Nets. Medicines. Spraying. Vaccines. For decades, Kenya has thrown everything at malaria. The Kenya Malaria Strategy 2023–2027, aligned with the WHO Global Technical Strategy, has an ambition to reduce the malaria burden and deaths by 75 per cent from 2016 levels.  

But while the national target is clear, county -by-county data from the Kenya National Bureau of Statistics tells a messier story: geography still decides whether a child or a pregnant woman sleeps protected- or wakes exposed. 

The dashboard tracking malaria interventions across Kenya’s 47 counties measures three indicators: access to insecticide-treated nets (ITN access), actual usage of those nets (ITN use), and the percentage of pregnant women receiving SP/Fansidar doses, a preventive medicine given during antenatal visits to protect both mother and unborn child from malaria. Taken together, these three measures offer a picture not just of disease burden, but of how well Kenya’s prevention infrastructure is reaching the people who need it most. 

The ITN access data in the full 47-county view reveals a striking western and south-western concentration of high coverage. Bomet leads with 89 per cent ITN access, followed closely by Nyamira at 88 per cent, Vihiga at 86 per cent, and Trans Nzoia and Taita Taveta both at 83 per cent.  

Bungoma, Nandi, Busia, Kericho, Kakamega, and Kisii all register above 79 per cent. These are counties in the lake endemic and highland endemic regions, where malaria transmission is perennial and where national distribution programmes have, over time, concentrated their efforts.

Nairobi records the highest ITN use at 17 per cent, Nakuru at 16 per cent and Laikipia at 15 per cent 

The picture shifts sharply when examining the ten most affected counties. Here, ITN access drops considerably. Nakuru leads this group at 21 per cent, Laikipia at 20 per cent, and Nairobi at 19 per cent. Marsabit records 17 per cent, Nyeri and Elgeyo-Marakwet 15 per cent each, with Mandera and Garissa at 10 and 11 per cent respectively. Nyandarua trails at just 7 per cent. 

This divergence reflects the targeted nature of Kenya’s ITN distribution policy. ITNs are not distributed in low-risk malaria areas, which explains the lower access figures in counties such as Nairobi, Nyeri, and Nakuru, where malaria transmission is less endemic. The concern lies with counties like Mandera and Garissa, arid, remote, and historically underserved, where low access may reflect genuine distribution gaps rather than low clinical need. 

ITN usage figures among the ten most affected counties follow a similar pattern but with telling divergences. Nairobi records the highest ITN use in this group at 17 per cent, Nakuru at 16 per cent, and Laikipia at 15 per cent. Nyeri, Elgeyo-Marakwet, and Garissa follow at 11, 10, and 9 per cent respectively, with Samburu and Mandera at 8 per cent each, Marsabit at 7 per cent, and Nyandarua at just 5 per cent. 

Amongst the broader 47-county dataset, ITN usage climbs sharply in the lake and highland endemic regions. Nyamira records 79 per cent usage, Taita Taveta and Busia at 75 per cent, Vihiga at 74 per cent, and Trans Nzoia and Bomet at 73 per cent each. These figures are broadly consistent with what the KDHS 2022 found: 75 per cent of children under five and 75 per cent of pregnant women slept under an insecticide-treated net in the western region. 

ITN coverage reduced the entomological inoculation rate and malaria incidence by 58 per cent and 41 per cent, respectively, according to modelling of western Kenya data from 2007 to 2022. The counties showing high usage are, in part, reaping the benefit of sustained, decades-long distribution campaigns.  

In some households, it’s the male spouse who makes decision on whether to use ITN or not 

The gap between having a net and using it, visible in several counties, points to the behavioural and social dimension of malaria prevention that net distribution alone cannot solve. Community perceptions limit the efficacious use of ITNs; in some households, it is the male spouse who makes the decision on whether to use an ITN or not. 

The SP/Fansidar data, tracking doses of preventive antimalarial medicine given to pregnant women, reveals perhaps the most significant concern in the dashboard. Among the broader county picture, Vihiga leads with 59 per cent, Kakamega at 46 per cent, Lamu at 42 per cent, and Bungoma at 41 per cent. Coverage drops progressively through Busia, Siaya, Homa Bay, Mombasa, Kwale, Kilifi, Kisumu, and Migori, the last recording just 25 per cent. 

In the ten most affected counties, Nairobi records the highest SP/Fansidar coverage in this group at just 6 per cent. Marsabit follows at 3 per cent, Nyandarua and Nakuru at 2 per cent each. Samburu, Garissa, Nyeri, Mandera, and Elgeyo-Marakwet all record figures at or below 1 per cent. 

Intermittent preventive treatment in pregnancy, of which SP/Fansidar is the primary medicine, is a cornerstone of global malaria strategy for protecting pregnant women in endemic regions. Globally, only 45 per cent of eligible pregnant women and girls in 34 countries received at least three doses of preventive medicine in 2025, still below the global target of 80 per cent coverage. 

Kenya’s Malaria Strategy flags challenges, including devolution, supply chain fragility, uneven distribution of skilled medics 

 Kenya’s county-level data suggests the country is not merely below that target; in most counties, it is not meaningfully close to it. 

Kenya recorded an estimated 3.3 million malaria cases in 2023, with malaria accounting for approximately 15 per cent of outpatient consultations in 2022. Annual incidence for confirmed outpatient malaria has decreased over time, from 113 per 1,000 population in 2017 to 93 per 1,000 in 2022, a measurable but insufficient decline given the scale of the challenge. PMI investments since 2006 total 528 million dollars, which has contributed to an estimated 55 per cent decrease in child deaths since 2003. 

Globally, an estimated 282 million new malaria cases were recorded across 80 endemic countries in 2024, up from 273 million in 2023. Available malaria funding of 3.9 billion US dollars in 2024 fell far short of the Global Technical Strategy target of 9.3 billion dollars by 2025. 

Kenya’s Malaria Strategy 2023–2027 acknowledges the structural challenges of devolution, supply chain fragility, and the uneven distribution of skilled health workers across counties. The dashboard data gives those acknowledgements a precise geography. Counties like Bomet, Nyamira, and Vihiga show what sustained, targeted investment in net distribution and community health infrastructure can achieve. Counties like Mandera, Garissa, and Nyandarua show what happens when that investment does not arrive. 

Sources: KNBS 2022, KDHS 2022, WHO World Malaria Report 2024, Kenya Malaria Strategy 2023–2027, US President’s Malaria Initiative FY2024, Medicines for Malaria Venture 2025, Scientific Reports (Nature, 2026) 

Data analytics and visualisation by Stanley Njihia & Text by Yvonne Kawira.