Can Uganda meet its 2030 malaria elimination target?

Uganda is aiming to eliminate malaria entirely by 2030 but developments such as resistance and the lingering question of underfunding threaten to reverse the gains. Latest reports from the health ministry show that the country will have to do much more if it is to meet this target.

Already, the African Union goal of reducing malaria incidence and mortality by 40 percent by 2020, a key milestone to eliminating malaria in Africa by 2030, was missed. According to the World Health Organization (WHO) estimates, 96 percent of global malaria cases and 98 percent of malaria deaths occur on the continent. 

In 2020, 611,802 Africans died from this disease of which 80 percent were children under the age of five. Furthermore, revised estimates by the World Health Organisation (WHO) in the 2021 World Malaria Report indicate that the number of malaria deaths was previously underestimated, and the burden is worse than previously understood. Malaria is a driver for up to $12b lost productivity in Africa annually, drastically impeding economic growth and societal progress despite it being preventable and treatable.

Grim picture 

On July 14, Dr Jane Ruth Aceng, the health minister, told Parliament that over the last decade, Uganda has achieved a notable reduction in the malaria burden and that the malaria parasite prevalence rate was reduced from 42 percent in 2009 to nine percent in 2019.

Government’s own latest report on malaria is, however, cautious warning that the gains made are “fragile” because of “ever-present risk of reversal should funding end or interventions withdrawn without a properly managed exit plan”.

The Covid-19 pandemic is also cited for straining the country’s health system. Focus was moved away from problems such as malaria to deal with the immediate threat. 

“The response to Covid-19 has demonstrated African countries’ leadership and ownership in strengthening their public health systems and adapting new delivery approaches of malaria control interventions. More resources and commitments must be mobilised by all sectors so that we can all reach our goal of ending malaria,” Dr Corine Karema, the interim CEO of the Roll Back Malaria Partnership to End Malaria says. 

Effects

Uganda has seen a sustained upsurge in malaria cases in various districts with the current average of 37,600 cases per day, resulting in increased hospitalisation and deaths. 

Malaria kills 16 Ugandans daily and causes an estimated annual economic loss of $658m (Shs2.4 trillion) due to treatment costs and work time lost, according to statistics from the Ministry of Health.

Between January and March this year, Uganda saw an increase in the burden of malaria for both outpatients and inpatients and this translated into more deaths recorded. In the period, out of 11, 251, 900 outpatient visits recorded, 3,156,500 (28 percent) had malaria, health ministry figures show. Of the 189,900, 80,900 (17 percent) pregnant women attending the first antenatal visit had malaria. Of the 3,156,500 reported malaria cases, 774,180 (25 percent) were children under five years.

Further, of the 804,470 total admissions, 61,160 (8 percent) of people were admitted with malaria. 628 malaria deaths were reported between January and March, of which 371 (59 percent) were children under five years. Of the 628 deaths, 41 (7 percent) were pregnant women.

“I am deeply concerned that more than 80,000 women go to health centres with malaria. We also know that malaria is one of the leading causes of miscarriages. I have had encounters with women who have lost their pregnancies through malaria even without knowing,” Kassanda Woman legislator Flavia Kalule Nabagabe told Parliament on July 14. 

The statistics are grim. For example, only India registered progress on malaria according to the 2021 world malaria report by the WHO of the world’s 11 highest-burden countries.

When it comes to the malaria burden, Uganda is in the company of other African countries such as Nigeria, the Democratic Republic of the Congo (DRC), United Tanzania and Mozambique. These countries, latest WHO figures show account for just over half of all malaria deaths worldwide.

Need for funding

Uganda has one of the highest global burden of malaria cases and with more than 90 percent of the population at risk, malaria remains Uganda’s leading cause of death, especially among children.

Fighting malaria is expensive and for a poor country such as Uganda, the financial burden is huge with donors playing a critical role. 

Total funding realised for implementation of interventions between 2015- 2019 was Shs3.2 trillion representing 63.8 percent of the financial requirements (Ush5 trillion). This has left a gap of 36.2 percent. Most of the funding (84.6 percent) was from donors, the health ministry says, while government contributed on average 15. 4 percent. 

Risk factors

Malaria risk in Uganda is influenced by a host of factors such as rainfall, temperature, population movement, poverty, access to health services, urbanisation, and altitude, health ministry reports show. 

“The entire population of Uganda remains at risk of These include pregnant women, children under five years of age, people with immune compromising conditions (such as HIV, sickle cell disease and cancer, among others),” Anifa Kawooya, the state minister for health in charge of general duties, is quoted in a July 12 statement to Parliament.  Transmission is driven, mostly, by five to15 year olds. 

Health experts have warned, recently, that many malaria patients in the country are misdiagnosed and are experiencing treatment failure because of mutation of the malaria parasite and drug resistance. 

Youth voice

Young people have decided to take action. In an open letter, also supported by The RBM Partnership to End Malaria and Speak Up Africa, young people vow to be the generation to end malaria by 2030.

“As young people we are concerned that malaria continues to plague our continent taking millions of lives and despite recent progress, a child still dies from malaria every minute.  The open letter is a call-to-action to decision makers because we, young people, believe that ending malaria is an attainable goal if we sustain decisive,” says Moses Kodah, executive director, Naye-Salone.

The open letter turns up the pressure on African leaders to achieve a malaria-free world in line with Agenda 2063 for socio-economic transformation.  Calling on leaders to recommit to keeping malaria high on national development agendas, mobilise additional resources (especially from the domestic public and private sector), empower communities to act, strengthen data and evidence-based governance, accelerate the deployment of new malaria commodities and interventions, actively engage youth leaders and rapidly deploy the new tools to address the growing threats of insecticide and drug resistance.

