Merlin programmes worldwide Update 01 Oct 1999: Kenya

At a Glance
The Situation

  • The western highlands of Kenya is affected by its worst ever epidemic of malaria.
  • Changing weather patterns and increasing drug resistance has caused the disease to escalate.
  • Up to 79% of children under five and 37% of adults are suffering from malaria in the region.

Merlin Programme

  • Responding to a malaria epidemic in Kisii & Gucha districts, western highlands of Kenya.
  • Running mobile health clinics to provide treatment in isolated communities.
  • Providing health education and distributing impregnated bed nets to prevent malaria.

Merlin's Response

Merlin began working in Kenya in 1998 in response to a malaria outbreak in Wajir in the north-east of the country. In May 1999, western Kenya was devastated by a similar epidemic and Merlin launched an immediate intervention in the worst affected districts of Kisii and Gucha.

A survey was carried out of villages throughout the area to determine the full extent of the epidemic. This revealed a catastrophic situation with up to 47% of the total population infected with malaria; more than double the level of previous years. Increasing populations, changing climate and widespread resistance to the usual drugs have all contributed to this dramatic rise.

However, despite health centres running at 300% of their designed bed & staffing capacity - the hospital alone is treating 500 patients with only 200 beds - the majority of people remained untreated in the district, and many have little access to health care.

Working with the Ministry of Health, Merlin is running four mobile health clinics to provide medical care to people in isolated communities. In the three months since the programme began, Merlin has treated 35,000 people for malaria. At the same time, we have supported and expanded three regional health centres, and thereby provided extra beds and staff to cope with the growing number of patients. Just as importantly, Merlin is ensuring that treatments are used correctly, to limit drug resistance.

Prevention is as important as cure. To this end, Merlin is carrying out a two-phase programme to protect the population from malaria whilst also destroying the disease at source - the mosquito. In the first phase, at the height of the epidemic, we are spraying insecticide onto household walls to kill the mosquitoes as they land to rest. This technique has been proven to reduce the level of malaria by up to 60%. In two months, we have already sprayed almost 6,500 houses, providing protection to approximately 45,500 people.

As the epidemic has started to diminish, Merlin has begun the second phase of prevention - use of impregnated mosquito nets. Initially, our teams are distributing 20,000 mosquito nets to the most vulnerable people - children & pregnant mothers. As families share sleeping areas, these nets will provide protection to 80,000 people. Health education will also form an important element to encourage people to use the nets and re-impregnate them with insecticide when necessary. This approach can reduce malaria by 80% and its long-term impact will help limit the extent of the epidemic next year.

Health Overview

"Each year one million people worldwide die from malaria - more than from any other tropical disease"

There are 300 million cases of malaria reported worldwide each year. This is one for every 20th man, woman or child and nearly five times as many cases as TB, AIDS, measles and leprosy combined. 95% of deaths occur in sub Saharan Africa, of which 85% are amongst children under five years of age. In Kenya, 50% of childhood illness is malaria

Malaria has symptoms similar to influenza, including fever, vomiting and headache, and, as the parasite invades and destroys the blood cells, anemia. In severe cases, it infects the brain and death can occur within 24 hours. The malaria parasite is spread by the mosquito, which passes on the infection through its bite.

Strategies to prevent malaria focus upon preventing the mosquito biting people. The most effective technique available to-date is the use of mosquito nets, impregnated with insecticide. They provide protective barrier for those sleeping underneath as well as the insecticide killing the mosquito itself. This reduces the pool of insects in the environment.

Unlike AIDS or TB, treating malaria can be relatively simple, given the necessary resources and treatment. Even in severe cases, patients can be cured in only a few days. In recent years, resistance to particular drugs has emerged and developing new medicines has become a priority.

The need for more concerted and collaborative methods by which to tackle malaria and thereby reduce this incredible death toll has now been recognised. The World Health Organisation (WHO) has launched the "Roll Back Malaria" initiative bringing together governments, pharmaceutical companies, medical institutes and aid agencies to improve ways of fighting the disease. It aims to prevent half of all malaria deaths in the next ten years. Merlin is one of the lead implementing partners of this initiative.

Country Background

Kenya became independent from British rule in 1963, and until recent years was one of the most stable and least violent countries in Africa. Since 1992 however, lawlessness has become increasingly rife and this level of insecurity has resulted in both a sharp decline in visitors and the state of the economy.

Kenya's main sources of income are agriculture, with cash-crops of coffee, tea and tobacco; relatively well-developed industries, and tourism, particularly around the game parks.

Kenya is the 22nd poorest country in the world. Half of its 28 million population exist on less that $1 per day and it has one of the highest divides between the rich and the poor.

Approximately, 55% of people work in service industries, 26% in manufacturing and construction, and 19% in agriculture and forestry. However, the vast majority of the country's economically active population, consist not of wage earners but of farmers and herders at a subsistence level.

This poverty and associated ill-health amplifies the burden of malaria. Kisii and Gucha Districts have some of the highest infant, child and maternal mortality rates in Kenya. Life expectancy is low, malnutrition is high and safe water and sanitation is insufficient.

Key Indicators
Population (millions)
Population under 18 years of age (%)
GNP per capita (US$)
% Adult Literacy Rate (male/ female)
Death rate for children under 5 years of age per 1,000 live births
Women dying in childbirth per 100,000 births
Life Expectancy at birth (years)

Source: Unicef "State of the World's Children" 1999