Dorothy Kweyu
25 April 2008
Nairobi — When a community nurse in a Kisumu neighbourhood received a phone call from a friend asking her to attend to a very sick sister-in-law, little did she know what awaited.
The patient, Mrs Agnes Oloo*, 23, who had lived in a childless marriage for five years, had all the clinical symptoms of malaria.
"She was running high fever, a temperature of 40 degrees Celsius, and was vomiting a lot," says the nurse, who requested anonymity because of the drastic decisions she had to make to save the patient's life.
"I wanted to refer her to the general hospital, but when she told me that she had earlier been admitted to a private hospital for five days with no improvement, I decided to handle the case as best I knew," said the 52-year-old nurse.
Mrs Oloo then said she had missed her periods for one month. This prompted the nurse to do a pregnancy test even as she sent a blood sample to the lab for a malaria test.
The pregnancy test turned out positive, as did the malaria test, which showed a parasite load of three plus - very high.
The nurse decided to put Mrs Oloo on a quinine drip, a procedure that should normally be administered in a hospital.
Happily, Mrs Oloo responded well to the treatment. "She is now very pregnant," says the nurse with a chuckle.
At Kiboswa Medical Clinic, Lucy Wayodi, a clinical officer, describes malaria among pregnant women as "very bad; it can result in miscarriage."
"When (malaria) parasites fill the placenta, they make the mother anaemic and can kill the baby," says Ms Wayodi.
She advises that serious cases of malaria, especially in pregnancy, be referred to a hospital, because of the high risk of miscarriage or premature birth.
Both Ms Wayodi and the nurse, are part of a Government initiative known as the National Malaria Strategy 2001-2010, which is aimed at fighting malaria as part of the UN decade to roll back malaria.
The initiative targets pregnant women who are at the greatest risk of dying from malaria. It involves distribution of insecticide-treated mosquito nets to mothers at a highly subsidised cost of Sh50 each.
The division of malaria control in the Public Health Ministry describes malaria as the leading cause of illness and death in Kenya.
According to officials from the division, 25 million out of the 34 million Kenyans are at risk of contracting malaria. It is estimated that 170 million working days are lost to the disease each year.
The disease is also responsible for 20 per cent of all deaths of children aged five years and below. The division describes this age group and pregnant women as most vulnerable to malaria.
The management of malaria and anaemia in pregnancy is one of the Government's key strategies in bringing down the prevalence of the disease, which is endemic in the Lake Victoria region.
In this region, the disease occurs throughout the year unlike in Nairobi, Nyeri and Nakuru which are considered to be malaria-free.
Malaria, which is prevalent across Africa, is caused by Plasmodium falciparum. Africa accounts for 90 per cent of malaria cases globally.
Although people around the lake region and Coast Province live within areas where malaria is prevalent, women in low malaria transmission areas are at greatest risk of contracting malaria in pregnancy.
Immunity level
This is because such women have not acquired any significant level of immunity and usually become ill when infected with Plasmodium falciparum.
Accordingly, they are at a two-or-three times greater risk of developing severe infection than are the non-pregnant women in the same regions.
Malaria kills either directly or indirectly because of the anaemia that the parasite causes in pregnant women. The high fever that an infected woman suffers can result in convulsions, which unless attended to promptly, can result in death.
Miscarriage, death of the newborn and low birth weight are some of the effects of malaria in pregnancy.
The reason why women in low malaria prevalence areas are at higher risk of dying from the disease is that they are most likely to suffer the full symptoms of the disease, including convulsions.
First symptoms
According to the US Centers for Disease Control (CDC), the danger in malaria lies in the fact that its first symptoms (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific and are also found in other diseases such as the flu and common viral infections.
In the Kisumu area, a doctor's worst nightmare lies in confusing malaria symptoms with those for typhoid.
Indeed, self-medicating patients have died after taking anti-malaria drugs when they actually needed typhoid treatment. By the time the typhoid, which is also common in the lake region, is diagnosed, the patient's intestines have been damaged, leading to death.
