Malaria Health Promotion Plan for Marsabit County, Kenya

Introduction

Though malaria has been eradicated in some parts of the world, especially in 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 declined 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 on 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 greater risk compared to the rest of the population (WHO, 2017).

Kenya is one of the countries in sub-Saharan Africa where malaria is prevalent. The country has been grappling with a malaria crisis that 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 northern Kenya. This paper provides a health promotion plan for this poverty-stricken community. Based on the MAP-IT framework, the plan describes an intervention for addressing the ongoing malaria crisis, highlighting the stakeholders involved, the objectives of the intervention, strategies for addressing the problem, and implementation and evaluation considerations.

Community Characteristics and the Malaria Crisis

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 conditions, a disproportionately high level of illiteracy, little economic activity, poor transport infrastructure, and an acute shortage of healthcare facilities and personnel.

Marsabit County has been one of the most severely affected counties during 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 coincided with the short rains, during which affected areas received heavy downpours — conditions that provide an ideal breeding ground for mosquitoes. The problem has been further compounded by an ongoing healthcare workers' strike that 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 the majority cannot afford private healthcare services. Being one of the poorest counties in Kenya, Marsabit has been significantly affected by the strike, which has made access to malaria treatment difficult for the majority of its residents.

Understanding Malaria Transmission

Malaria is a preventable and curable disease. Addressing it requires a proper understanding of its causes and risk factors. The malaria parasite is transmitted to humans by the female Anopheles mosquito (Shretta, Avancena & Hatefi, 2016). The magnitude of transmission depends 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 — typically small, shallow pools of water. In tropical countries, such pools are often plentiful during the rainy seasons. Once Anopheles mosquitoes lay their eggs, they seek blood meals to nurture them. Though mosquitoes may obtain blood from many animals, human beings are a common target, especially for African mosquito species. This explains why the majority of malaria cases are reported in Africa. Due to low immunity, children tend to be the most severely affected.

Health Promotion Plan Using the MAP-IT Framework

A health promotion plan is essential for addressing the malaria outbreak in Marsabit County. The crisis requires urgent attention to prevent further escalation. Though there is no single broadly agreed definition, a health promotion plan is an intervention aimed at improving the health of a community or population (Groepe et al., 2013). The intervention focuses not only on the health issue itself but also on its underlying causes. The MAP-IT framework provides a suitable model for designing such a plan. According to the framework, a health promotion plan involves five stages: (1) mobilise; (2) assess; (3) plan; (4) implement; and (5) track (Hansen et al., 2017).

Mobilise: Mobilising involves bringing the relevant stakeholders together to address the issue (Hansen et al., 2017). Given that Kenya recently devolved healthcare responsibilities, the Marsabit County government is a particularly important stakeholder, 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-governmental organisations (NGOs), and local vernacular radio stations. Local healthcare facilities would be involved in diagnosing patients, administering malaria treatments, distributing mosquito nets, and providing malaria-related data. As the county government may not have sufficient funds, the national government and NGOs can supplement financing. Using local vernacular radio stations would enable the county government to more easily familiarise the community with the intervention and inform residents of where they can seek help.

Assess: After mobilising stakeholders, the next step is to assess the problem (Hansen et al., 2017). This involves ascertaining the type and number of people affected by malaria as well as the specific needs of the community. Estimates indicate that 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 verify these figures, as they are mostly reported by the media. The specific needs of this community relate to factors such as poverty, illiteracy, poor housing, scarcity of healthcare facilities and personnel, religious beliefs, and the widespread presence of small water pools during rainy seasons. These factors will necessarily shape 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 outbreak (Hansen et al., 2017), which include not only financial resources but also skilled personnel.

Plan: The third step involves planning (Hansen et al., 2017). Planning entails setting goals and outlining steps for achieving them. The aim of this plan is twofold: to end the ongoing malaria outbreak and to prevent a similar outbreak in the future. Based on the data collected in the assessment phase, specific, measurable, and time-bound objectives should be formulated. In this case, reducing the prevalence of malaria by 70% within six months would be an appropriate objective. A preventive approach involving vector control is generally the most effective intervention for preventing malaria (Groepe et al., 2013; WHO, 2017). Vector control encompasses preventing or minimising transmission through the use of insecticide-treated mosquito nets (ITNs) and indoor residual spraying (Kumar & Preetha, 2012). ITNs will be particularly important in addressing the malaria outbreak in Marsabit County. It is not sufficient merely to distribute ITNs to at-risk households; a wide-ranging educational campaign should also be launched to encourage residents to use the nets regularly and correctly. Another useful preventive measure is minimising standing water pools during rainy seasons by, for instance, improving drainage systems (Hemingway et al., 2016).

Conclusion

Marsabit County is facing a public health crisis that requires a durable and enduring intervention. Vector control presents a lasting solution to the malaria outbreak the community is experiencing. A key benefit of this approach is that it prevents malaria transmission rather than merely treating it after the fact. Whereas the specified objective may be achievable 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 entirely. A number of countries around the world, including countries in the developing world, have already achieved zero malaria prevalence (WHO, 2017), demonstrating that this goal is also achievable for Marsabit County with sustained commitment and adequate resources.

References

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