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