The piece below originally appeared on PMI Impact Malaria’s blog.
As the flagship global service delivery project of the U.S. President’s Malaria Initiative, PMI Impact Malaria works with national malaria control programs (NMCPs) to fight malaria and save lives by strengthening the diagnosis, treatment, and drug-based prevention of malaria, especially for young children and pregnant women. Led by PSI—in partnership with Jhpiego, Medical Care Development International, and UCSF—PMI Impact Malaria has been working this year with NMCPs in Cameroon, Mali, and Niger to prevent childhood malaria by supporting seasonal malaria chemoprevention (SMC) campaigns, and will have reached an estimated 3.7 million children altogether.
Kakamega, Kenya — Nineteen-year-old Jane* delivered a full-term baby in a health facility near her home without complications. When the new mother was discharged a day later, there was no hint of any problem. She was happy to go home and care for her newborn.
However, six hours later, Jane spiked a fever. She experienced convulsions and confusion, and was refusing to breastfeed.
Jane’s family rushed her back to the health facility, where a clinician mistakenly diagnosed her with postpartum pre-eclampsia—a rare condition characterized by high blood pressure and excess protein in the urine, which, like severe malaria, can cause convulsions. Jane lost consciousness and immediately was referred to Kakamega County Teaching and Referral Hospital for specialized treatment. She was admitted to the intensive care unit due to her altered consciousness and put on oxygen.
Clinicians there suspected that Jane had developed severe malaria. They quickly ordered a malaria microscopy test. Sure enough, Jane tested positive for malaria and immediately received treatment for severe malaria, using Kenya’s recommended regimen of IV artesunate. These clinicians had recently participated in a refresher course on the diagnosis and treatment of severe malaria, run by Kenya’s National Malaria Control Program (NMCP) and supported by PMI Impact Malaria (IM).
Dr. Erick Anyira, the consultant doctor who saw Jane and is a trainer of trainers with NMCP/IM, felt there was a strong link between the recent training and how well Jane’s case was managed. According to him, “Were it not for the severe malaria training, Jane’s case could have been missed and would have been another funeral.”
During Jane’s hospitalization, treatment with IV artesunate led to her full recovery. She regained consciousness on the second day and was discharged a few days later to rejoin her newborn baby.
Timely diagnosis and treatment of severe malaria are critical to fighting malaria, saving lives, and ultimately achieving malaria elimination. To date, IM has supported Kenya’s NMCP in training and mentoring 84 clinicians on the identification and treatment of severe malaria.
But a lack of national data on severe malaria and malaria deaths has complicated Kenya’s fight against this mosquito-borne disease that, although preventable and curable, globally killed an estimated 405,000 in 2018 (WHO).
IM has focused its resources in Kenya on supporting the NMCP to close this gap by enhancing the availability of data on malaria in its focus counties. A training in late 2019 prompted the review and documentation of inpatient malaria data in the western Kenya counties of Kakamega, Bungoma, Busia, and Vihiga. In a three-month period following the training, 12 health facilities recorded more than 5,000 admissions and more than 600 deaths related to malaria. The findings: Malaria accounted for one-quarter of all hospital-related admissions in the four counties, and 12 of every 100 people admitted were likely to die from malaria.
Because accurate data lead to timely decisions and ultimately strengthen the quality of health services, IM is supporting Kenya’s NMCP to take positive action in communities and in the context of outpatient visits and inpatient stays, while also ensuring that community health workers are able to identify and refer severe cases of malaria to appropriate health centers.
Without a doubt, Jane and her family can attest to the personal impact that this important work has already had on strengthening malaria service delivery in Kenya.
*Not her real name.
Written by Justus Nondi and Catherine Ndungu. Contributions from Dr. Willis Akhwale, Chief of Party for PMI Impact Malaria in Kenya, and Anne Bulchis, PMI Impact Malaria Communications Manager.
Header Photo Credit: Mwangi Kirubi for PMI Impact Malaria. Caption: Emily Atieno Achieng at Ahero County Hospital in Kisumu, Kenya.
PMI Impact Malaria is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.