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Kisumu County Malaria Bulletin – Issue 4

Director’s Message

Welcome to the fourth issue of the malaria surveillance bulletin from Kisumu County. Surveillance remains a key strategy in malaria control in our efforts to achieve the vision of malaria free Kenya. The surveillance bulletin will aim to be a scorecard of the progress made towards achieving the set targets in our Kenya malaria control strategy and Millennium Development goals.

During the third quarter of 2015/2016 – January to March 2016 , there was an remarkable improvement in the uptake of Sulphudoxine pyrimethamine (SP) amongst pregnant women attending our antenatal clinics. This is attributed to use of data in making timely decisions with intensive advocacy, communication and social mobilization activities leading to procurement of SP from Kenya medical supplies agency through the national malaria control program. However there was over testing of suspected malaria cases in some facilities.

Ladies and Gentlemen, as we continue fighting malaria, I would like to thank you all for your great support during this years’ world malaria day. It was during this event that we observed great participation of schools in passing key malaria messages through football, poems, theatre dramas and songs. Everyone in the community therefore has a role to play in either small or big way in control of malaria.

Keep up the spirit and Pamoja Tumalize Malaria Kenya.

June 2016

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Outpatient confirmed malaria cases

Figure 1a: Outpatient confirmed malaria cases per thousand persons

Figure 1b. Outpatient TPR for < 5years and all ages

Figure 1a shows the number of outpatient suspected malaria cases that are confirmed to have malaria parasite by microscopy or rapid diagnostic tests (RDT) per 1000 people resident in Kisumu. As shown in the graph there was an increase in the outpatient cases in the last quarter as compared to the same quarter the previous years. This could be attributed to the El Niño rains that were experienced.

This indicator shows the overall outpatient test positivity rates for the under fives and all ages in Kisumu County. The graphs indicate the proportion of malaria cases that tested positive against the total number of cases tested for parasites. As shown in the graph the there was a decrease in the outpatient TPR cases as compared t o the previous quarter. This could be as a result of decrease in the El Niño rains that were experienced in the previous quarter.

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Figure 2: Suspected malaria cases among the outpatients tested with parasite-based test

Figure 3: Outpatient cases treated with ACT as a proportion of confirmed malaria cases

This indicator illustrates the percentage of the suspected malaria cases among the outpatients that underwent a laboratory diagnosis (rapid diagnostic tests or Microscopy). There is a gradual upward trend in parasite based test of malaria cases as observed in the last quarter. This could be as a result of the redistribution of malaria commodities within Kisumu county and the rapid diagnostic tests supplies by Kenya medical supplies agency to the lake endemic counties increasing supply hence more testing.

Kisumu County has adopted the policy of testing suspected cases of malaria before treatment. The first line anti-malarial for uncomplicated malaria - artemisinin-based combination therapy (ACT), should only be administered to patients who are tested for malaria parasites using a parasite laboratory test, and the results are positive. This indicator shows the percentage of outpatient cases that were treated using ACT over the number of confirmed malaria cases (positive parasitological results) expected to be treated with appropriate anti-malarial medicines during the reporting period.

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Figure 4: Coverage of clients receiving LLINS and IPT2 during antenatal visits

Figure 5: Reporting rates by data sources

The prevention of malaria in pregnancy involves combination strategies aimed at reducing maternal and perinatal morbidity and mortality occasioned by malaria. The strategies includes antenatal care (ANC) package that comprises of at least two doses of intermittent preventive treatment (IPT) for expectant mothers and provision of long lasting insecticidal nets (LLINs). The graph shows an improvement in the uptake of both IPT1 and IPT2 which has been occasioned by the procurement and distribution of the sulfadoxine-pyrimethamine to health facilities.

The Malaria data is derived from various routine data reporting systems that includes the district health information software Ver2 (DHIS2), electronic-integrated disease surveillance and response (EIDSR), and the logistics management information system (LMIS). The reporting rates presented are for DHIS2 and LMIS indicating the number of health facilities that send in monthly reports against the number of health facilities expected to report each month. In this quarter there was a marked decrease in reporting rates of malaria commodities as compared to the previous quarter

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Figure 6: Outpatient all cause and suspected malaria cases all ages

Figure 7: Outpatient test positivity rate for all ages

This section is an overview of how the sub counties performed in malaria case management, routine LLIN distribution and IPT uptake in the six sub counties.

Figure 7 shows that total positivity rate still remained high in the third quarter in all the sub counties. Overall there was an increase in outpatient test positivity rate for all the sub counties in this quarter. Seme and Nyando still have the highest positivity rates.

Outpatient confirmed malaria cases

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Figure 8: Percentage of coverage with outpatient treated with artemisinin-based combination therapy

Figure 9a: Coverage of clients receiving IPT2 during antenatal visits

The treatment guidelines emphasize testing before treatment of malaria. Figure 8 indicates that some of the patients in Kisumu county still receive ACT without a laboratory confirmation test for malaria. The lack of this commodity may have contributed to this occurrence, however, in this quarter there has been a decrease in coverage as compared to the previous quarter except in Nyando and Seme sub counties which reported an increase in coverage.

There is a general increase on IPT2 uptake in all the sub counties. This could be as a result of procurement and distribution of SPs to the sub counties

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Figure 9b: Coverage of clients receiving LLINs during antenatal visits

Table 4: Reporting rates by data sources

The routine net distribution is effective as reflected on the graphs. In this quarter, there is a general increase in coverage of clients receiving LLINs during antenatal care visits. This coverage was however higher than the target of 100% for most of the sub counties except in Nyando and Seme.

Table 4 shows the reporting rates for malaria commodities in the DHIS 2. In this quarter, most of the sub counties did not report malaria commodities on time.

Sub-County Name

Reporting Rates - DHIS Reporting Rates - Malaria Commod-ities

Qtr4 - 14/15

Qtr1 - 15/16

Qtr2 - 15/16

Qtr3 - 15/16

Qtr4 - 14/15

Qtr1 - 15/16

Qtr2 - 15/16

Qtr3 - 15/16

Kisumu County 98.4 98.2 100.0 96.9 93.8 93.5 95.1 71.8

Kisumu East 94.4 96.8 99.2 97.6 88.9 88.3 85.0 81.7

Kisumu West 100.0 98.5 93.9 89.9 100.0 100.0 91.7 50.0

Muhoroni 98.9 96.8 98.9 96.9 98.7 95.2 92.9 88.9

Nyakach 97.5 100.0 100.0 100.0 82.5 90.9 95.5 64.8

Nyando 98.4 96.8 100.0 97.0 87.0 96.3 88.9 72.2

Seme 100.0 95.8 100.0 98.6 98.3 83.3 92.4 60.6

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Editorial Team

Managing Editor: Dr. Dickens Onyango

Editor: Lilyana Dayo

Writers: George Odhiambo, Dr. Peter Ouma, Elly Nyambok, Cecilia Ochieng, Dr. Agneta Mbithi, Dr. George Wadegu

Design: MEASURE Evaluation PIMA

Contacts: lilyanadayo@gmail.com, Department of Health, Kisumu County, Malaria Control Coordinator