RESUMO
As less than twenty five per cent of persons suffering from malaria seek formal treatment in most of sub-Saharan Africa, Facility-based morbidity statistics are inadequate for monitoring malaria control programmes. This explorative study assessed whether a health centre equipped with a microscope and trained personnel could monitor malaria transmission within its catchment area. The study was conducted at Chemase Health Centre in Nandi District in Kenya, an area holoendemic for malaria with Anopheles gambiae as the main vector and Plasmodium falciparum as the commonest cause of malaria. From first August to 31 October 1991, first seven children under five years of age on each working day accompanied by their mothers to the maternal and child health clinic were studied. A general examination was performed by a Registered Clinical Officer (Medical Assistant) and thin and thick blood smears made, stained with Giemsa stain and examined for malaria parasites by a Medical Laboratory Technologist. Mothers were interviewed by enrolled community nurses on antimalarial measures they were using in their homes. Four hundred and fifty five children mostly under five years of age, consisting of 48.1% males and 51.9% females, were studied. Malaria parasites were present in 209 (45.9%) blood smears of the children. The percentage of blood smears positive for malaria parasites was high in children below 36 months of age. There was a tendency for low percentage of blood smears positive for malaria in children whose mothers reported using mosquito nets or insecticide sprays. The study did not interrupt the routine of the health centre. Periodic monitoring of new malaria illnesses. and percentage of blood smears positive for malaria parasites in children aged 0 to 35 months should be introduced into health centre practice in Kenya. This catchment area approach could be used to monitor malaria control programmes as well as predicting malaria epidemics.
PIP: Traditionally, new cases are used to assess the presence and level of transmission of malaria. In sub-Saharan Africa, where only 8-25% of persons suffering from malaria use formal health services for treatment, facility-based morbidity statistics are inadequate for monitoring malaria control programs. The present study investigated whether children and mothers attending a primary health care center equipped with a microscope and trained personnel could serve as a basis for such monitoring. The first 7 children under 5 years of age presenting to Chemase Health Center in Kenya's Nandi District each day in a 3-month period in 1991 were enrolled, yielding a cohort of 455 children mostly under 5 years of age. A general examination was performed by a Registered Clinical Officer and thin and thick blood smears were prepared and examined for malaria parasites. Parasites were detected in 209 blood smears (45.9%), with the highest prevalence among children under 36 months of age. Mothers who reported use of mosquito nets or insecticide sprays were less likely to have children with malarial infection. Periodic monitoring of new malaria illnesses and the percentage of blood smears positive for malaria parasites in children 0-35 months of age should be introduced into health centers in Kenya in order to monitor malaria control programs and predict epidemics. Personnel reported that the study did not interrupt normal health center routines.
