In an interview with Malaria No More, Dr. Damaris Matoke-Muhia, Principal Research Scientist at the Kenya Medical Research Institute (KEMRI), discusses her work to expand malaria elimination efforts. Matoke-Muhia traps mosquitoes to study their behavior and learn how they develop insecticide resistance. In the lab, she is researching new techniques to counter this resistance and specific innovations to control malaria. In villages across Kenya, she surveys breeding sites, investigates the effectiveness of preventive tools, conducts health education for families, and screens for malaria infections. On the international level, she is helping women rise to leadership positions in the fight against malaria and other mosquito-borne diseases.
We understand that your first experience with malaria started with you getting sick at an early age. Can you tell us about how that experience led to the work you do today?
MATOKE-MUHIA: During my childhood, getting malaria was very normal. I lost relatives and school mates. Then, I got malaria when I was in high school and had to be admitted for a while. I was out the full semester and had to be at home. So that experience really taught me that malaria is not something to joke with. However, the worst still was when I lost my brother to the disease. So I was questioning, why ….when this is a disease that is extremely preventable …why is it still taking people?
But also, I was seeing the frustrations in the community, because we used to have seasons of malaria, like a period of time when half the class of children were not attending school because they were infected. So, the patterns were huge to the community.
This gave me the desire to work on malaria, the desire to want to contribute scientifically to it, and really motivated me to become a scientist. I thought I was going to be an accountant, given my performance in math and statistics, but when I thought about the health of my community and the health of my family, and the role malaria was playing, I thought I needed to be in the field and joining forces to fight the disease.
As the Kenya Medical Research Institute’s senior research scientist focused on malaria, can you tell us what your role entails?
MOTOKE-MUHIA: I am a research scientist based at KEMRI. My main research focus is malaria. Mostly, I’ve been watching the fight on the control of mosquitoes that transmit malaria. Over the years, it’s been intense work … ensuring the latest facts and statistics are current, but also ensuring that the vector control tools provided are working effectively by monitoring resistance and mosquito diversity in communities.
How long have you been doing this work?
MATOKE-MUHIA: I’ve been in the malaria lab for the last 15 years. In that time, the malaria fight changed. Initially, the change was for the better where we saw decline of morbidity and mortality for malaria, especially in sub-Saharan Africa, including Kenya where we have seen a decline of malaria prevalence from 30% to 6%, but still that scenario is changing, and we are seeing sites where we did not expect malaria to be, now with malaria cases. So, our research looks at the factors that are contributing.
How has your role changed?
MATOKE-MUHIA: My work has had to change … as some of the vector control tools that we’ve been using, most of them had been implemented inside the houses…tools such as nets or spraying the houses. But we are still seeing malaria cases on the increase. Therefore, we started thinking, how can we implement other tools outdoors. So, this made us start thinking differently. Rather than just focusing on infections that are occurring inside the houses when people are asleep, we found that the mosquito biting times have changed to include early evenings or early mornings, when people are around homes. So, we started thinking, what other tools can we implement during those times – or what tools can we implement outdoors.
Do you see climate change impacting the malaria fight?
MATOKE-MUHIA: Yes, one of the reasons climate change has really contributed to malaria infections is because, for example, the emergence of anopheles stephensi, a mosquito that was known to be occurring in Asian countries, has now started being reported in the homes of Africa. The emergence has really contributed to more malaria infections in the country. The same has been reported in Ethiopia as well as Nigeria, Kenya, Ghana. Climate change has really made mosquitoes or malaria cases evolve. One of the disadvantages we see with the control that we have, and why they are challenged to tackle anopheles stephensi, is that this is an evasive species known to breed differently. It breeds in [smaller environments], areas like containers with water. Therefore, the control tools for malaria need to change too. But it is very concerning because anopheles stephensi is an invasive species, meaning it can spread far and wide. So, we need to be vigilant.
What gives you hope?
MATOKE-MUHIA: The hope I have is that in countries, where malaria is endemic, they are keen to make sure they are well taken care of, from the ministries of health and national malaria control programs, they are putting strategies to not only tackle the disease and the mosquito, but we’ve gotten a lot of support [with research]. Our continent is collaborating among governments to ensure things don’t get out of hand. So, my confidence comes from knowing a lot is being done and communities are being sensitized and engaged. There is also ownership among communities, which gives me assurance that there is vigilance.
Can you tell us about the role you see women playing in malaria elimination and why you say more women need to be involved?
MATOKE-MUHIA: Women can never be left out if we are serious about malaria elimination. At the community level, we are having more women being the caregivers. And when medicine is given, it’s the mothers who usually make sure the child is treated. But also, this same woman, when they are provided with bed nets, she is the one to ensure that it is placed so that children are underneath and make sure the community is protected from malaria. We are not saying that men are not important but at the ground level it is typically women ensuring protections against malaria. The problem we are seeing is that we don’t see the same percentage of women at the decision-making tables. So, we see the decisions being made in regard to the malaria fight are male dominated so we find the gender or female lens is not applied. So, it is important that we ensure equal representation, as far as leadership, because women speak from experience and from what has worked and not worked at community levels. Women should always be at the forefront at leadership levels, which is key to elimination of malaria on the continent.
Can you talk about the impact of malaria vaccines?
MATOKE-MUHIA: I am very excited that we now have a vaccine [rolling out], because it will be given to children and covers a percentage of the vulnerable population. Therefore, once they get the vaccine, we know they will be protected from severe malaria infections…which means the populations coming up will be extremely protected from infection, which directly impacts the community. The amount of time taking care of a young one will no longer be there. Or the amount of economic impact, the amount of money spent by a family member on not going to work, will be helped. So, there will be both economic growth of the countries but also it will reduce the number of people suffering from the disease.