Even if adequate stocks of ITNs/LLINs were available for ALL people in malaria endemic communities, as the UN hopes … Even if there were supplies of ACTs to treat ALL people who suffer from malaria … even when effective vaccines become available … if human beings themselves continue to disrupt countries and health services (what the New York Times has termed “self-inflicted wounds”) – within and across borders – malaria will not be eradicated.
In a letter to the editor of the American Journal of Tropical Medicine and Hygiene colleagues from the US Centers for Disease Control and Prevention (CDC) and the Kenya Medical Research Institute (KEMRI) take stock of the health care situation as Kenya tries to return to normal after months of violence sparked by the national elections in December.
“It is possible that the health impact of Kenyas chaos could â€™ linger well beyond a political rapprochement. We may see increases in mental illness, substance abuse, and unemployment in response to the violence, which may lead to new public health challenges for the country. Disruptions in food supply, immunizations, medications, and health services could affect peopleâ€™s health for months, and perhaps years, to come. For example, the national malaria control program, which had made notable progress over the past 5 years, now faces the challenge of delivering life-saving antimalarial drugs and long-lasting insecticide-treated bednets in a country where the roads are far less secure. Gains in HIV care and prevention may also have been compromised. An undisrupted supply of drugs and reliable access to clinical care are essential for the health of the 180,000 HIV-infected people receiving antiretroviral therapy. The influx of tens of thousands of internally displaced people to areas of the country already struggling with ongoing public health challenges, such as malaria and HIV, could place an unsustainable weight of health needs on an already fragile public health infrastructure. In addition, future research collaborations and their associated gains in capacity building for the country could be limited by reluctance of research partners to locate projects in Kenya.”
The New York Times today also reports on the post-election situation and efforts to begin national and community healing in Kenya. The Kenyan government, facing an economic and food crisis arising from the conflict, is encouraging people to return to their farms, even in ethnically conflicted areas, with promises of food, tool, new houses and cash. “To make its plan work, the government has said, there must be genuine ethnic reconciliation,” which is the real challenge. Political jockeying and an over-bloated cabinet do not help, according to the NY Times.
As CDC/KEMRI staff remind us, 30 years of collaboration for improving the health of Kenyans can be nearly destroyed in a few days. Clearly conflict prevention and resolution need to be considered among the key strategies for eliminating malaria from the world.