Uganda on track in the fight against malaria

Before taking any medication, one should seek proper medical care and get a diagnosis. PHOTO/

What you need to know:

  • On Wednesday April 25, the world commemorated World Malaria Day 2023 under the theme Time to Deliver Zero Malaria: Invest, Innovate, Implement. Although the goal to deliver zero malaria faces a number of challenges, we look at where Uganda is in the fight and what more needs to be done.

In July 2022, the Minister of Health,  Dr Jane Ruth Aceng, revealed plans to eliminate Malaria from Uganda by 2030. According to the minister, the prevalence rate of the malaria parasite has reduced from 42 percent in 2009 (about 13 million cases) to nine per cent in 2019 (about four million cases) reported per year. This reduction is attributed to five years of sustained indoor residual spraying (IRS) with insecticide.
However, the country experienced a new burden of malaria since January 2022 and the cases are said to have risen higher as the year ended. A surge was reported, where more than 300,000 cases per week were reported during the peak.
Malaria is common in more than 95 percent of the total population in the country. According to a recent report by the World Health Organisation (WHO), Uganda has the world’s highest malaria incidence rate of 478 cases per 1,000 population per year. It is also the leading cause of sickness and death in Uganda and is responsible for up to 40 percent of all outpatient visits, 25 percent of hospital admissions and 14 percent of all hospital deaths. The malaria death rate in Uganda is estimated to be between 70,000 and 100,000 deaths per year; a toll that exceeds that of HIV/Aids.
What caused the surge?
Different regions of the country reported different numbers of cases but Eastern Uganda was the most affected. 
Ignatius Asasira, a public health advocate at Makerere University, says there is under and overdosing because many people, especially those in urban areas, buy over the counter medicines when they notice some symptoms without getting a proper diagnosis and prescription.
“The body then becomes resistant to the treatment. This is why some people get treatment but get a relapse after a short time. We always advise people to seek proper diagnosis from a qualified health-worker,” Asasira says.
Dr Jimmy Opigo, the programme manager National Malaria Control Division, attributes the surge in rural areas to improper use of the mosquito nets. 
“Some people use the government-issued nets to grow vegetables while others use them to rear chicken,” he states adding; “In areas where indoor residual spraying was supposed to be done, people used the chemicals for their crops instead of spraying their houses. The mosquitoes then became resistant to the chemicals, hence the rise in the number of malaria infections in some regions.” 
“Although the surge is being brought down to below 180,000 cases per week, the country has a good score when it comes to treatment of malaria,” Dr Opigo remarks.
He indicates that only nine percent of the cases are resistant to Coartem, a first line drug for the treatment of malaria, while in Ethiopia and Rwanda the resistance is as high as 14 and 15 percent respectively.
The government of Uganda has re-energised its efforts in the fight against malaria. The Ministry of Health and its partners will distribute a total of 21 million long-lasting insecticide-treated mosquito nets across the entire country, with a ratio of two people sharing one net. 
According to Dr Opigo, the ministry is also organising sensitisation campaigns on the importance of mosquito nets and the need for Ugandans to value their lives more.
He states: “We shall also support with the installation of the nets by providing strings and will recruit village health teams to ensure this happens. There will also be by-laws for those who do not use the nets for their intended purposes.”
According to Opigo, the ministry will continue with the traditional methods of preventing malaria in the country with “under the net '' campaign by distributing more than 28.5 million new generation long standing mosquito nets by the end of the year. Insecticide spraying and larviciting (spraying on water sources that are potential breeding places for mosquitoes) will also continue and the ministry will procure chemicals that will be used for indoor residual spraying and “this time the chemical will specifically be used indoor and cannot be used in the gardens.”
These strategies will work hand in hand with the integrated community case management strategy where the ministry uses existing structures such as community health workers (village health teams) to routinely check on recently discharged patients to monitor any comorbidity that may appear after the treatment.
Uganda also adopted the WHO guidelines for Intermittent preventive treatment in pregnancy (IPTp), which includes a treatment dose of sulfadoxine- pyrimethamine (SP) for HIV negative women at each scheduled antenatal care visit starting at 13 weeks with a minimum of four weeks between the doses  and the recommended minimum of three doses. This control strategy is aimed at reducing the burden of malaria in certain high-risk groups such as pregnant women and children.
With such a big burden of malaria disease, according to the minister of health, the government will start implementing the malaria vaccine by the end of the year. Dr Opigo says the malaria vaccine offers about 50 percent of personal protection and works in combination with other control mechanisms.
In October 2022, Uganda launched the Seasonal Malaria Chemoprevention (SMC) across five districts in Karamoja region. 
“This highly effective community based intervention to prevent malaria in the most vulnerable regions involves administering monthly courses of anti-malarial medicines to children aged 3-59 months during peak malaria transmissions. Children that once suffered from malaria are usually followed up with a prophylaxis and are said to be doing well,” Opigo says.
Elsewhere in Africa 
There are no new malaria strains according to Asasira because about 90 percent of the cases are caused by the plasmodium germ but in Kenya, the Kenya Medical Research Institute (Kemri) announced the discovery of a new species of mosquito, the Anopheles Stephensi, which threatens to reverse all the gains made in the fight against malaria in Kenya and beyond its national borders.
The species is said to spread fast and the institute warns of an imminent surge in infections and deaths. The challenge with diseases such as malaria is that the mosquitoes that carry the parasites easily cross over national borders.
Malaria has been on the rise, with Africa hardest hit. The latest World Malaria Report indicates that four African countries accounted for half of malaria deaths worldwide in 2021.
Nigeria led the pack with 31.3 percent of the reported cases. The Democratic Republic of Congo came second, with 12.6 percent. Tanzania and Niger had four percent each. Kenya accounted for two percent of the deaths in 2020 and 1.9 percent in 2021.
Several interventions in the country have been undertaken to put the disease under control but the plasmodium parasites that carry malaria have become increasingly resistant to existing interventions.
According to Kemri, “The plasmodium-carrying mosquitoes are becoming resistant to insecticides that were previously effective.  Shifts in the patterns in which mosquitoes are biting have also been reported. These include the times and locations.”