Abstract
Records from tea estates in the Kericho district in Kenya show that malaria reemerged in the 1980s. Renewed epidemic activity coincided with the emergence of chloroquine-resistant Plasmodium falciparum malaria and may have been triggered by the failure of antimalarial drugs. Meteorologic changes, population movements, degradation of health services, and changes in Anopheles vector populations are possible contributing factors. The highland malaria epidemics of the 1940s were stopped largely by sporontocidal drugs, and combination chemotherapy has recently limited transmission. Antimalarial drugs can limit the pool of gametocytes available to infect mosquitoes during the brief transmission season.
Highlights
Records from tea estates in the Kericho district in Kenya show that malaria reemerged in the 1980s
We examine historical and contemporary data to define the long-term epidemiologic transition of malaria in 1 district of the western highlands of Kenya
We use these data in support of our hypothesis that drug resistance is a key element in highland malaria epidemics in East Africa, and we examine how past control might guide future efforts to reduce the clinical impact of epidemics
Summary
Records from tea estates in the Kericho district in Kenya show that malaria reemerged in the 1980s. Whatever the cause of recent increases in malaria in the western highlands of Kenya, the tea plantation health systems have continued identifying, counting, and treating malaria infections among their workers. For the years in which data were provided in the medical officer’s reports (1966, 1967, 1970, 1975, and 1976), 95 deaths occurred among 5,686 malaria patients admitted to Kericho district hospital (case-fatality rate 1.7%).
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