The clinical burden of malaria in Nairobi: a historical review and contemporary audit

Abstract

BackgroundWidespread urbanization over the next 20 years has the potential to drastically change the risk of malaria within Africa. The burden of the disease, its management, risk factors and appropriateness of targeted intervention across varied urban environments in Africa remain largely undefined. This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya.MethodsA review of historical reported malaria case burdens since 1911 within Nairobi was undertaken using archived government and city council reports. Contemporary information on out-patient case burdens due to malaria were assembled from the National Health Management and Information System (HMIS). Finally, an audit of 22 randomly selected health facilities within Nairobi was undertaken covering 12 months 2009-2010. The audit included interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria.ResultsFrom the 1930's through to the mid-1960's malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. A more detailed facility review suggests, however that malaria remains a common diagnosis (11% of all paediatric diagnoses made) and where laboratories (n = 15) exist slide positivity rates are on average 15%. Information on the quality of diagnosis, slide reading and whether those reported as positive were imported infections was not established. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria.ConclusionCombined with historical evidence there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation. To be prepared for effective prevention and case-management of malaria among a diverse, mobile population in Nairobi requires a major paradigm shift and investment in improved quality of malaria diagnosis and case management, health system strengthening and case reporting.

Blood Pressure and Arterial Stiffness in Kenyan Adolescents With α + Thalassemia

“…Nairobi, the capital city of Kenya, was chosen for this study for 2 reasons. First, Nairobi is located at a high altitude (1800 m above sea level), and there is no evidence of malaria transmission . This made it possible to study the effect of α + thalassemia on BP unconfounded by the presence of malaria, which could potentially influence BP and which α + thalassemia protects against.…”

Quantifying the Impact of Human Mobility on Malaria

“…In Nairobi, the density of cell towers enabled further localization of these estimates and a comparison with cross-sectional clinical surveys of malaria incidence carried out in 2010 (16). Frequent malaria epidemics occurred in the capital at the beginning of the 20 th century, but declined significantly following substantial control efforts, rapid population growth and urbanization (16–19).…”

“…Frequent malaria epidemics occurred in the capital at the beginning of the 20 th century, but declined significantly following substantial control efforts, rapid population growth and urbanization (16–19). The current potential for local transmission within the city is controversial, with studies showing substantial infection prevalence and ongoing treatment of presumed clinical cases despite the scarcity of suitable mosquito vectors (16–19). Figure 4C shows the ratio of monthly clinical cases to our predicted monthly imported cases from mobile phone data at the location of each hospital survey (see SI for methods, Table S10, Figure S6).…”

Shifting from Presumptive to Test-Based Management of Malaria - Technical Basis and Implications for Malaria Control in Ghana

“…40,41 According to the 2010 and 2011 World Malaria Reports, appreciable progress was made between 2000 and 2010 to reduce the burden of malaria globally. A 26% decline in malaria deaths was recorded globally, with sub-Saharan Africa accounting for 33% of this decline.…”