Kenya, Softcover reprint of the original 1st ed. 1978 A Geomedical Monograph Medizinische Länderkunde Geomedical Monograph Series, Vol. 5

municable Disease Control, Dr. Itotia, Director of the The geomedical monograph on Kenya continues the National Public Health Laboratories, Dr. J. M. D. Ro­ series of Regional Studies in Geographical Medicine berts, Head of the Division of Vector-Borne Diseases, founded by Ernst Rodenwaldt in 1965, which may be considered as supplementing the World Atlas of Epidem­ and to Mr. Ted Abukuse, Chief Statistician at the Minis­ ic Diseases of the Heidelberg Academy of Sciences. Since try of Health, Nairobi. The authors offer their particular thanks for support the appearance of the first volume in 1967 the series has and valuable suggestions to Dr. 1. C. Vogel, formerly been edited by Helmut]. Jusatz under the aegis of the Professor of Community Health in the Medical Faculty Mathematical and Natural Sciences Class of the Heidel­ berg Academy of Sciences. at the University of Nairobi and member of the Royal The authors wish to express their thanks to the edi­ Tropical Institute, Amsterdam. Thanks are due to the Survey of Kenya for their willingness to allow the au­ tor for his suggestion that they should undertake this thors to reproduce some maps in the National Atlas of kind of teamwork, and to acknowledge with gratitude Kenya. The authors extend their thanks to their col­ the manner in which Professor Jusatz ensured the most league, Professor S. H.

Methodological Considerations.- A. The Land and its Inhabitants.- I. Fundamentals of Physical Geography.- 1. Surface Configuration.- 2. Climate.- a) Precipitation.- b) Temperature.- 3. Hydrology.- 4. Ecological Potential.- II. Demographic Basis.- 1. Development of Population.- a) African.- b) Europeans.- c) Asians.- d) Arab.- 2. Distribution of Population.- 3. Structure of the African Population.- a) Ethnic Differentiation.- b) Age Structure.- 4. Internal Migrations.- III. Fundamentals of Settlement Geography.- 1. Rural Settlements.- 2. Urban Settlements.- 3. Central Place System.- 4. Health Problems in the Urban Sphere.- a) National Health.- b) International Health and Port Health in Nairobi and Mombasa.- IV. Fundamentals of Economic Geography.- 1. Agriculture.- a) Small-Scale Agriculture and Cattle Keeping.- aa) Livestock.- bb) Forms of Agricultural Techniques.- cc) Land Tenure.- dd) Relation of Peasant Farms to Marketing.- b) Large-Scale Ranching, Mixed Farming, and Plantations.- 2. Distribution of Population.- 3. Structure of the African Population.- 4. Energy Supply.- 5. Forestry.- 6. Fisheries.- 7. Internal and External Trade.- V. Transport and Tourism.- 1. Transport.- a) Railways.- b) Roads.- c) Waterways.- d) Air Transport.- 2. Tourism.- B. Health Services in Kenya.- 1. The Development of Health Services in Kenya until Independence in 1963.- 2. The Structure and Organisation of the Health Services since 1963.- 3. The National Health Budget.- 4. Church Health Services and other Voluntary Societies.- a) Church Health Services.- b) Voluntary Societies.- 5. Health Service Facilities and their Regional Distribution.- a) Hospital Services.- b) Basic Health Services.- c) Mental Health, Dental and Pharmaceutical Services.- d) Regional Distribution of Health Services.- aa) Hospitals.- bb) Hospital Beds.- cc) Physicians.- dd) Health Centres, Dispensaries.