KISUMU, Kenya--The rainy season in East Africa is also the malaria season.
Rain water collects in puddles and old tires and gutters. It also accumulates in discarded tin cans and in the folds of plastic shopping bags in garbage heaps. Malarial mosquitoes lay their eggs in the stagnant water and pretty soon you have killer mosquitoes hatching.
Around the world more than 800,000 people die every year from malaria, mostly young children. More than 90 percent of the deaths are in Africa, and Kenya is among a handful of African countries where the disease is at its worst.
The red clay flatlands and hills here in western Kenya, around Lake Victoria and the hard-scrabble city of Kisumu, lie in the worst part of a bad malaria zone - ground zero in Kenya. "There's a very high chance of getting malaria here," said Tom Guda, a Kenyan researcher at the International Center of Insect Physiology and Ecology in the nearby lake shore town of Mbita.
Western Kenya is an ideal place to study malaria and American and Kenyan researchers have been working together here for years at a joint laboratory of the Centers for Disease Control and Prevention and the Kenya Medical Research Institute. The Centers for Disease Control and Prevention, one of the main research institutes in the United States for malaria and other infectious diseases, began nearly 70 years ago as an important player in the ultimate elimination of malaria in the United States.
In the last few years malaria has caught the imagination of Hollywood entertainers, government leaders around the world, gazillionaires and ordinary people. Lots of money has been raised. The World Health Organization estimates that $1.7 billion was available for malaria in 2009, double the amount just three years earlier. The American Idol television show, alone, raised $9 million for the organization Malaria No More during a single charity broadcast, and the Bill and Melinda Gates Foundation has put more than $168 million into overcoming the disease.
This may be a time of great progress against malaria. But it is hard to be sure. The latest data compiled by the World Health Organization shows little change in recent years: 863,000 deaths and 243 million cases of malaria reported in 2008 compared with 881,000 deaths and 247 million infections two years earlier. But experts say that record-keeping on malaria is poor and that the numbers don't tell the whole story.
Much of the malaria money is going into buying and handing out mosquito nets saturated with insect repellant-at $10 each -- and to spraying insecticide on the inside walls of houses. And it may be paying off.
"We know that sleeping under insect nets is effective and we know that the number of people sleeping under nets is increasing rapidly," said Dr. Matthew Lynch, the director of the Global Program on Malaria at the Johns Hopkins Bloomberg School of Public Health in Baltimore in an interview.
Richard Tren, the director of Africa Fighting Malaria, a small organization with offices in Durban, South Africa and in Washington, told me that "progress in some places is phenomenal." But, he added, "there are a lot of other places where things are not working."
The World Health Organization says it believes there have been big gains against malaria in some small countries, including Rwanda and Zambia and on the island of Zanzibar off East Africa. But it is urging that anti-malaria efforts be concentrated more on bigger countries like the Democratic Republic of Congo and Nigeria, where malaria is rampant and where the situation has either gotten worse or not changed much.
At the Center for Insect Physiology and Ecology on Lake Victoria, Mr. Guda said that malaria infections and deaths are increasing in western Kenya.
"People are getting bed nets but it is still rising," Mr. Guda told me one sweltering afternoon at his center. One reason, he said, is that "people are not using the nets properly."
In the one-room huts that are home to many people here, Mr. Guda said, there is one bed. "The big people sleep in the bed," with the net, he said. "The children sleep on the floor."
Dr. Laurence Slutsker is the chief of the malaria branch at the Centers for Disease Control and Prevention in Atlanta, Ga. Dr. Slutsker, who worked at the Centers for Disease Control and Prevention laboratories in western Kenya for five years and still watches the area closely, said that after dropping sharply over the last 15 years, infections in children around here have begun to rise. Two years ago, 30 percent of those under five had malaria parasites in their blood. The latest samplings, he said, showed 40 percent were infected -- not a good sign.
The big picture on malaria around the world? "I think it's getting better in some places," Dr. Slutsker said in an interview. "I think it's basically the same in other places. We talk about our success, which is good. But there's a lot of work that needs to be done."