One of the volunteers, Rose Mukhaye, reminded Delourice to regularly attend the antenatal clinics at the local Esiriambatsi Health Centre as soon as she found out she was pregnant.
“One day, Rose found me sleeping under a tree when she was doing her regular rounds in the village. She recognized that I could have been pregnant and suggested I go to the hospital to find out and to start planning for clinic visits if my result was positive. I did not know I was pregnant,” said Delourice.
Occasionally, when Delourice could not afford to pay her fare to the health facility, David would use his motorbike to drive her there to pick up Fansidar, which is medication that protects her from malaria.
High malaria cases
Delourice lives in Ebunangwe village in Vihiga County in Kenya. Vihiga is one of eight villages with some of Kenya's highest malaria cases and deaths. According to the Centre for Diseases (CDC), growing up in an environment with regular exposure to mosquito bites and malaria transmission should offer her some immunity to severe malaria, though it is not guaranteed.
Pregnancy, however, alters any potential protection. Dr. Dickson Mwakangalu, malaria specialist at the Johns Hopkins affiliate Jhpiego and Chief of Party for the United States President’s Malaria Initiative (PMI) Impact Malaria project in Kenya, said that pregnant women like Delourice lose that protection because pregnancy lowers women’s immunity.
What further complicates lowered immunity during pregnancy is that the placenta, which nourishes a child in utero, is a prime organ to which malaria can attach itself, Dr Mwakangalu explained.
“There is a risk of miscarriage and death for the mother and the baby if they develop severe malaria,” Dr. Mwakangalu said. “The malaria parasite disrupts the nutritional exchange between mother and foetus, and children are often born preterm, and with low birth weight.”
Kenya is one of the 33 countries the World Health Organisation (WHO) ranks as moderate to high malaria transmission countries, which means the majority of the population is at risk of the life-threatening disease. WHO’s 2021 world malaria report said one in every three pregnancies (34 per cent, 11.6 million pregnancies) of the estimated 33.8 million in the WHO Africa region were exposed to malaria infection.
Continentwide, the report notes that West Africa has the highest exposure rate to malaria during pregnancy (40 per cent), followed by Central Africa (39 per cent), and East and Southern Africa (22 per cent).
The WHO advises governments to protect women from infection by giving mothers-to-be insecticide-treated bed nets and prompt treatment when they fall sick. The WHO also recommends that clinicians give pregnant women sulfadoxine-pyrimethamine, a medication known by its generic name Fansidar, from the second trimester.
In 2020 alone, donors such as PMI Impact Malaria procured 21,997,664 doses of Fansidar. Countries such as Angola, the Democratic Republic of the Congo, Malawi, Mali, and Tanzania received more than two million doses.
Dr George Githuka, head of the Division of the National Malaria Programme (DNMP) in Kenya’s Ministry of Health, told Africa Renewal that the Ministry gives Fansidar to pregnant women in malaria-endemic areas in the country until the time of delivery. Despite its life-protecting potential, only 49 per cent of pregnant women took three or more doses of Fansidar in 2020 — an increase from 35 per cent in 2015, according to the Kenya Malaria Indicator Survey (KMIS).
“Intervention relies on expectant mothers going to the hospital, and this is where the community health workers [like David and Rose] are critical,” said Dr. Githuka.
The Kenyan Ministry of Health and partners, such as PMI Impact Malaria, train community health assistants like David and Rose what to tell the expectant mothers about malaria, including identifying signs and symptoms of the disease.
David and the more than 300 hundred community health volunteers he supervises know about the cultural, health system, and economic barriers that inhibit women from visiting hospitals for care. As a result, he tapped into the community’s love for socialising. He organized community meetings called Barazas, persuading the chief to talk to other men about the importance of supporting and participating in their wives seeking medical care.
Catherine Lagat, the clinician in charge of Esiriambatsi Health facility where Delourice received regular antenatal care, said she has not handled a case of pregnant women suffering from malaria since 2019. She credits this to the community health assistants and volunteers. The facility’s malaria records charts show an 80 per cent drop in malaria cases from as many as 60 per week to just 12.
Kenya is working towards reducing the number of people falling sick and dying of malaria by seventy-five per cent by 2023. Ensuring pregnant women like Delourice have information and access to care throughout their pregnancy will help this effort by decreasing the risk of women contracting malaria and its life-threatening impact on both mother and baby. The role of community health workers in teaching individuals how to protect themselves from malaria and guiding them from their homes to the clinicians when they fall sick will be essential as well.
