Progress towards understanding the ecology and epidemiology of malaria in the Western Kenya Highlands : opportunities and challenges for control under climate change risk
Date
2011
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Publisher
Elsevier
Abstract
Following severe malaria epidemics in the western Kenya highlands after the late 1980s it became
imperative to undertake eco-epidemiological assessments of the disease and determine its drivers,
spatial–temporal distribution and control strategies. Extensive research has indicated that the major
biophysical drivers of the disease are climate change and variability, terrain, topography, hydrology
and immunity. Vector distribution is focalized at valley bottoms and abundance is closely related with
drainage efficiency, habitat availability, stability and productivity of the ecosystems. Early epidemic prediction
models have been developed and they can be used to assess climate risks that warrant extra
interventions with a lead time of 2–4 months. Targeted integrated vector management strategies can
significantly reduce the cost on the indoor residual spraying by targeting the foci of transmission in
transmission hotspots. Malaria control in the highlands has reduced vector population by 90%, infections
by 50–90% in humans and in some cases transmission has been interrupted. Insecticide resistance is
increasing and as transmission decreases so will immunity. Active surveillance will be required to monitor
and contain emerging threats. More studies on eco-stratification of the disease, based on its major
drivers, are required so that interventions are tailored for specific ecosystems. New and innovative control
interventions such as house modification with a one-application strategy may reduce the threat from
insecticide resistance and low compliance associated with the use of ITNs.
Description
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Journal Article (peer-reviewed)
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Keywords
MALARIA, HIGHLANDS, KENYA, ECOLOGY, EPIDEMIOLOGY, VECTOR CONTROL, CLIMATE CHANGE, ECOSYSTEMS