The MENTOR Initiative’s Response
Emergency Flood response brought the MENTOR team into Kenya in 2007 where they have been operating in both North Eastern Province and Western Province to assist displaced, host and refugee communities to reduce the burden of malaria..
North Eastern Province
The MENTOR Initiative first responded in January 2007 after El Nino caused severe flooding affecting the districts of Garissa and Tana River. Over 100,000 were displaced when the Tana River's banks overflowed and floodwaters pushed the communities surrounding Fafi out of their homes. An entire section of the overpopulated Dadaab refugee camps and villages across the district were washed out leaving some 30,000 vulnerable Somali refugees and over 100.000 people in host communities without any form of protection. In order to avoid a malaria epidemic amongst those at risk, emergency stocks of Indoor Residual Spraying (IRS), LLINs, and case management supplies were brought into the country and deployed immediately.
Communities were taught how to implement IRS campaigns to protect the entire community, and LLINs were distributed as a supplementary tool. Ensuring that the health services could deal with the caseload required scaling up and training of those providing services and providing them with the tools to accurately diagnose and treat malaria cases. A bigger challenge was accessing those in remote locations and nomadic populations where roads were washed out and almost unusable.
In 2008 another flash flood hit the northern part of the province in Mandera District. The MENTOR Initiative responded again, in this highly volatile part of the country. Primarily a Kenyan Somali area of the country, this region had seen kidnappings of internationals by Al Shabaab crossing into the country. Clan fighting in the region compounded the insecurity and made implementation of activities all the more difficult for malaria control activities.
In January 2010, The MENTOR Initiative launched a 4 year special initiative, with Comic Relief, to achieve systemic change in malaria across the three districts of Garissa, Fafi and Lagdera.Specific activities in this 4 year long Special Initiative include:
- Improve local capacity at district level to plan and co-ordinate malaria control responses in semi arid areas.
- Improve malaria case management through technical capacity building of health workers to accurately diagnose and treat malaria
- Increase speed and accuracy of malaria incidence and health facility stock reporting by establishment of a robust and "real time" ARGOS early warning system (EWS), and local climate change monitoring, comparing advance technology with paper based systems.
- Improve commodity supply chain to health facilities, and potentially in the future also to community health workers, through access to regular stock updates.
- Weekly monitoring of EWS data and climate predictions at central level to identify early indicators of an epidemic and mount timely responses.
- Increase community ownership to deliver malaria prevention activities through supply of LLINs specifically adapted for nomadic communities, technical and material support to implement indoor residual spray (IRS) campaigns to communities exposed to the risk of epidemics and, generally speaking, deliver key messages about why and how to access effective services.
- Increase community understanding of malaria, demand for and usage of effective malaria control services and participation in malaria control programming.
- Increase understanding of malaria epidemiology in NEP by all partners, including collaboration with KEMRI to implement standardised annual base line malaria surveys for plasmodium faciparum malaria, and the implementation of studies to actively identify plasmodium vivax cases and measure their relative burden.
- Improve understanding of the benefit of the standardised use of malaria RDTs and how this may contribute to health system strengthening, especially in relation to the rationalisation of ACT usage and the detection and case management of other febrile illnesses.
In September 2007 flooding in Budalangi District on the shores of Lake Victoria caused the dyke on the Nzoia River to break and flood the lower half of the district displacing 10,000 people. The same happened again in late 2008. In this malaria endemic area, the risk of infection for all 30,000 inhabitants on the flooded side of the district was increased due to the heavy rains, flooding and exposure with lack of shelter which brought the MENTOR team to respond. The risk was further increased as a result of a national malaria drug shortage in late 2008 that left health facilities without stock of basic diagnostic tools or effective anti-malarial drugs.
A full coverage IRS campaign covered those living on the south of the dyke and emergency stocks of case management supplies were distributed. Mass education of the population made them aware of their increased risk and the need to use the prevention tools and health facilities.
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Please see the article published by Comic Relief and given to the UK press in March, describing our the start up of our innovative work on malaria epidemic detection with ARGOS: