Tag Archives: world health organization

How Many People Died Of The 1918 Spanish Flu in Kenya?

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This is the abstract and excerpts from Andayi, Chaves, and Widdowson, a paper focusing on the impact of the Spanish flu on coastal Kenya:

The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half a billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been poorly documented in many countries especially those in Africa. We used colonial-era records to describe the impact of 1918 influenza pandemic in the Coast Province of Kenya. We gathered quantitative data on facility use and all-cause mortality from 1912 to 1925, and pandemic-specific data from active reporting from September 1918 to March 1919. We also extracted quotes from correspondence to complement the quantitative data and describe the societal impact of the pandemic. We found that crude mortality rates and healthcare utilization increased six- and three-fold, respectively, in 1918, and estimated a pandemic mortality rate of 25.3 deaths/1000 people/year (emphasis added). Impact to society and the health care system was dramatic as evidenced by correspondence. In conclusion, the 1918 pandemic profoundly affected Coastal Kenya. Preparation for the next pandemic requires continued improvement in surveillance, education about influenza vaccines, and efforts to prevent, detect and respond to novel influenza outbreaks.

We noted, that in 1918, the crude death rates and healthcare utilization drastically increased, six- and three-fold, respectively and stayed relatively high until at least 1925. The sharp increase in health care utilization was certainly due to the pandemic and is corroborated by the anecdotal reporting of overwhelmed health systems. The very large majority of these cases would have been in the native population, though we had no data on race. The higher rates of mortality and facility visits after 1918 compared to before 1918 were likely due to improved reporting health facility expansion rather than prolonged pandemic transmission. Equally, it is plausible that several documented outbreaks such as the plague (1920) and smallpox (1925), also contributed to high reported mortality and morbidity in those late years studied. We estimate pandemic mortality from September 1918 to March 1919 to be approximately 25 deaths/1000 population and morbidity at 176/1000 population or an attack rate of 17.6% (emphasis added).

Read the whole (ungated) paper here.

Writing over at The Conversation, Andayi notes that overall the flu might have killed as many as 150,000 people in the Kenya Colony, or 4-6% of the population at the time. The Spanish flu (which actually probably originated in New York) could have killed anywhere between 1-5% of the global population.

The Spanish flu is believed to have come to Kenya with returning veterans who docked in the Mombasa port. The country was still a British colony at the time. In nine months the epidemic killed about 150,000 people, between 4% and 6% of the population at the time.

COVID-19 is nowhere near these mortality rates. The estimates I have seen (which for some reason are for “Africa” and not individual countries) suggest that between 300k and 1.3m people might die of COVID-19 on the Continent (see image with UNECA estimates). Proportionately, that would mean roughly between 12k – 51k Kenyans, or .03-.01% of the population (still absolutely catastrophic figures).

uneca

If you know of any country-level estimates please share in the comments.

 

How to Eliminate Malaria

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Sri Lanka is the latest country to be declared malaria free by the WHO.

How did they do it?

According to the New York Times:

In 2000, outside the rebel-controlled areas in the northeast, malaria cases began dropping as the government, with donor help, deployed a mix of indoor spraying, bed nets, rapid diagnostic kits and medicines that combined artemisinin, an effective treatment, with other drugs.

The government also screened blood samples drawn — for any reason — in public clinics and hospitals for malaria infection, and officials established a nationwide electronic case-reporting system.malariaeradication

In war-torn areas, the disease retreated more slowly, although the Tigers often cooperated with malaria-control teams because their villages and fighters also suffered.

Nonetheless, in a population of 20 million, it took years to get rid of the last few hundred annual cases. Most were soldiers and itinerant laborers, often from India, who worked in remote slash-and-burn farming areas and in logging and gem-mining camps.

Someone tell African policymakers that bed nets and behavior change are not enough.

Every other region of the world appears to be willing and able to combine vector (mosquito) control with other strategies of containing malaria with success (and enthusiastic donor support). But for some reason mosquito control is still lagging in Africa, even in otherwise strong and stable states. In some instances this has been due to environmental concerns while in others it has been due to the misplaced priorities of public health officials, donors, development agencies, and academic researchers.

The result:

About 3.2 billion people – nearly half of the world’s population – are at risk of malaria. In 2015, there were roughly 214 million malaria cases and an estimated 438 000 malaria deaths. Increased prevention and control measures have led to a 60% reduction in malaria mortality rates globally since 2000. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of malaria deaths. 

214 million malaria cases amount to lots and lots of lost productivity. Also, losing one Miami every year in deaths is simply unacceptable.

More on this here. 

What if we killed all the mosquitoes?

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It appears that a malaria vaccine will not be available for some time. According to Reuters,

“The world’s first potential malaria vaccine proved only 30 percent effective in African babies in a crucial trial, calling into question whether it can be a useful weapon in the fight against the deadly disease.”

Reading this reminded me of my own illness with malaria at the end of summer.