- 6. Medical Manpower and Training of Medical Personnel.- a) The Medical Profession.- b) The Paramedical Personnel.- 7. Hospital Insurance Act and Social Security.- a) The National Hospital Insurance Act..- b) The National Social Security Fund Act..- C. The Diseases of the Country.- Introduction: Source, Material, and Methods.- I. Diseases Transmitted by Arthropods.- 1. Malaria.- 2. Trypanosomiasis.- 3. Leishmaniasis.- a) Visceral Leishmaniasis (Kala Azar).- b) Cutaneous Leishmaniasis.- 4. Arthropod-borne Virus Diseases (Arbovirus Diseases).- 5. Diseases Caused by Bacteria and Bacteria-like Organisms and Transmitted by Arthropods.- a) Plague.- b) Rickettsioses.- c) Relapsing Fevers (Borrelioses Transmitted bei Ticks and Lice).- 6. Filarial Infections Transmitted by Arthropods (Filariasis).- a) Bancroftian Filariasis (Wuchereria bancrofti).- b) Onchocerciasis.- II. Infectious Diseases Usually Transmitted Directly from Man to Man (Contact and Air-borne Diseases).- 1. Tuberculosis.- 2. Leprosy.- 3. Leishmaniasis.- a) Foci in Western Kenya.- b) Foci in the Coastal Area.- c) Foci in the Taveta Area.- d) Focal Areas in the Central Low lands of Kenya.- e) Prevention and eradication.- 3. Smallpox.- 4. Cerebrospinal Meningitis.- 5. Yaws.- 6. Trachoma and other Infections Causing Blindness.- III. Infectious Diseases Usually Transmitted Indirectly from Man to Man by Water or Food (Water-borne and Food-borne Diseases) and Tetanus.- 1. Poliomyelitis.- 2. Viral Hepatiti.- 3. Typhoid Fever and other Enteritic Infections.- 4. Cholera.- 5. Amoebic Dysentery.- 6. Tetanus.- IV. Helminthic Infections Associated with Soil, Water, and Food.- 1. Intestinal Helminths.- 2. Schistosomiasis.- a) The Distribution of Schistosomiasis in Kenya.- b) The Ecology of the Intermediate Hosts in Kenya.- aa) Intermediate Hosts of S. haematobium.- bb) Intermediate Hosts of S. mansoni.- c) Regional Distribution of the Frequency of Schistosomiasis in Kenya.- 1) East Coast and Tana River Valleymansoni.- l a) Bura.- 2) Tavet.- 3) Kamba-Kitui.- 3a) The Adjacent Highland around Kitui.- 4) Aberdare and Mwea Tebere.- 5) Nyanza Region.- 6) Western Province.- V. Anthropozoonoses.- 1. Anthrax.- 2. Brucellosis.- 3. Echinococcosi.- 4. Leptospirosis.- VI. Nutritional Problems and Anaemias.- 1. Nutritional Problems.- 2. Anaemias.- VII. Diseases of Special Geomedical Relevance.- 1. The Geographical Distribution of Endemic Goitre.- 2. Fluorosis.- 3. Cancer and other Malignant Tumours.- 4. Diabetes.- D. Economic and Socio-geographical Classification and the Patterns of Health Services and of Disease Occurrence.- 1. African Peasant and Pastoral Societies.- a) Peasant Societies in Areas of Rainfed Agriculture over 1,500 m above Sea-Level.- b) Peasant Societies in Areas Rainfed Agriculture between Sea-Level.- c) African and Afro-Arabic Peasant Societies in Areas of Rainfed Agriculture in the Coastal Low-land.- d) African Peasant Societies in Marginal Areas of Rainfed Agri-culture.- e) African Peasant Settlement Schemes in Areas of Rainfed Agriculture.- f) African Peasant Societies (Tenant Farmers) in State-Organised Irrigation Scheme.- aa) Mwea Tebere Irrigation Scheme.- bb) Ahero and Kano II Irrigation Schemes.- cc) Irrigation Schemes on the Tana River.- dd) Perkerra Irrigation Scheme.- ee) Irrigation Schemes in the Yala Swamps Area.- g) African Peasant Societies with Irrigated Cultivation.