Malaria interventions in Kakamega county
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Transcript of Malaria interventions in Kakamega county
African Canadian Continuing Education Society
An analysis of the sustainability and effectiveness of Malaria intervention programs supported by the government and donor partners within Kakamega
County, Kenya
Naira Tahir, Monica Amunga Wamwayi, Lucy Tengeye
7/15/2011
Abstract: Malaria is the leading cause of morbidity and mortality in Kenya. In 2008 it was reported that there was an estimate 74 deaths per 1000 individuals throughout the country. Much effort has been taken by the Ministry of Health and the Government of Kenya to eradicate the disease through free distribution of mosquito nets in local communities, education initiatives that are extended to each household, frequent surveillance and media broadcasting to reach populations on the prevention of the disease. Nonetheless, due to lack of government and donor funding, monitoring and evaluation does not effectively determine if government intervention programs are sustainable within the community.
TABLE OF CONTENTS
Chapter One: Introduction
1.1 Background
1.2 Statement of the Problem
Chapter Two: Objectives and Research Questions
2.1 Objectives of the Study
2.2 Research Questions
2.3 Significance of the Study
2.4 Justification for the Study
2.5 Limitations of the Study
2.6 Scope of the Study
Chapter 3: Methodology
3.1Study Area
3.2Research Design
3.3Sampling Procedures and Sample Size
3.4Data Collection Procedures
3.5Data Analysis Method
References and Questionnaire
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
Malaria is the number one cause of death in Kenya. The Government of Kenya has made
numerous initiatives to prevent the disease and decrease the mortality rates. In 2009 the Ministry
of Health determined that there were an estimated 158,542 reported cases in Kakamega Central
and in 2010 over 160,000 reported cases in this region alone. Epidemiological zones classify
Kakamega County in the Lakeside region, as a high risk malaria area and a region where the
disease is constituted as an endemic. Deaths due to malaria are significantly high in April, May,
June and July.
Community initiatives to bring down the numbers in admissions and outpatient cases are being
implemented through the Ministry of Health partnered with UNICEF, Global Fund, CDC, and
other organizations in the prevention of the disease. A community based strategy was started in
Kakamega County in 2006 with government and donor support. The initiative has established 31
malaria clinics within Western Province and plans to have a universal coverage of mosquito nets
by distributing nets to communities within Kakamega. The community strategy works to
empower people to take care of their own health at the community level by emphasizing
education and prevention. This includes training health workers to make home visits to educate
individuals on prevention and care for malaria and use a surveillance tool to assess the number of
nets in each household and curative measures taken to ensure that access to treatment is taken
early enough. Additionally, the cost of malaria medication has been reduced so that more
individuals can purchase malaria medicine. Media houses are also giving free air-time to inform
the public on prevention of malaria. The aim for the government is to have a malaria free Kenya
by 2017.
Regardless of these initiatives, it has been shown that individuals may still misuse mosquito nets,
for example covering vegetables from insects and protecting gardens from grazing animals
instead of its intended use. Additionally, there are a number of unreported cases of malaria, as
individuals neglect using primary health care for prevention and care of the disease. Due to a
relatively high number of reported cases within the region and lack of funding to monitor and
evaluate prevention programs, an assessment will determine whether intervention programs are
as effective.
1.2 Statement of the Problem
Malaria continues to be the number one killer disease in Kenya which has resulted in millions of
deaths throughout the world regardless of intervention efforts made to help reduce the death toll.
This analysis helps to understand if these initiatives will be effective in significantly reducing the
prevalence of the disease with the combination and preventive measures sustained after the
interventions are complete. Lack of funding from the government and donor organizations have
limited monitoring and evaluation to determine if the interventions are effective. The study aims
to evaluate the sustainability of the malaria pandemic interventions and the effectiveness of
prevention measures implemented in Kakamega County Central in Kenya. It will take place from
September 2011 until December 2011 (a period of 4 months)
A mosquito net is seen on the right which is being used to dry farm produce as opposed to it’s intended as a bed net to help prevent malaria.