High temperature, perspiration and fatigue, which are associated with malaria, are also not specific to the disease. Such symptoms are also linked to Aids, which has serious implications in pregnancy and malaria.
In severe malaria, clinical symptoms such as confusion, coma, severe anaemia and respiratory difficulties are more striking and may increase the suspicion index for malaria, says a document from the CDC.
"Thus, in most cases, the early clinical findings in malaria are not typical and need to be confirmed by a laboratory test," the centre adds.
It is the above symptoms, which are often severe in first-time patients, that make malaria so dangerous for pregnant women in non-endemic area.
Malaria results in low birth weight babies because the parasites feed on the nutrients in the mothers' blood, technically starving the unborn child.
Child survival is also compromised since such babies are prone to disease compared to others.
Because of the serious implications of malaria on the lives of women and children, the Government and various partners have joined hands to roll back malaria through distribution of mosquito nets.
The campaign targets pregnant women and mothers with children aged below five years.
Ms Wayodi of Kiboswa, for instance, said that through the Population Services International, they were acquiring insecticide-treated mosquito nets at Sh30, which they sell at Sh50. Retail outlets in Nairobi sell untreated mosquito nets at Sh300 on average.
Compared to the major risks associated with malaria, which go beyond the medical cost of admission to hospital, the cost of treated nets through the Roll Back Malaria initiative is an option that has drastically brought down the prevalence of malaria.
Treated nets
Ms Wayodi confirmed that medics were now recording fewer cases of severe malaria in pregnancy than before the introduction of the insecticide-treated nets.
Coupled with routine coverage of all pregnant women with anti-malarials, the thrust to roll back the disease appears to be bearing fruit.
But there is no room for complacency. As the world marks the malaria day, it is to be hoped that special attention will go towards creating greater community awareness on the dangers the disease poses especially to women and children.
Such effort should also target the dangerous trend of self-medication, which can be lethal especially in cases of misdiagnosis.
The patient's name has been withheld at the nurse's request.
Though preventable, the disease kills 92 children every day
Although malaria is a preventable and curable disease, it remains the leading cause of death and illness especially among pregnant women and children aged five years and below.
The disease, which is spread by infected female mosquitoes - anopheles gambiae - kills 34,000 children aged five years and below annually, or 92 children daily.
The disease also leads to the birth of 6,000 underweight babies each year and is the leading cause of anaemia among pregnant women.
Malaria also accounts for 20 per cent of all hospital admissions and between 30 to 50 per cent of outpatients. According to experts, about 25 million people in Kenya are at risk of malaria attacks every year.
In Kenya and other sub-Saharan African countries, the type of malaria parasite commonly found, Plasmodium falciparum, causes a severe, potentially life-threatening infection.
SYMPTOMS OF MALARIA include fever, chills, headache, muscle aches and fatigue. Nausea, vomiting and diarrhoea may also occur.
Malaria may cause anaemia and jaundice (yellow colouring of the skin and eyes) because of the loss of red blood cells.
Infection by one type of malaria - Plasmodium falciparum - if not promptly treated, may cause kidney failure, seizures, confusion, coma and eventually death.
For most people, symptoms begin 10 days to four weeks after infection, although a person may feel ill as early as eight days or up to one year later.
Two kinds of malaria - Plasmodium vivax and Plasmodium ovale - can relapse; some parasites can rest in the liver for several months up to four years after a person has been bitten by an infected mosquito.
When these parasites come out of hibernation and begin invading the red blood cells, the person will become sick.
Malaria is diagnosed by looking for the parasites in a drop of blood. Blood will be put onto a microscope slide and stained so that the parasites will be visible under a microscope.
EXPERTS ADVISE COMMUNITIES where malaria is prevalent to ensure they sleep under insecticide treated nets for protection against mosquito bites.
Other effective methods of malaria control include indoor residual spraying, screening of houses, environmental management and killing mosquito larvae using pesticides.
Additional reporting by Mike Mwaniki
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