How one father is leading Kenya's malaria fight

The death of seven children to malaria was a tragedy that shook Samson Okoth’s world.

The children, aged between one and five years, died from the mosquito-borne disease between 2018 and 2022.

Okoth was left in despair.

The resident of Ripe village in Homa Bay says when the children first fell ill, he thought it was just a normal fever.

But the condition worsened, and despite hospital care, they all succumbed to the disease.

Okoth regrets delaying taking the children to hospital. “Malaria is a monster. I never realised how serious it could be until it swept through my children. Their deaths have left a permanent scar. I sit at their graves and imagine what they could have become, only for their light to be cut short by death,” says Okoth, the father of 15, with two wives.

The first wife lost three of her 11 children while the second wife lost four of her ten children. Had it not been for malaria, Okoth would now be a father of 21.

A national burden

Since death struck the family, each one now sleeps under an insecticide-treated mosquito net.

Today, Okoth is a champion of the malaria vaccine, a jab he says should be administered to each child, to avert malaria deaths.

Enrolment for the malaria vaccine, according to Okoth, is a silver lining in the fight against malaria. He is a champion of the malaria vaccine in the community. “My five children below two years have been vaccinated against malaria. I wish the jab was introduced earlier, as it could have saved my children who died,” he says.

Okoth’s experience is not in isolation. In Kenya, there are an estimated 3.5 million new clinical cases and 10,700 deaths each year. Data by the Ministry of Health shows children under five years and pregnant mothers are the most affected.

In 2010, the mortality rate of malaria stood at 13 per cent, with over 90 per cent of hospital admissions.

Due to these high numbers of cases and deaths, Kenya was among eight African countries that participated in clinical trials for a new malaria treatment designed for newborns, released this year.

Other countries involved in the research that led to the development of Coartem Baby (artemether-lumefantrine) included Nigeria, the Democratic Republic of Congo (DRC), Burkina Faso, Mali, and Zambia.

The medicine was approved by Swissmedic, Switzerland’s regulatory authority. The approval marked a major milestone in the fight against malaria in infants, as Coartem Baby becomes the first-ever treatment tailored for babies.

The ground-breaking therapy is expected to be rolled out in Kenya and other malaria-endemic African countries in the coming months.

The malaria medicine, also known as Riamet Baby, is meant for newborns and young infants amid increased malaria deaths and cases.

The medicine is dissolvable, including in breast milk, and has a sweet cherry flavour to make it easier to administer to babies.

Drug approval

Coartem Baby was developed through Medicines for Malaria Venture (MMV), in collaboration with Novartis, to treat malaria disease rampant on the African continent.

Kenya, alongside the other seven African countries that participated in trials of the treatment, are expected to issue rapid approvals under the Swiss agency’s Marketing Authorization for Global Health Products procedure.

The Swissmedic approval is based on phase two and three studies, which investigated a new ratio and dose of Coartem (artemether-lumefantrine) to account for metabolic differences in babies under five kilograms.

It is indicated for the treatment of infants and neonates weighing between two and less than five kilograms with acute, uncomplicated infections due to Plasmodium falciparum or mixed infections.

Coartem is known by the brand name Riamet in Switzerland and some other countries.

Novartis plans to introduce the infant-friendly treatment on a largely not-for-profit basis to increase access in areas where malaria is endemic. “Malaria is one of the world’s deadliest diseases, particularly among children. But with the right resources and focus, it can be eliminated,” said CEO of MMV Martin Fitchet, adding; “The approval of Coartem Baby provides a necessary medicine with an optimised dose to treat an otherwise neglected group of patients and offers a valuable addition to the antimalarial toolbox.”

Globally, there has been no approved malaria treatment for babies under 4.5 kilograms. Previously, infants were treated with formulations intended for older children, risking overdose and toxicity. Current data on safety for young babies was also extremely limited, as infants are rarely included in clinical trials of antimalarial agents.

Professor Umberto D’Alessandro, Director of the MRC Unit in The Gambia at the London School of Hygiene and Tropical Medicine, notes: “Neonates and young infants metabolise medicines differently, so doses for older children may not be appropriate. This new treatment fills a critical gap.”

The infant-friendly therapy, largely not-for-profit, is expected to be rolled out in Kenya and other malaria-endemic African countries in the coming months. Alongside Coartem Baby, preventive measures such as mosquito nets and the RTS,S/AS01 malaria vaccine remain vital.

In Kenya, malaria is a major public health problem, with at least 75 per cent of the population at risk of the disease.

Data by the World Health Organisation (WHO) documented 11,478 malaria deaths in 2023.

Additional data from the Ministry of Health shows malaria kills about 10,700 people in Kenya annually, primarily children under five years, with at least 3.5 million new clinical cases.

In 2023, at least 600,000 malaria deaths were reported globally, with most of the cases in Africa.

Dr Simon Kariuki, a researcher at the Kenya Medical Research Institute, describes the discovery of Coartem Baby as a significant breakthrough. “This is a ground-breaking development. The medicine has been tested in infants and found to be safe and effective,” he says.

Previously, clinicians had little guidance on how to treat malaria in babies weighing less than five kilograms. Tablets intended for adults or older children were broken into smaller portions, with no clear data on safety or toxicity. “There was no proper documentation on dosing or side effects in very young infants,” Dr Kariuki explains. “Having a medicine specifically designed for this group is a major boost in the fight against malaria.”

Although he was not involved in the Coartem Baby trials, Dr Kariuki is part of ongoing research into new drugs for complicated malaria and drug resistance.

A combined approach

Experts stress that medication alone is not enough. Preventive measures such as insecticide-treated mosquito nets, indoor residual spraying and vaccination remain critical.

With support from the World Health Organization, Gavi, the Vaccine Alliance, and UNICEF, Kenya has also introduced the malaria vaccine (RTS,S/AS01) in endemic regions as part of a broader strategy to reduce child deaths.

“All these tools, used together, will significantly reduce the malaria burden in Kenya and across sub-Saharan Africa,” Dr Kariuki says.

For families like that of Samson Okoth, the new treatment offers hope that others will not endure the pain he has lived with. “If this medicine can save even one child, then it is worth everything,” he says.