ISP? Check.

Sorry for slacking a little bit, things have been pretty crazy as this semester has come to an end! Or maybe I just haven’t wanted to feel like things are, in fact, actually coming to an end. Wow. By popular demand, and by popular demand I mean my dad, I’ve poured my sweat, blood, and tears into a few more posts.

I finished up my ISP with remarkably little procrastination, mostly because it was by far the most enjoyable paper I have ever written. It was cool and nice change of pace to be producing something for which I am responsible for all of the content. Whereas the typical research paper at school involves reading others’ books and journal articles and developing new ideas from them, this project involved me doing the research and using what I found in the field to develop some new ideas. Also, I was entirely in control of the topic and structure for my paper.

The title turned out to be “Inexcusable Infections: Malaria, Children, and Barriers to Prevention in Nyahera Village, Kisumu, Kenya”. “Inexcusable Infections: _______” because a) alliteration is sweet and b) a colon makes any title considerably more intense. Inexcusable, mind you, doesn’t put the blame of malaria in Nyahera on the people inhabiting the village, but on our world as a whole and the actions we take that allow poverty, and thus eradicable diseases such as malaria, to continue ravaging certain populations. I found some interesting things, which I’ll highlight here should you care to read on…

• People in Nyahera (at least the 80ish involved in my study) tend to understand that mosquitoes transmit malaria and that bushy areas and stagnant water promote mosquito breeding. Nobody except one belligerently drunk man met in passing mentioned Anopheles (the species which transmits malaria) or anything about the malaria parasite, Plasmodium. But all mosquitoes, whether carrying malaria or not, can be deterred in the same way, so there’s no real harm in thinking all mosquitoes transmit malaria.
• More detrimental to the fight against malaria are peoples’ misconceptions about why children are more affected. In reality, it’s because young children have weak immune systems in general and especially to malaria, to which the human body can build up resistance over time with periodic infections. Lots of the people I spoke with attributed children’s plights with malaria to their carelessness (i.e. playing in stagnant water). If widespread, this could be a dangerous misconception, because children and adults are equally as likely to be bitten by malarial mosquitoes, especially at night when uncovered by nets. If families (typical in this village) can’t afford a net for everyone, they may cover the adults before the children for comfort reasons, when children are much more likely to contract severe malaria. Bad news.
• Climate and lifestyles in Nyahera contribute to malaria big time. The village is filled with bushy areas where mosquitoes can breed, crop fields (Anopheles can breed in the leaf axils of some plants), garbage piles in the markets or at matatu stages, and poor quality roads with huge, water-filled ruts. People collect rainwater off their roofs for drinking (this is what I drank the 3 weeks I was studying there) and let the water stand for weeks at a time. The majority of homes look as though they were designed by mosquitoes. There’s a gap between the walls and the corrugated iron roofs through which mosquitoes are free to fly and open windows with usually only a flapping curtain for privacy.
• A low percentage of the people I interviewed use insecticide-treated nets (ITNs) to protect their children at night. I found 56% coverage for children less than 5, still shy of the goal the UN set in 2000 for 60% coverage in endemic areas (like Nyahera) by 2005. Too few, too late.
• People in Nyahera don’t use nets because they simply can’t afford them. I was expecting to see some cultural barriers to using nets. An earlier study in “deeper” Luo land (further from Kisumu) found that people were nervous about mixing up bedding items (such as nets) between adults and children who have undergone puberty during washing sessions. Such mixing, according to the Luos in a 2003 study, causes infertility. Sleeping arrangements, with children frequently on the floors of living rooms or kitchens, also made hanging, opening, and closing nets each day a nuisance for the families in that study. I found none of this, just money issues.
• The money issues I found a little bit hard to believe. Nets are available at the village hospital for just 50 Shillings (about 70 cents) for children less than 5. After age 5, parents have to buy more expensive nets from town. Why not just buy the cheap nets when the children are of age and prevent infections for years to come?
• I have a strong suspicion that the free care offered at the hospital for malaria among children less than 5, although a great and necessary policy, may actually contribute to the low net usage. Why buy nets when your kids can always get free treatment? This is dangerous, as overuse contributes to the ability of Plasmodium to develop resistance to malaria drugs, and frequent episodes undoubtedly wreak havoc on young kids’ immune capabilities. I think the hospital should create a registry of families purchasing nets for their children under 5, and then later, when the children are over 5 and ineligible for free care, offer small discounts for treatment for those families which can prove they use/used hospital nets.
• Families in Nyahera are widely receptive of spraying residual insecticides, such as controversial DDT, inside their homes. The World Health Organization banned DDT in the 1980’s after decades of overuse in agriculture created worldwide environmental problems. However, DDT was huge in eradicating malaria from North America and Europe by the 1960’s. The WHO just lifted its ban on DDT in 2006 and now encourages its use in small amounts for controlling malaria. European countries, however, are threatening to ban agro-imports from Sub-Saharan countries using DDT for malaria, and thousands involved in Kenyan healthcare fear losing the “industry of malaria” (the disease accounts for 75% of hospital bed occupancy in Kenya) if it were to be completely eradicated. A predicament for sure. Regardless, it’s good to see that the people are receptive of a control tactic that, if widespread, could effectively eradicate malaria.

So there’s my ISP, in a nutshell. It’s a 45 page monster with lots more info than I gave here, should anyone have a hankerin’ for more malaria. Let me know and I can email it to you (from faster comps back in the states) or let you borrow a hard copy. I’m pretty proud of it!