, 2017). Anopheles mosquitoes usually lay their eggs in aquatic habitats, usually small, shallow pools of water. In tropical countries, these pools are often in plenty during the rainy seasons. Once Anopheles mosquitoes lay their eggs, they scout for blood meals to nurture them. Though mosquitoes may obtain blood from many animals, human beings are a common target, especially for African mosquito species. Indeed, this explains why majority of malaria cases are reported in Africa. The transmission of the virus occurs during a bite. Due to low immunity, children tend to be the most affected.
A health promotion plan is imperative for addressing the malaria outbreak in Marsabit County. The crisis requires urgent attention to prevent further escalation. Though there is no broadly agreed definition, a health promotion plan is an intervention aimed at improving the health of a community or population (Groepe et al., et al., 2013). The intervention focuses on not just the health issue itself, but also the underlying causes. The MAP-IT framework provides a suitable model for designing a health promotion plan. As per the framework, a health promotion plan involves five stages: 1) mobilise; 2) assess; 3) plan; 4) implement; 5) track (Hansen et al., 2017).
Mobilising involves bringing the relevant stakeholders together to address the issue (Hansen et al., 2017). Given that Kenya recently devolved healthcare, the Marsabit County government is a particularly important stakeholder in addressing the problem, especially with respect to providing funding and sensitising the community. The county government can partner with other stakeholders, including local healthcare facilities, the national government (specifically the Ministry of Health), non-government organizations (NGOs), and local vernacular radio stations. Local healthcare facilities would be involved in roles such as diagnosing patients, administering malaria treatments, and distributing mosquito nets, and providing malaria-related data. As the county government may not have enough funds, the national government together with NGOs can supplement funding. Using local vernacular radio stations would enable the country government to more easily familiarise the community with the intervention and where they can get help.
After mobilising stakeholders, the next step would be to assess the problem (Hansen et al., 2017). This would specifically involve ascertaining the type and number of people affected by malaria and the specific needs of the community. Estimates indicate that so far approximately 1,300 people in Marsabit County have been diagnosed with malaria, including both children and adults (Obi, 2017). More data should be collected to ascertain these figures as they are mostly reported by the media. The specific needs of this community relate to aspects such as poverty, illiteracy, poor housing, scarcity of healthcare facilities and personnel, religious beliefs, and widespread presence of small water pools during rainy seasons. These factors will certainly affect the formulation and implementation of the health promotion plan. Due to high levels of illiteracy, for instance, information must be presented in a manner that is understandable to residents. Problem assessment also involves determining the resources required to address the problem (Hansen et al., 2017). Addressing the outbreak requires not only financial resources, but also personnel.
The third step involves planning (Hansen et al., 2017). This is an especially crucial step. Planning entails setting goals and outlining steps for achieving those goals. The aim of the plan is twofold: to end the ongoing malaria outbreak and to prevent a similar outbreak in the future. Based on the data collected in Step 2, specific, measurable, and time-bound objectives should be formulated. In this case, reducing the prevalence of malaria by 70% in the next 6 months would be an ideal objective. How can this objective be achieved? A preventive approach that involves vector control is generally the best intervention for preventing malaria (Groepe et al., et al., 2013; WHO, 2017). Vector control encompasses preventing or minimising transmission using insecticide-treated mosquito nets (ITNs) and through indoor residual spraying (Kumar & Preetha, 2012). ITNs will be particularly important in addressing malaria outbreak in Marsabit County. It is not just enough to provide at-risk households with ITNs: a wide-ranging educational campaign should also be initiated to encourage residents to regularly and properly use the nets. Another preventive measure that would be useful is to minimise water pools during rainy seasons by, for instance, improving drainage (Hemingway et al., 2016).
Antimalarial drugs such as sulfadoxine-pyrimethamine can also be used to prevent malaria (Hemingway et al., 2016). These drugs work by suppressing the development of malaria. While antimalarial interventions and vector control are useful in preventing malaria, it should be noted that insecticide and antimalarial drug resistance are increasingly significant challenges in the fight against malaria (WHO, 2017). Accordingly, the implementation process should be closely monitored to ensure resistance is detected early enough if present.
Once the prescribed interventions have been implemented, there should be ongoing evaluation to ascertain whether the set goals and objectives were achieved (Hansen et al., 2017). Though the plan is to reduce malaria prevalence by 70% in the next six months, data should be collected more frequently (on a weekly basis, for instance) to monitor progress. Progress in this case can be evaluated by monitoring cases of malaria successfully treated and new malaria cases reported in the plan period. Periodic evaluation is crucial for documenting strengths and areas of improvement.
Conclusion
Marsabit County is facing a public health crisis that requires a more enduring intervention. Vector control presents a more lasting solution for the malaria outbreak the community is experiencing. A key benefit of this approach is that it prevents malaria transmission. Whereas the specified objective may be achieved in the medium term, the county government should ultimately focus on malaria elimination. The county government should deliberately roll out a more wide-ranging initiative aimed at eradicating malaria prevalence. A number of countries around the world, including countries in the developing world, have already achieved zero malaria prevalence (WHO, 2017). This means it is also possible for Marsabit County.


References
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