Hypothesis
Intervention programs implemented by the Government of Kenya and donor organizations in the
prevention of Malaria are not being sustained within the community and therefore not decreasing
the number of reported cases or the mortality rate within Kakamega County Kenya.
CHAPTER 2: OBJECTIVES AND RESEARCH QUESTIONS
2.1 Objectives of the Study
General Objective
1. Evaluate and assess the level of utilization in hygienic measures in the prevention of Malaria
2. Evaluate and assess the level of utilization of environmental measures in the prevention of Malaria
3. Evaluate and assess the utilization of curative measures in the prevention of Malaria
Specific Objectives
1. To determine the factors that result in the spread of malaria by performing a literature
review of relevant data using the Ministry of Health and partnering agencies to provide
information on the disease which will be completed within the first 4 weeks after the
initial start of the study.
2. To evaluate the use of preventive measures (environmental and hygienic) for malaria that
are initiated by the government and donor organizations in Kakamega county Kenya
which will be completed from October 2011 to November 2011
3. To evaluate the use of curative measures for malaria initiated by the government and
donor organizations in Kakamega county which will be completed from October 2011 to
November 2011
4. To determine the effectiveness of health promotion programs utilized in the public health
sector and amongst donor partners in the prevention of malaria within Kakamega County
Kenya which will be completed from October 2011 to November 2011
2.2 Research Questions
Section Research Question
A. Household What do you do to prevent malaria in your environment?
How is the mosquito net being utilized in the household?
Do every 2 people in the household have a mosquito net?
When malaria presents, do you use curative measures to treat it?
Do you utilize an insecticide in your household?
Have you been educated on prevention of malaria?
What do you do to prevent malaria in your environment? (i.e. removing stagnant water)
B. Government and Donor Organizations
What preventive methods are being implemented to control malaria in the community?
Which drugs do you recommend individuals use for the treatment of malaria?
What is the relevant and updated epidemiology of the disease (mortality rates, prevalence rates, incidence rates, surveillance etc.) within Kakamega County?
To what extent does the Division for Malaria Control work with community leaders, faith based organizations, and partnering bodies in the prevention of the disease?
C. Faith Based Organizations Do you educate your community on prevention of malaria?
How best do you work with the government on prevention and health promotion?
What supplements do you provide on the malaria intervention program?
2.3 Significance of the Study
The findings of this study will be useful to disaster mitigation agencies that will use it to
formulate policies to make their response strategies more effective. The findings will also be
used by the Kenyan government, the Ministry of Public Health & Sanitation, NGO’S , CBO’S
and other donor partners dealing with health programs to determine the current situation of
Malaria intervention strategies and how to make them more sustainable. The emergency bodies
such as Red Cross will also benefit from the study by knowing the endemic and epidemic areas
of malaria in Kakamega County hence they will know the areas to lend assistance in remedying
these shortcomings. Government agencies dealing with emergency response will get to know
where they should channel resources through the study hence assisting them being effective in
resource utilization.
2.4 Justification for the Study
Currently, there is no empirical study that has been conducted to establish the sustainability of
the malaria interventions in Kakamega County, Western Province, Kenya. The current study
will therefore target to fill this gap in knowledge.
2.5 Limitations of the Study
The major limitation of this study will be the financial and time limitations that may not allow
the researcher to reach all the key stakeholders in Kakamega County to carry out an in-depth
investigation. However, all possible measures will be put in place to ensure the data collected
will be sufficient and significant to allow for generalization and valid conclusions. The time
frame of the study shall be limited from September 2011 until December 2011, and the study
shall focus only on Kakamega County and the malaria interventions used by the Kenyan
Government and other donor partners in the medical field within the county. Lack of authentic
documented information by the implementing partners on malaria interventions in Kakamega
County will be the other limitation of the study.
