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

Malaria Journal

Research

Elizabeth Juma¹  Sandra A Mudhune²  Robert W Snow³  Dejan Zurovac³  Abdisalan M Noor³  Emelda A Okiro³  Sam A Ochola⁴ 

[1] Division of Malaria Control, Ministry of Public Health & Sanitation, P.O. Box 19982-00202, Nairobi, Kenya;Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, GPO, P.O. Box 43640, 00100, Nairobi, Kenya;Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, GPO, P.O. Box 43640, 00100, Nairobi, Kenya;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, OX3 7LJ, Oxford, UK;Provincial Director of Public Health & Sanitation Services, Ministry of Medical Services, P. O. Box 34349-00100, Nairobi, Kenya;

关键词: Malaria;    Health Facility;    Health Worker;    Malaria Case;    Clinical Malaria;   

DOI  :  10.1186/1475-2875-10-138

 received in 2011-01-21, accepted in 2011-05-20,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Mudhune et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.