- h) African Pastoral Societies in Predominantly Arid and Semi Arid Area.- 2. Class Societies.- a) Afro-European Class Societies Engaged in Pastoral Economy in Arid Area.- b) Afro-European Class Societies on large Farms in Areas of Rainfed Agriculture.- c) Afro-European Class Societies on Coffee Plantations.- d) Afro-European Class Societies on Tea Plantations.- e) Afro-European Class Societies on Sisal Plantation.- f) Afro-Asian Class Societies on Sugar Plantations.- Conclusions.- Annex.- References.- Illustrations.- Annex: Tables.- Table I: Population according to tribes.- Table II: Small farms and settlement schemes — Estimated crop areas by rains cycle.- Table III: Large farms — Land utilization 1974.- Table IV: Quantiry and value of fish landed — selected years 1966 – 1972 and projected for 1978 —.- Table V: Visitor days in Kenya by country of residence of visitors and purpose of visit, 1971, 1972, 1978.- Table VI: Details on “Estimates of Recurrent Expenditures on Health” by the Ministry of Health.- Table VII: “Estimates of Recurrent Expenditures” of the Governmen t of Kenya 1968/69 1973/74.- Table VIII: Hospital and hospital-bed-ratio per province in relation to areas and population to be covered, Kenya, 1970.- Table IX: Health centres and dispensaries by operating agency and province, 1970, and health centre — dispensary — population ratio per province.- Table X: The present strength of medical officers in Government hospitals, 1974.- Table XI: Relative frequency of 4 helminths from stool examinations in 54 hospital laboratories in Kenya from “Annual Laboratory Returns” 1958 – 1973 (cumulative) grouped by hospitals with similar frequency distribution pattern.- Table XII: Schistosoma haematobium findings from urine examinations in 54 hospital laboratories in Kenya from “Annual Laboratory Returns” 1958 – 1973, cumulative, grouped by hospitals with similar frequency distribution pattern of intestinal helmin ths.- Table XIII: Summary of results of examinations of school children in some districts of Kenya.- Table XIV: Gross domestic product by industrial origin for 1964 and 1974.- Figures.- Fig. 2. Population of Nairobi by sex and tribe, 1969.- Fig. 3. Population of Mombasa by sex and tribe, 1969.- Fig. 4. Hospital catchment area after.- Fig. 5. Trypanosomiasis, 1950 – 1972.- Fig. 6. Kala azar, 1945 – 1972.- Fig. 7. Tick ryphus, 1950 – 1970.- Fig. 8. Relapsing fever, 1950 – 1972.- Fig. 9. Tuberculosis vaccinations, 1962 – 1973.- Fig. 10. Smallpox, 1942 – 1972.- Fig. 11. Meningococcal meningitis, 1951 – 1972.- Fig. 12. Poliomyelitis, 1945 – 1972.- Fig. 13. Typhoid fever, 1945 – 1972.- Fig. 14. Anthrax, 1950 – 1972.- 1 Clinical Malaria.- 2 Meningococcal Meningitis.- 3 Hepatitis.- 4 Brucellosis.- 5 Pulmonary Tuberculosis.- 6 Acute Poliomyelitis.- 7 Tetanus.- 8 Anthrax.- Maps.- Map No. 1 Topography 1 : 2,000,000.- Map No. 2 Mean Annual Precipitation.- Map No. 3 Climatology.- Map No. 3a Ecological Zones.- Map No. 4 Distribution of Population.- Map No. 4a Ethnic Differentiation.- Map No. 5 Economic and Socio-Geographical Classification.- Map No. 6 Health Facilities.- Map No. 6a Health Services Density.- Map No. 7 Vector-borne Diseases: Bancroftian Filariasis — Leishmaniasis — Malaria — Onchocerciasis — Sleeping Sickness.- Map No. 8 Intestinal Helminths Relative Frequency and Geographical Distribution of Intestinal Helminths.- Map No. 9a Kwashiorkor, Measles, and Anaemias.