In a congested ward in Kisii in the western highlands of Kenya, 50-year-old Nelly Kwamboka wails, curses and collapses in anguish at the foot of the bed. Her young son has just died.

Two months ago, Kisii bore the brunt of an epidemic of highland malaria, which resulted in hundreds of deaths. Nelly is too shocked to walk. She looks pale and exhausted, after trekking many kilometres with her child to reach the hospital.

Nearby, a mother of two, Elizabeth Momanyi from the village of Bomorenda, Suneka, has already lost one son - and her husband - to the epidemic. She rarely seeks medical services for herself, but when her own fever worsened, neighbours intervened, urging her to go to the hospital. But she is not impressed with the treatment she received: "Attendants at this hospital are cruel," she said. "During the few occasions I have been here, I have had my prescription written before I even described my condition or had any medical examination."

In a bed close by, Elizabeth Kemunto had been ailing for two months but could not get to the hospital. Instead, she lay waiting for divine intervention. "We took her to the local pastor for prayers after which she felt better, but then her condition worsened" says her mother, Eunice Nyamato. But even then, she did not see the doctor, opting to buy over-the-counter drugs.

Kisii residents told the Bulletin that they normally use chloroquine as the first line of treatment because it is cheap. But the malaria parasite here is resistant to chloroquine, and to next-line drugs like Fansidar. By the time some neighbours took Elizabeth to hospital, her condition had deteriorated seriously. She may not live.

Even in the capital, Nairobi, malaria takes its toll. In the city's Kibera slums, Stella Wangui, a casual worker at the Nairobi City Council, recalls how she lost her daughter, Angela Muthini, four years ago to the disease. Stella had travelled to her rural home in Embu with her daughter and remembers Angela playing with other children by a nearby stream.

"She probably died because she was playing there - hundreds of mosquitoes were buzzing around the water," she said. "My beautiful little girl died so quickly. Some days later, I became ill too." Back in Nairobi she had bouts of fever at regular intervals, but her temperature always returned to normal without medication. She thought that her body was merely reacting to the death of her daughter. But she decided to take medical tests, which revealed that hers was mild form of malaria "I thought it would kill me the way it did to Angela," she said.

According to Kenya's National Malaria Strategy Paper 2001-2010, malaria kills 26 000 children per year in the country and accounts for 30% of all outpatient attendance.

James Njoroge, Nairobi