Can Uganda meet its 2030 malaria elimination target?

Stephen Kafeero

Uganda is aiming to eliminate malaria entirely by 2030 but developments such as resistance and the lingering question of underfunding threaten to reverse the gains. Latest reports from the health ministry show that the country will have to do much more if it is to meet this target.

Already, the African Union goal of reducing malaria incidence and mortality by 40 percent by 2020, a key milestone to eliminating malaria in Africa by 2030, was missed. According to the World Health Organization (WHO) estimates, 96 percent of global malaria cases and 98 percent of malaria deaths occur on the continent. 

In 2020, 611,802 Africans died from this disease of which 80 percent were children under the age of five. Furthermore, revised estimates by the World Health Organisation (WHO) in the 2021 World Malaria Report indicate that the number of malaria deaths was previously underestimated, and the burden is worse than previously understood. Malaria is a driver for up to $12b lost productivity in Africa annually, drastically impeding economic growth and societal progress despite it being preventable and treatable.

Grim picture 

On July 14, Dr Jane Ruth Aceng, the health minister, told Parliament that over the last decade, Uganda has achieved a notable reduction in the malaria burden and that the malaria parasite prevalence rate was reduced from 42 percent in 2009 to nine percent in 2019.

Government’s own latest report on malaria is, however, cautious warning that the gains made are “fragile” because of “ever-present risk of reversal should funding end or interventions withdrawn without a properly managed exit plan”. The Covid-19 pandemic is also cited for straining the country’s health system. Focus was moved away from problems such as malaria to deal with the immediate threat. 

“The response to Covid-19 has demonstrated African countries’ leadership and ownership in strengthening their public health systems and adapting new delivery approaches of malaria control interventions. More resources and commitments must be mobilised by all sectors so that we can all reach our goal of ending malaria,” Dr Corine Karema, the interim CEO of the Roll Back Malaria Partnership to End Malaria says. 

Effects

Uganda has seen a sustained upsurge in malaria cases in various districts with the current average of 37,600 cases per day, resulting in increased hospitalisation and deaths. 

Malaria kills 16 Ugandans daily and causes an estimated annual economic loss of $658m (Shs2.4 trillion) due to treatment costs and work time lost, according to statistics from the Ministry of Health.

Between January and March this year, Uganda saw an increase in the burden of malaria for both outpatients and inpatients and this translated into more deaths recorded. In the period, out of 11, 251, 900 outpatient visits recorded, 3,156,500 (28 percent) had malaria, health ministry figures show. Of the 189,900, 80,900 (17 percent) pregnant women attending the first antenatal visit had malaria. Of the 3,156,500 reported malaria cases, 774,180 (25 percent) were children under five years.

Further, of the 804,470 total admissions, 61,160 (8 percent) of people were admitted with malaria. 628 malaria deaths were reported between January and March, of which 371 (59 percent) were children under five years. Of the 628 deaths, 41 (7 percent) were pregnant women.

“I am deeply concerned that more than 80,000 women go to health centres with malaria. We also know that malaria is one of the leading causes of miscarriages. I have had encounters with women who have lost their pregnancies through malaria even without knowing,” Kassanda Woman legislator Flavia Kalule Nabagabe told Parliament on July 14. 

The statistics are grim. For example, only India registered progress on malaria according to the 2021 world malaria report by the WHO of the world’s 11 highest-burden countries.

When it comes to the malaria burden, Uganda is in the company of other African countries such as Nigeria, the Democratic Republic of the Congo (DRC), United Tanzania and Mozambique. These countries, latest WHO figures show account for just over half of all malaria deaths worldwide.

Need for funding

Uganda has one of the highest global burden of malaria cases and with more than 90 percent of the population at risk, malaria remains Uganda’s leading cause of death, especially among children.

Fighting malaria is expensive and for a poor country such as Uganda, the financial burden is huge with donors playing a critical role. 

Total funding realised for implementation of interventions between 2015- 2019 was Shs3.2 trillion representing 63.8 percent of the financial requirements (Ush5 trillion). This has left a gap of 36.2 percent. Most of the funding (84.6 percent) was from donors, the health ministry says, while government contributed on average 15. 4 percent. 

Risk factors

Malaria risk in Uganda is influenced by a host of factors such as rainfall, temperature, population movement, poverty, access to health services, urbanisation, and altitude, health ministry reports show. 

“The entire population of Uganda remains at risk of These include pregnant women, children under five years of age, people with immune compromising conditions (such as HIV, sickle cell disease and cancer, among others),” Anifa Kawooya, the state minister for health in charge of general duties, is quoted in a July 12 statement to Parliament.  Transmission is driven, mostly, by five to15 year olds. 

Health experts have warned, recently, that many malaria patients in the country are misdiagnosed and are experiencing treatment failure because of mutation of the malaria parasite and drug resistance. 

Youth voice

Young people have decided to take action. In an open letter, also supported by The RBM Partnership to End Malaria and Speak Up Africa, young people vow to be the generation to end malaria by 2030.

“As young people we are concerned that malaria continues to plague our continent taking millions of lives and despite recent progress, a child still dies from malaria every minute.  The open letter is a call-to-action to decision makers because we, young people, believe that ending malaria is an attainable goal if we sustain decisive,” says Moses Kodah, executive director, Naye-Salone.

The open letter turns up the pressure on African leaders to achieve a malaria-free world in line with Agenda 2063 for socio-economic transformation.  Calling on leaders to recommit to keeping malaria high on national development agendas, mobilise additional resources (especially from the domestic public and private sector), empower communities to act, strengthen data and evidence-based governance, accelerate the deployment of new malaria commodities and interventions, actively engage youth leaders and rapidly deploy the new tools to address the growing threats of insecticide and drug resistance.

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