Background Information on Health Issues in Bungoma

            In Kenya’s Bungoma District, three key issues can be identified as among the most significant contributors to morbidity and mortality. The first two are diseases: AIDS and malaria. These are diseases that have proven difficult to combat and present a significant drain not only on the health of individuals infected but more broadly on the economic productivity of Bungoma. The third issue is that of healthcare access. With access to affordable, quality healthcare lacking in Bungoma, diseases including AIDS and malaria are able to flourish. This section describes the present situation in Bungoma regarding AIDS, malaria, and healthcare access, identifies key causes of this situation and describes some of the effects the situation is having on the general population.

AIDS

            Acquired Immune Deficiency Syndrome (AIDS) represents one of the greatest health crises and challenges to development ever encountered. As of the end of 2002, approximately 42 million people in the world are infected with HIV, the virus that causes AIDS. Some 95% of all AIDS cases occur in the world’s poorest countries. In Kenya’s Bungoma District, approximately one-third of the population is living with HIV. The virus is spread primarily by unprotected sexual contact between men and women. The virus is also spread by mothers to their children during the process of birthing and through breastfeeding.

            Preventing the spread of HIV in Kenya has proven difficult and condom use is not common. In Kenya, many females do not enjoy much control over their own risk-taking behavior regarding HIV transmission. Women who are faithful to a single sexual partner may not necessarily have partners who are faithful, and persuading their partners to use condoms can be difficult. Feldman reports that the woman is often viewed as the “carrier,” even though transmission from a man to a woman is as likely, if not more likely, than transmission from a woman to a man, and “a wife or girlfriend who insists that condoms be used would be regarded with deep suspicion by her husband or boyfriend” (1991, p. 130). This atmosphere of distrust has limited use of condoms in Bungoma. Also, Myths surrounding the ineffectiveness of condoms at preventing HIV transmission continue despite educational efforts. Indeed, some non-governmental educational programs continue to teach inaccurately that latex condoms provide no protection against HIV transmission.

            The onset of the AIDS pandemic has significantly lowered life expectancies throughout Sub-Saharan Africa. In Bungoma, the female life expectancy is 61 years and the male life expectancy is 59 years. AIDS disproportionately affects young adults in the community, depleting the workforce of its most productive members. When those members of a family who would normally be the most productive become ill or die, the rest of the family is burdened with their responsibilities. Elderly family members become responsible for the care of dozens of grandchildren, while very young children must assume their parents’ roles in earning a wage to support their families. The social and economic effects of AIDS on families in Bungoma can be truly devastating.

Malaria

            Worldwide, Malaria infects about 500 million people every year, killing 2.7 million (Wade, 2002). Five thousand children die every day as a result of malaria infection. In Bungoma, malaria is considered the number one cause of both morbidity and mortality. The 1999 district health report cites malaria as the cause of 42% of morbidity and 36% of mortality in the total population.

The cause of malaria is infection with one of four species of parasitic protozoan organisms of the genus Plasmodium, which alternate during their life cycle between human and mosquito hosts. The parasite develops inside the salivary glands of a female Anopheles mosquito host. The mosquito, requiring a meal of blood to nourish her eggs, bites a human and injects material from her salivary glands, including immature malarial parasites called sporozoites. The characteristic chills and fever of malaria are caused as these parasites multiply within red blood cells, causing these cells to burst and releasing the contents into the bloodstream.

            In parts of Africa, people may be bitten as many as one thousand times per year by Plasmodium-infected mosquitoes (Miller et al., 2002). This fact makes controlling the spread of malaria very difficult. One key to saving the lives of children in Africa is devising an effective and affordable method of diagnosis and treatment of the disease. It is also important to reduce the spread of drug-resistant varieties of Plasmodium. Integrated management of childhood illness (IMCI) guidelines, issued by the World Health Organization (WHO), prescribe treatment for malaria in any child under the age of five presenting with history of fever and pallor resulting from anemia. In many cases, these symptoms overlap with those of other endemic diseases, such as pneumonia, typhoid and brucellosis. Researchers have found that in some areas where malaria is endemic, only 70% of children prescribed treatment for malaria under these guidelines actually had microscopically detectable malaria parasite infections. Additionally, in these endemic regions many people have low-level infections of the parasite that are not necessarily responsible for the symptoms they are experiencing. Misdiagnosis of malaria as the cause of sickness means that under IMCI guidelines, more drugs are used than necessary, and this potentially contributes to the emergence of drug resistance (Tarimo et al., 2001). Misdiagnosis also means that treatment for malaria may be undertaken instead of treatment for other deadly diseases, like typhoid.

            One of the most critical means of preventing malarial infection in endemic areas is the use of insecticide-treated nets. Sleeping under such nets helps prevent bites from Plasmodium-infected mosquitoes. In Bungoma, only 31% of households possess one or more insecticide-treated nets. Only 44% of children under five and 18% of pregnant women, the two groups most at risk of death due to malaria, sleep under insecticide-treated nets.

Healthcare Access

            The Bungoma District has a total of 42 general health care facilities, including 6 hospitals, 14 health centers and 21 dispensaries. The majority of these facilities are located in the town of Bungoma and in the largest surrounding villages. These facilities are unable to meet the needs of the general population. Government facilities are overburdened and while both government and non-government facilities remain inaccessible to much of the population. Only 16% of the population utilizes Bungoma’s hospitals. Only about a quarter of the population uses health centers and dispensaries.

            The Bungoma District is also severely lacking in trained medical personnel. In the United States, there exists one doctor for every 442 people. By contrast, in Bungoma, there is just one doctor for every 34,426 people.