A few years ago, malaria would have been a nurse's worst nightmare in Nyanza Province, Kenya.
Outbreaks used to be common here. Dennis Ngare, the nurse in charge of Ogango Dispensary, recalls how on one morning during the long rains of 2005 he arrived at the facility to find over a hundred people waiting for treatment.
Now, as this year's rainy season begins, the health facility - which is supported by international medical charity Merlin - has only had two confirmed cases of malaria in the past week.
Perhaps the starkest difference has been felt by pregnant mothers-to-be, a group particularly vulnerable to malaria. Jerusha Nyaruri, another nurse at Ogango, tells me how three weeks ago she administered quinine to a pregnant patient in her second trimester suffering from fever and headache.
Her colleagues told her that a few years ago, the patient would have been unlikely to have been brought to the facility until she was unable to walk without assistance. She might have developed anemia or even a miscarriage, as the fever caused by malaria can induce early labour.
According to USAID, an estimated 6,000 pregnant women suffer from malaria-associated anemia in Kenya every year, and 4,000 babies are born with low birth weight as a result.
"Through Merlin we were able to take messages about malaria to the ground. It used to be common to blame malaria on the rain or eating too much sugar cane or maize. But as time moved on Merlin introduced community health workers, who helped us to disseminate information, leading to early and preventive treatment," Dennis says.
Community health workers like Stella Moraa Gwaro, 39, have been vital in driving forward health seeking behaviour in Nyanza, where distance, cost and prevalence of traditional beliefs can often be barriers to seeking medical aid for diseases such as malaria.
She is one of 300 community health workers in Nyanza who have been trained by Merlin to educate communities about the signs and symptoms of malaria and correct use of mosquito nets.
She recalls how pregnant mothers often assumed that their fevers were a result of morning sickness. Net distribution is not new in the area, but she used to see people using nets for fencing or simply storing them.
Based at Tindereti Dispensary, another facility supported by Merlin, Stella gives health talks at local markets, community gatherings and churches, and also makes home visits to twenty families in the area.
Working an average of three days a week and delivering a talk at church most Sundays, she refers those showing signs of malaria to the dispensary for treatment and encourages expectant mothers to go for antenatal checkups where they will receive mosquito nets.
This has knock-on benefits for maternal health, as coming to health facilities for malaria prevention gives women access to a range of other services including safe deliveries.
Local nurses unanimously say that successful use of mosquito nets has been the single most important factor in the dramatic reductions in the malaria burden in Nyanza over recent years, from 80% of people infected with the malaria parasite to 38%. Stella estimates that she makes referrals on average once or twice a week, but that when she first started she made referrals almost on a daily basis.
Nonetheless, with the disease still being a leading cause of mortality in Kenya, we should consider World Malaria Day 2012 as an occasion to sustain momentum.
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