Kenya makes major changes to the way malaria is treated

Kenya will introduce a new malaria treatment approach from October, aiming to curb drug resistance and preserve the effectiveness of existing medicines.

Health officials say the country will begin implementing Multiple First-Line Therapies (MFTs), a system in which more than one approved malaria treatment is used across hospitals and health facilities, rather than relying on a single standard drug.

According to the National Malaria Control Programme, the move is a response to early signs that malaria parasites are beginning to adapt to current treatments in some parts of the country.

Dr Edwin Onyango, head of National Malaria Control Programme Case Management, said the approach is designed to reduce pressure on a single medicine and extend the lifespan of existing treatments.

“Multiple First-Line Therapies mean more than one Ministry of Health-approved malaria medicine is used at health facilities,” he said in his presentation.

He added that all approved medicines under the system are safe and effective for treating uncomplicated malaria, and that the change is based on emerging scientific evidence rather than a failure of current drugs.

For years, Kenya has largely depended on artemether-lumefantrine as the main first-line treatment. While it remains effective in most regions, studies indicate a gradual decline in its performance in some areas.

Data presented by Onyango shows that in Siaya county, effectiveness dropped from 97.8 per cent in 2011 to 88.5 per cent in 2017, a trend experts describe as an early warning sign of resistance development.

Under the new system, health workers will rotate between several treatment combinations, including artemether-lumefantrine, artesunate-pyronaridine and dihydroartemisinin-piperaquine.

The aim is to reduce uniform exposure of the malaria parasite to one drug, making it harder for resistance to develop.

Onyango said the change will also affect patient experience at health facilities.

“Receiving different malaria medicines at different visits is expected and correct under MFT policy,” he said, adding that patients should not be alarmed if they are prescribed different treatments on subsequent visits, as all options are approved.

Patients presenting with malaria will still undergo testing before treatment.

Once confirmed positive, health workers will select one of the approved drug combinations.

On future visits, the treatment may differ depending on availability and rotation schedules.

The government plans to roll out the programme in phases, beginning with high-burden counties such as Siaya, Kakamega, Busia, Kisumu and Migori before expanding nationwide.

The rollout will include training for health workers, supply chain adjustments and public awareness campaigns.

Officials have also raised concern over drug misuse, including incomplete dosage, self-medication and circulation of substandard medicines, all of which contribute to resistance.

“Complete the full malaria treatment dose exactly as instructed,” Onyango said, urging adherence to medical guidance.

Health authorities say MFT is part of a broader strategy to preserve the effectiveness of current treatments while new antimalarial drugs are being developed.

With malaria remaining a leading cause of illness and death in Kenya, officials say public acceptance will be key to success.

Public Health Principal Secretary Mary Muthoni has, however, warned that Kenya’s broader malaria response is being slowed by implementation gaps, particularly at county level.

She said the country has sufficient knowledge and tools to eliminate malaria but struggles with execution.

“Malaria today is not a mystery. We understand how it spreads, who it affects most, and what interventions work. Yet it continues to persist, not because solutions are absent, but because delivery is uneven,” she said.

She added that counties remain central to the fight, as they are responsible for turning policy into actual services.

“Counties are where policies become services, where strategies become action and where outcomes are ultimately determined,” she said, calling for stronger alignment between national plans, budgets and local implementation.

Latest data shows Kenya recorded about 4.2 million malaria cases in 2024, with the disease accounting for 18 per cent of outpatient visits. About three in every four Kenyans live in malaria-risk areas.

Despite this burden, progress has been slow.

Incidence has declined by only five per cent between 2023 and 2025, while mortality has fallen by 32 per cent over the last strategy cycle.

These figures fall short of targets under the Kenya Malaria Strategy 2023–27, which aims to reduce incidence by 80 per cent and deaths by 90 per cent, and eliminate local transmission in selected counties by 2027.

The strategy also acknowledges persistent challenges, including limited funding and weak surveillance systems in some areas.

However, Muthoni said some counties, particularly in the Mt Kenya region such as Kirinyaga, Laikipia, Nyandarua and Nyeri, are approaching near elimination levels.

She praised Kirinyaga county for recording near-zero local transmission, describing it as a positive example in the national response.

Experts, however, caution that Kenya’s malaria burden remains concentrated in western regions, especially around Lake Victoria, where climatic conditions favour transmission.

Muthoni warned that emerging threats such as climate change, insecticide resistance and financing gaps could slow progress further, calling for increased domestic investment and stronger county-level health systems.

She emphasised that sustained progress will depend on coordination, surveillance, and consistent public awareness to ensure interventions are effectively implemented across all regions.