Is Uganda losing the fight against malaria control?




 On April 26, Uganda marked the World Malaria Day under the theme: “End malaria for good.” However, the country is challenged with shortage and theft of anti-malarial drugs and a resurgence of the epidemic in ten districts of Northern Uganda.

Last year, the Ministry of Health confirmed a malaria outbreak in the districts of Agogo, Amuru, Apac, Gulu, Kitgum, Kole, Lamwo, Oyam, Nwoya, and Pader. At the time of the outbreak confirmation, the ten districts had registered a total of 22,873 cases and about 162 deaths in less than two months.

A 2015 statistical abstract prepared by the Uganda Bureau of Statistics indicates that malaria is the leading cause of illness in the country, followed by cough and cold.

According to the same report, about 15 million new cases of malaria were diagnosed between 2013 and 2014. In 2015, 214 million cases were reported globally.

The report also ranks malaria as the leading cause of death among in-patients in the last three years.

Out of the total 31,868 health-facility related deaths reported in the 2013/14 financial year among Ugandans aged below five years, malaria accounted for about 19.9 percent of deaths, followed by pneumonia at 12.4 percent and anemia at 12.2 percent. 

In most sub-Saharan African countries, malaria mainly affects children below five years, pregnant mothers and other adults with low immunity once they are bitten by a female anopheles mosquito that spreads malaria with parasites known as plasmodium.

Uganda ranks sixth among African countries with the highest malaria transmission rates in the world. The World Health Organisation (WHO) reports that globally, malaria is the leading cause of ill-health and death.

According to the Ministry of Health, everyone in Uganda is at risk of malaria infection, although pregnant mothers and children under five years are most-affected.

Malaria also accounts for 30-50 percent of outpatients and 15-20 percent of hospital admissions in the country. In 2010, 7.2 million nets were distributed under the Global Fund Round 7 Malaria Grant, targeting mainly children under five and pregnant women and in 2014, about 15.5 million nets were given out during a nationwide distribution campaign.

This year, the State Minister for Primary Health Care, Ms Sarah Opendi, announced yet another mosquito net distribution exercise aimed at replacing the old mosquito nets whose factory life expectancy is three years.

The nets will be distributed under the previous criterion where one net targeted every two people in a household.

In recent years however, there has been growing concern that mosquitoes are becoming resistant to the pyrethroid insecticides used on the nets, making them less effective.

However, the impact of this resistance on malaria as a public health problem has been harder to demonstrate, for reasons that remain unclear.

Innovations and plans 

In September 2015, the Malaria Consortium, in partnership with the Ministry of Health and the National Drug Authority, WHO and other NGOs launched a US $6.2 million quality malaria rapid diagnostic to enable all health service providers to diagnose patients with suspected malaria cases in just 20 minutes.

Global Malaria statistic infographic. Source: WHO

In addition, Dr Jimmy Opigo, the National Malaria Control Programme manager, says they are currently conducting studies on using larvicidies as a means of controlling mosquitoes while in their early lifecycle stages.

The pilot studies will help ascertain the effectiveness of the method. He also acknowledges that mass treatment is the most effective malaria control method as seen from the experience of Comoros Islands where the entire population is given anti-malarial drugs.

Dr Opigo, however, notes the process is not cost-effective since it requires a lot of resources like the availability of artemisinin-based combination therapy (ACTs) for the entire population.

The Ministerial Policy Statement for 2016/17 prepared by Health Minister, Dr Elioda Tumwesigye, indicates that malaria control needs an additional Shs19.6 million for implementation of Indoor Residue Spraying (IRS) in the most affected districts of Northern Uganda.

It also indicates that USD 153 million is required by the Ministry of Health to implement the malaria control strategy in the medium term. The country needs Shs275 billion to conduct IRS across the country.

This only means that the fight against malaria is far from won.

Additional reporting by Daily Monitor, Centre for Disease Control and the Malaria Consortium