Uganda’s challenge in ending malaria

DO IT THIS WAY: Health Minister Dr Stephen Malinga shows how to use a mosquito net on Friday in Kaliro. PHOTO BY GEOFFREY SSERUYANGE

Uganda like many African countries is struggling to eradicate malaria despite existing control measures and available drugs. So; what is going wrong? Evelyn Lirri reports

An estimated 300 Ugandans, mostly children and pregnant women, die of malaria every day. April 25, which is World Malaria Day, is not an extra-ordinary day, except that it’s the annual rare occasion to highlight the extent and burden caused by the disease.

But malaria is a disease that is eminently curable if detected on time and medication made available. However, it continues to pose a great public health challenge to the country, costing the economy more than $600 million a year in treatment expenses and lost productivity, according to official statistics from the Ministry of Health.

Figures show
Figures also show that because of its high toll on the population, malaria is responsible for the widespread poverty across the country. This is because at least 25 per cent of Ugandan households spend their annual income on treating malaria alone.

Officials acknowledge that malaria is still a big problem. Dr George Mukone Mudanga, the acting programme manager of the national malaria control programme, said the battle against malaria has not been very successful because most control interventions have been haphazard.
“No single intervention has been started and concluded. This is because we depend heavily on donors and when the donor money ends, we fail to sustain the programme,” he said.

Dr Mudanga cited the example of the home-based management of fever programme which was heavily funded by donors, but which could not be sustained when the Global Fund to fight HIV/Aids, TB and malaria suspended funding to Uganda in 2005 over mismanagement of the Fund.
The home-based management of fever programme has not been revived since it was abandoned in 2005.

According to Dr Mudanga, with donor money increasingly becoming unreliable, government has now taken over funding for most malaria programmes.

Malaria drugs
Over the past two years, for example, he said government allocated has Shs60 billion to purchase anti-malaria drugs. An estimated 16 million dozes of the drugs were bought with this money. But this still falls short of the 20 million dozes that the country requires annually to treat malaria.

According to the medic, the Ministry of Health is hoping to increase the amount of malaria drugs to be purchased annually through the $24 million grant recently given to Uganda by the Global Fund.

The money will be used to purchase drugs like Artemisinin-based combination therapies (ACTs) such as Coertem, Artemether and Quinine injections and Quinine tablets.

Stock outs
Dr Mudanga said the money from the Global Fund will also help address the critical challenge of anti-malarial stock-outs that has partly contributed to the high mortality rate.

International health charity, Médecins Sans Frontierès (MSF), has also raised concern over persistent stock-out of life-saving anti-malarial drugs in Uganda, saying it has contributed to the sharp increase of malaria cases in the past year, especially in the rural areas.

“MSF was shocked to see such high numbers of malaria cases in our clinics throughout 2009. It seems the drugs are arriving in Kampala, but are not getting to the more remote areas where they are so desperately needed,” said Dr Kodjo Edoh, the Head of Mission at MSF in Kampala.

Since it resumed funding to the health sector, the Global Fund has so far given Uganda another $125 million to buy up to 17 million long-lasting insecticide treated nets.

Mosquito nets have been hailed as an effective way to combat malaria.
Health experts say net use can cut malaria transmission by 50 per cent and child deaths by 20 per cent, and yet only 42 per cent of the Ugandan population sleeps under a net.

Increasing the number of people sleeping under an insecticide treated mosquito net, indoor residual spraying, diagnosis and treatment, including preventive treatment for pregnant women is the new ministry’s strategy to reduce the number of malaria deaths to near zero by 2015, in line with the UN Millennium Development Goals.

Residual spraying
Mr Michael Okia, a senior entomologist, said malaria cannot be defeated through treatment with drugs alone. “If we are talking of ending malaria deaths, we should combine indoor residual spraying with drugs. Indoor spraying has been found to be an effective malaria control intervention,” Mr Okia said.