Back in September I contracted malaria while on a short trip back home in Kenya. Due to malaria’s incubation period I only started feeling sick after I was back in Palo Alto. My illness set off a total freakout at the Stanford Hospital. No less than four medical students, besides the crowd from the infectious disease unit at the hospital, passed by my hospital bed to ask the EXACT same questions. And of course they wanted to keep me overnight. They had an IV drip already installed in my arm. I tried my best to tell the doctor that I didn’t think I needed to be hospitalized to no avail.

The nurse who took my vitals put a mask on her face the moment I told her that I had malaria. I had to restrain myself from reminding her that malaria is not airborne.

A week later the Santa Clara County infectious disease office called me to get my details and ask me if I was feeling better. The government wanted to know where and how I got malaria. The grad student in me was fascinated by the level of state capacity in Santa Clara.

A few weeks before my Kenya visit I was in Fort Worth, TX. This was at the height of the West Nile virus outbreak that killed dozens of people. At the time health authorities in the Dallas-Fort Worth area were in the middle of spraying the area to kill all the vectors (mosquitoes). My girlfriend reminded me of the fact that as recent as when her parents were growing up in Grand Prairie, TX much of the American South still had to be sprayed regularly (with DDT) to get rid of disease-bearing mosquitoes.

The reason I recounted these stories is to illustrate the fact that there is an alternative to pouring tons on money on vaccine research or bed nets. Yes, these may result in cool scientific discoveries or provide excellent opportunities for social scientists to get published on their RCT findings. But the reality is that millions of people are still dying.

Instead of asking those living in high disease burden environments to change their behaviors and sleep under mosquito nets, how about we get rid of the mosquitoes??

If it worked in the American South, and many other places, why can’t it work in Africa?

I would very much love to live in a place free of malaria. Because of my age and health, my malaria infection at the end of summer was a mere nuisance – mild aches and fatigue. But for millions of children and post-natal mothers across much of tropical Africa malaria is a fatal disease.

But is DDT the answer? Haven’t we been made to internalize the evils of DDT?

It turns out that what we know about DDT might not be the whole truth. As Gourevitch argues, the environmental impact of DDT might have been overblown by the environmentalists.

Writes Gourevitch:

“Around the same time, the U.S. government launched an ambitious DDT-centered malaria eradication project which by the early ’60s had virtually eliminated malaria from Southern Europe, the Caribbean, and parts of East and South Asia. (In India, for example, annual deaths went from 800,000 to zero.) At the time, DDT was thought to be such an effective and useful substance that in 1948, Muller received a Nobel Prize in medicine. “To only a few chemicals does man owe as great a debt as to DDT,” declared the National Academy of Sciences in a report in 1970. “In little more than two decades, DDT has prevented 500 million human deaths, due to malaria.””

Adding that:

“But over the years, mainstream scientific opinion has absolved DDT of many of its supposed sins. Indeed, the Stockholm Convention partially backfired because it brought to light a slew of studies and literature reviews which contradicted the conventional wisdom on DDT. Like nearly any chemical, DDT is harmful in high enough doses. But when it comes to the kinds of uses once permitted in the United States and abroad, there’s simply no solid scientific evidence that exposure to DDT causes cancer or is otherwise harmful to human beings……

Not a single study linking DDT exposure to human toxicity has ever been replicated.”

But even assuming that the effects were as bad as they were claimed to be, shouldn’t we as humans be able to decide on the relative importance of human lives versus bald eagles?

How many children should be allowed to die so that bird watchers can better enjoy their Sunday afternoons?

hapa na pale (here and there)

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Bankelele has a nice post on medical investment in East Africa.

For the business-minded, here is one more reason for Kenyans to vote YES in the August 4th referendum for a new constitution. I remain apprehensive about the size of government that will result from a victory for the YES camp. But as a student of history I am also hopeful that effective government, i.e. creation of grassroots administrative and TAXATION apparatuses in provincial counties, will lead to faster Kenyanization of ALL of Kenya. And who knows, may be the need to finance government will give officials incentives to formulate policies that promote growth and generate revenue.

In other news, EASSy, the third international fibre optic cable to land on the Kenyan shores, will soon roll out, hopefully helping lower the cost of internet connectivity not only in Kenya but in the wider East African region as well.

And lastly, being only nine days away from a short vacation back home I join Magical Kenya in saying JAMBO!

malaria is still around, you know

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Researchers have discovered a trend in the habits of mosquitoes. The little insects are feeding on human blood earlier than they used to. This means that more and more people get bitten earlier in the evening before they get to sleep under bed nets – which in turn translates into higher malaria infection rates. Bed nets lower infection rates by a whole 40%. Now researchers are urging people to use mosquito repellents. Personally, I don’t think this will fly. I for one do not like the “tourist smell” of repellents (I still don’t get how tourists stand themselves smelling like that!). I would advocate for a more aggressive approach to eliminating mosquitoes. DDT is bad, I know. But can’t we find other means of doing this? Plus malaria deaths, lost man hours because of disease burden and expenditures on anti-malaria medication may outweigh the cost of eliminating mosquitoes – thereby making the latter the more rational option.

Meanwhile, the WHO in a 2003 report says that malaria is still alive and well and continues to kill 2000 African children every day. That translates to 0.73 million children every year. I need not even add the figures for people over the age of 5.