Cubans or not Kenya experts say ready to beat malaria

By Gatonye Gathura

Frustrated by the antics of malaria mosquitoes and coming of Cubans, local experts say they are ready to deal the insect a decisive blow.

“We are up to the task,” local scientists said as they walked us through their malaria fight back plans.

However current evidence shows malaria to be on the rise with both the mosquito and parasite having mastered new tricks against available control technologies.

Such tricks include mosquitoes changing meal times, feeding on beef when humans go under bed nets and waylaying night workers such as twilight girls, bodaboda riders, revelers and watchmen.

When control campaigns, for example at the Coast put babies under bed nets, mosquitoes had swiftly turned to the older and less protected school-age children.

“Suddenly more school age children than infants were reporting to the hospital with malaria,” says Aisha a health worker at Coast General.

Dr Ejersa Waqo, Head of the National Malaria Control Programme says malaria prevalence rose from four per cent in 2010 to eight per cent in 2015.

Insecticide treated nets with about 50 million pieces distributed in Kenya between from 2004 to 2015 have been the bedrock of malaria control in Kenya.

But over time the mosquito has managed to interact with the nets with little consequences.

“We used to collect dead insects in the mornings but now we see them cat walking all over the nets,” says Miriam Adhiambo, of Nyando in western Kenya.

For insects hanging around in the house waiting for owners to return for the night, indoor spraying with deadly chemicals such as DDT had been introduced.

The insects however have since learnt to live with the pesticides without being poisoned while spreading malaria.

“Initially it seemed to work, but not anymore, the insects are hanging all over the houses seemingly with no care,” said Naomi Chepkurui a farmer at Kambi Samaki in Baringo.

But these are hardly the only problems facing malaria control in Kenya with the parasite reported to have breached the second line of defense.

Last June (2017) the Kenya Medical Research Institute (Kemri) said the first line malaria treatment called AL was losing potency and advised it be replaced.

Seemingly frustrated with these failures and attendant 20,000 annual deaths, President Uhuru Kenyatta in March invited Cuban experts to help.

Though details are still being worked out Dr Waqo says 10 vector control experts from Cuba are on the way.

Initially, Dr Waqo says the Cubans will deploy in eight counties around Lake Victoria where malaria prevalence is highest at about 27 per cent.

“The first phase of the programme will last two years and we have reserved Sh500 million for the project,” said Dr Ejersa during a malaria briefing in Nairobi.

Cubans are coming to kill mosquitoes at their breeding sites using naturally occurring bacteria in a technology called larviciding.

Larviciding though is not new in Kenya having been tried in scientific studies and confirmed to be effective in western Kenya and at the Coast since 2005.

The most recent trials published this month (July 2018) showed larviciding to reduce mosquitoes by up to 65 per cent for up to six months.

The study by Kemri, and colleagues from Tanzania and the US was carried out in Kakamega using larviciding formulations manufactured by Central Life Sciences of the US.

“We found larviciding to be safe and effective,” says Dr Andrew Githeko, a senior researcher at Kemri and study co-author.

Dr Githeko says combined with effective bed nets, medicines and soon to be launched vaccine, larviciding will be an important tool.

Already there is a newly developed bed net that is effective against insecticide resistant mosquitoes.

Called PBO LLINs or Piperonyl butoxide long lasting insecticide treated nets will be available in some parts of the country with high insecticide resistant mosquitoes.

In March, Dr Yeri Kombe director Kemri reported their new study of the drug Ivermectin, found to kill mosquitoes when they bite treated humans.

“This may play a major role in malaria elimination while targeting insecticide resistant and outdoor mosquitoes,” said Dr Kombe.

“We have adequate and effective technologies to deal malaria a decisive blow,” said Dr Githeko.

But what happens next, scientists say depend on policy makers, though they refused to be drawn into the subject that would involve discussing their bosses.

Kenya could learn from Tanzania which in 2013 with technical assistance from Labiofam of Cuba opened the $2.1 million Tanzania Biotech Product Limited at Kabaha for the production of larvicides.

In April a Tanzania government report showed the factory to be on the verge of collapse due to lack of product demand. This is because malaria control projects were found to prefer technologies driven and paid for by donors.

The Sh500 million set aside for the Cuban led larviciding in Kenya is insignificant in the annual Sh10 billion malaria budget, largely provided and controlled by donors.

Major malaria donors in Kenya include the US government, Global Fund and the World Health Organization.

With support from the African Academy of Sciences (AAS)



Malaria milestones Kenya

1910: Deployment of “Mosquito Brigades” for larval control

1912: Sanitary inspectors dispatched to Nairobi, Kisumu and Mombasa

1925: First national malaria control policy

1941: Anti-Mosquito Military Unit created

1944: First use of DDT in Indoor Residual Spraying (IRS) reported in Kericho

1944: Chloroquine (CQ) adopted as first line malaria treatment

1959: Daraprim(drug) was introduced prevention and treatment

1963: Independence from Britain

1986: DDT use banned in Kenya

1990 First laviciding in Kenya

1991 Widespread failure of CQ

1993 Large-scale trial of Insecticide Treated Nets (ITN)

1998: CQ replaced with sulphadoxine-pyrimethamine (SP)

2002: Long Lasting Insecticide Nets (LLIN) adopted

2006: Artemisinin Combination Therapy (ACT) adopted with AL replacing SP

2006: Reintroduction of DDT

2010: Launch AMFm – highly subsidized malaria medicines but failed a year later

2011: Resistance to pyrethroid and DDT detected

2013: New Constitution promulgated and health devolution begins

2013: Artesunate replaced quinine for treatment of severe malaria

2015: Strategy to eliminate malaria by 2017

2016: Kenya signs UN framework to eliminate malaria by 2030

2017: Kemri say AL losing effectiveness

2018: Kenya invites Cubans to do larviciding



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