Malaria outbreak response in a nomadic pastoralist setting, Kenya 2019

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Background: On 22nd August 2019, Baringo county health department, Kenya notified of a suspected malaria outbreak. As at 26th August 2019, a total of 301 cases had been line-listed with six deaths (CFR = 2.0%), all under the age of five years. We carried out response activities to investigate the suspected outbreak with the specific objectives to confirm, determine the magnitude and describe the epidemiology of the suspected cases. We also proposed and initiated appropriate public health actions. Methods and materials: The outbreak epicentre was in Tirioko ward, Baringo county. A suspect case was defined as a case presenting with fever (axillary temperature≥37.5 °C), chills, malaise, headache or vomiting at examination or 1–2 days prior. A laboratory confirmed case was a suspect case with detection of Plasmodium species by either rapid diagnostic antigen or detection of malaria parasites by microscopy. Collected data was cleaned and analysed using Microsoft Excel software's and Epi info 7.2 software (CDC Atlanta. GA). Descriptive statistics was performed using means and medians for continuous variables and frequency and proportions for categorical variables. Results: A total of 1242 cases were line listed with 8 deaths(CFR = 0.6%). Females were 697 (56.1%) with those <5 years old being 424 (34.1%).Of the Sixty three (63) laboratory samples collected, RDT positives were 40 (63.4%) and Microscopy positive were 28 (44.4%).Additional arboviral screen testing yielded 2/13 (15.3%) positives for dengue fever. All were negative for chikungunya, riftvalley fever, yellow fever, west nile fever and crimean congo hemorrhagic fever. We observed that the epicenter was poorly served by health facilities, social ammenities and experienced security incidents occasion by cattle rustling. Short rains had been experienced a month prior and pools of water were evident in the environment. Additionally, the communities did not always use mosquito nets due to their temporary housing structures. Conclusion: We recommended the establishment and operationalisation of a health facilities in the region. Additionally, strengthen intergrated disease surveillance and response activities to proactively mitigate future outbreaks. There is also a need to customize malaria social behaviour change communication to fit the community's nomadic lifestyle.