Malaria hospitalisations among children on Kenya’s Coast have fallen by about 97% over the past 35 years, with researchers reporting a dramatic decline in both malaria infections and malaria-related deaths.
The findings, published in a preprint study in Malaria Journal, are based on long-term surveillance of children admitted to Kilifi County Hospital between 1990 and 2024.
The study found that malaria hospitalisation rates fell from a peak of 25.5 cases per 1,000 children per year in 1999 to just 0.65 cases per 1,000 children per year between 2020 and 2024.
The researchers also found that community malaria prevalence declined from 35% in the 1990s to about 2% in 2020–2024, representing a 94% reduction in parasite prevalence.
“There has been a sustained, dramatic reduction in paediatric malaria hospitalisation over the past 35 years,” they wrote.
The decline was also reflected in the proportion of children admitted to hospital with malaria. In the early 1990s, malaria accounted for about 44% of paediatric admissions, but this fell to less than 5% after 2021.
The study further found a major reduction in severe forms of malaria. Severe malaria anaemia declined from 2.91 cases per 1,000 children per year in 1990–1996 to 0.05 per 1,000 in 2020–2024. Hyperparasitaemia, a condition involving very high levels of malaria parasites in the blood, also declined from 2.72 to 0.11 cases per 1,000 children over the same periods.
Malaria-related deaths in hospital also dropped substantially. The malaria-specific hospital mortality rate declined from 0.43 deaths per 1,000 children per year in 1990–1996 to 0.03 per 1,000 in 2020–2024, a 93% reduction.
The researchers attribute the progress largely to sustained malaria prevention and improved treatment.
“Two core interventions, LLIN and prompt access to AL, have likely been pivotal in reducing severe malaria and associated deaths in this setting.”
LLIN refers to long-lasting insecticidal nets, while AL refers to artemether-lumefantrine, an antimalarial medicine.
The researchers noted that malaria transmission has also changed the profile of children being admitted. The median age of malaria admissions increased from 19 months in 1990–1996 to 48 months in 2012–2019, before settling at 43 months in 2020–2024.
Cerebral malaria, although representing a larger proportion of severe malaria cases in recent years, also declined in absolute terms. The study found that cerebral malaria fell from 0.97 cases per 1,000 children per year in 1990–1996 to 0.11 per 1,000 in 2020–2024.
The researchers caution that the decline does not mean malaria has disappeared from the Kenyan Coast.
“Hospital admission with malaria among children in Kilifi is now uncommon.”
They argue that continued malaria control will require maintaining access to effective treatment and sustaining the use of insecticide-treated nets, alongside continued local surveillance.
The researchers also warn that reductions in external development assistance without corresponding domestic investment could threaten the progress made against malaria.
IMAGE CREDIT