2.6 Scope of the Study
This study will limit itself to Kakamega County. It will target MOH, PDO’s, DDO’s, CSO’s,
CBO’s, non-governmental health organizations, faith based organizations, partnering agencies,
funders, stakeholders, and the inhabitants of Kakamega County, Kenya.
CHAPTER THREE: METHODOLOGY
3.1 Study Area
This study will be carried out in Kakamega County, an administrative County of Western
Province in western Kenya. According to the 2009 National Population and Housing Census,
Western Province has a population of 4,334,282 and Kakamega County has a population of
1,660,651, being among the top 10 most populated areas nationally. (Daily Nation, Wednesday
September 1, 2010). The main industries are subsistence agriculture and fishery on Lake
Victoria.
3.2 Research Design
The research design that will be adopted for this study will be a descriptive survey. This design
was chosen because it gives more accurate research results, this is because the design enables the
researcher to gather data from a large population of the study area. Kerlinger (1973) confirms
this view when he states that survey is a method that studies large population (universe) by
selecting and studying the samples from the population to discover the relative incidence,
distribution and interrelations of sociological and psychological variables. Survey also enables
the researcher to collect data across the years that the study is intended to cover.
3.3 Sampling Procedure and Sample Size
Purposive sampling will be used to select only subjects who will provide relevant data for the
study. Due to the small number of donor partners implementing health programs within
Kakamega County, all the subjects in the population will be targeted by the study.
Table 1: Sample Sizes
Category Total Sample Percentage
Provincial Hospitals 1 1 100%
DMOH 7 7 100%
PDO 1 1 100%
District Hospitals 8 8 100%
Local Churches in Kakamega County
10 10 100%
Local Administrative Bodies (i.e.: Assistant Chiefs and Chiefs Stations)
24 24 100%
Households within Kakamega County
1000 1000 100%
Total 1051 1051 100%
3.4 Data Collection Procedure
Before proceeding to field to collect data, the researcher will get permission from the
departmental head in the school of Disaster Management and Humanitarian Assistance at
Masinde Muliro University of Science and Technology. The researcher will also seek permission
from the Provincial Medical Officer, District Medical Officers, and other donor partners within
the County, the concerned provincial Administration Offices and the area Councilors. Data will
mainly be collected using questionnaires and interview sessions. The questionnaires will have
structured items.
3.5 Data Analysis Method: The quantitative data collected such as response to the structured
close-ended questions from questionnaires will be rated in frequencies and percentages. This
quantitative data will then be analyzed using computer software to determine statistical
significance. Qualitative data in the form of open-ended questions and interviews will be
triangulated in order to turn qualitative data into quantitative data. A narrative analysis will also
be conducted on qualitative data retrieved
REFERENCES
APPENDIX
A. Questionnaire
Section Research Question
A. Household What do you do to prevent malaria in your environment?
How is the mosquito net being utilized in the household?
Do every 2 people in the household have a mosquito net?
When malaria presents, do you use curative measures to treat it?
Do you utilize an insecticide in your household?
Have you been educated on prevention of malaria?
What do you do to prevent malaria in your environment? (i.e. removing stagnant water)
B. Government and Donor Organizations
What preventive methods are being implemented to control malaria in the community?
Which drugs do you recommend individuals use for the treatment of malaria?
What is the relevant and updated epidemiology of the disease (mortality rates, prevalence rates, incidence rates, surveillance etc.) within Kakamega County?
To what extent does the Division for Malaria Control work with community leaders, faith based organizations, and partnering bodies in the prevention of the disease?
C. Faith Based Organizations Do you educate your community on prevention of malaria?
How best do you work with the government on
prevention and health promotion?
What supplements do you provide on the malaria intervention program?
A. REFERENCES
Ministry of Health
Division of Malaria Control
http://www.nmcp.or.ke/section.asp?ID=4