Najum Mushtaq
NAIROBI, Jun 26 2008 (IPS) – The end of June marks the start of the malaria season in East Africa. After the long rains, conditions in lowland swamps and coastal regions are more conducive for mosquito breeding. But in recent years malaria has also appeared in the highland areas where it was previously unheard of.
Malaria has been so rare in Nairobi that doctors hardly ever suspect it when they see patients with symptoms of cold and fever. When a friend of mine went down with fever a few months ago, I asked in jest if he had had a malaria test, Dr Rupal Maru of the Kenyatta Nairobi Hospital recalls. She was surprised when her friend took the advice seriously and was diagnosed with malaria.
Now we regularly get cases of malaria not only from Nairobi but also other parts of the highlands which, unlike the rest of Kenya, were considered to be out of the range of this disease, Dr Maru told IPS.
Climate change, experts say, is the major factor responsible for malaria epidemics in the highlands. About 50 percent of all outpatients reporting at hospitals have malaria and 20-30 percent of hospital admissions are on account of ths disease. It is the leading cause of mortality in the country, accounting for 20-25 percent of all deaths.
In times of anomalous temperature variations, as many as 70 percent of the population could be at risk.
There is a clear correlation between climatic variations and malaria epidemics, says Dr Willis Akhwale, head of Kenya s National Malaria Control Programme. He referred to a 1998 investigation by his department into the breakout of epidemics in Kericho, a district in the southwestern highlands known for its tea production and cool climate. The study determined that the El Nino effect had raised temperatures by 2.2 4.5 degrees celsius between January and March 1997 and by 1.8-3.0 degrees celsius in February-April 1998, leading to the sudden occurrence of epidemics.
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The science of this phenomenon is simple: the mosquito-transmitted parasite requires an ambience temperature usually a quarterly mean of over 18-19 degrees celsius which occurs in the highlands only in unusually warm years, as in 1997-98 due to El Nino. Such years are becoming more frequent now.
Previous records in East Africa s highlands show, said Akhwale, that the epidemics of the 1940s, for example, and some in 1905 were also the times when high temperatures were recorded internally and globally.
But, generally, the highlands were cool, there were low temperatures and there was no malaria there in the past. So, people living in the highlands have no immunity against it, Akhwale said.
This means that when it does break out in high altitude areas, the population in these areas are more vulnerable to an epidemic than the population in the lowlands where malaria has long been common.
The low level of immunity adds another complication. While in the lowland areas, children are more likely to get the disease than adults who have been exposed it before, in the highlands adults and children are equally likely to be affected.
As people of all ages are vulnerable, the epidemic moves faster and the impact is more widespread. As 20 percent of Kenya s population eight million people living in the highland areas are now exposed to malaria, new plans for preparing and responding to an epidemic are needed. So far, this has meant introducing household indoor residual spraying in highland areas and ensuring health facilities are equipped with appropriate medicines.
Rising temperatures, changes in farming patterns and clearing of forests to make way for farming all play their part in the spread of malaria in the highlands. But according to Dr Akhwale the displacement of people for socio-economic reasons is one of the main causes of the increase.
Dr Maru also points to the displacement caused by conflict, especially the post-election violence earlier this year which left more than 600,000 people homeless, most of them from the Rift Valley and other farming regions. I can tell from my daily experience that there has been a noticeable increase in cases of malaria in Nairobi since the forced movement of people from malarial regions. With them the malaria vector mosquitoes find new habitats. Also, displacement restricts access to health facilities and medicines which makes the disease multiply. she said.
Akhwale believes that it will take at least 15 years of consistent effort, from community interventions to regional cooperation, before malaria can be brought under control in East Africa. The highlands of north-western Tanzania, eastern Uganda, Ethiopia, Brundi and Rwanda have also had recent epidemics.
He also cited the case of the Gulf of Guinea where the government was able to fully control the disease in the 1980s, only to see it recur years later as the parasite developed resistance to chloroquine, the medicine used to control malaria there. Beating malaria would take constant vigilance and persistence with effective control programmes.
Effective malaria control, Akhwale said, needed to include an environmental management component. His department s programme incorporated measures to protect the environment, but it was not always possible to include these measures in national policy because environmental considerations were overridden by economic factors. He noted, however, that businesses and industry in Kenya were becoming more environmentally conscious.
So, it s just the beginning of the war, said Akhwale. He believes that there has been an overall reduction in the cases of malaria over the last two years in Kenya; But we should not be excited that we can control the malaria anytime soon.