L-R: UNICEF country representative Mr Robin Nandy, WHO's Dr Kasonde Mwinga and Minister Dr Jane Ruth Aceng receive the vaccine at NMS Kajjansi on March 7. Photo/Paul Adude
Health officials in the districts selected for a three-year malaria elimination pilot project have expressed readiness to tackle the disease, aligning with the government’s ambitious goal to have a malaria-free country by 2030. The Ministry of Health has chosen Buliisa, Kamwenge, Nakaseke, Luwero, and Rukiga, home to over 1.3 million people for the initiative, which shifts from malaria control to elimination strategies.
Dr Jane Ruth Aceng, the minister of Health, described the districts as “malaria elimination demonstration zones.” “The aim is to demonstrate an applicable model of transitioning from control to elimination by conducting business differently,” she stated. According to the 2024 report of the World Health Organisation (WHO), there was an average of 15,945 malaria deaths in Uganda in 2023. There were over 12 million cases of infections, indicating huge amounts spent by individuals and the government on treatment, in addition to work time lost. Target Malaria research highlights that besides death, the disease causes economic losses exceeding $500 million (Shs1.8 trillion) in the country annually. The consortium notes, “The disease causes immense detrimental health effects and is responsible for 30 to 50 percent of outpatient visits and 15 to 20 percent of hospital admissions.”
District Selection
The selected districts represent varied malaria transmission levels: Buliisa and Kamwenge (high), Nakaseke and Luwero (moderate), and Rukiga (low). Dr Aceng explained, “The desired outcome is to demonstrate how the high endemicity (high malaria transmission) can be maintained at control and accelerated to pre-elimination. The moderate (malaria transmission areas) will be transitioned from control to pre-elimination, and the low (malaria transmission areas) will be transitioned from pre-elimination to elimination.”
The Rukiga District Malaria Focal Person, Mr Richard Twijukye, confirmed readiness, saying, “We are aware of the elimination programme in Rukiga as the zoning was made and a survey of the data collected and submitted to the personnel at the Ministry of Health.” Kamwenge District Health Officer, Dr William Mucunguzi, added, “We are in touch with the teams that were sent to us for the zoning and we agreed with them on the interventions we are going to promote.”
Interventions
The pilot divides sub-counties in each district, with 50 percent implementing elimination activities and the rest continuing routine control measures. Across the five districts, 65 sub-counties will pioneer elimination strategies, while 67 maintain standard practices over 36 months. Dr Aceng outlined tailored interventions: “Rukiga will do household-based case management, community-led environmental assessment, and management of breeding points. The inclusion of larviciding will be guided by the findings of the environmental assessment.” she noted, “Luwero will do a school-based approach, mass drug administration, community-led environmental assessment and management of breeding sites, including larviciding, but it will be guided by findings from the environmental assessment.” Nakaseke, Buliisa, and Kamwenge will focus on community case management, tracking household contacts of confirmed cases. She stressed, “This speaks seriously to our community engagement, and community health workers (CHEWS) for tracking of cases. Community-led environmental assessment and management of breeding sites, either by modification with or without larviciding.”
On November 29, 2024, the Ministry launched a nationwide Malaria Indicator Survey (MIS). Dr Aceng said, “This Malaria Indicator Survey (MIS) is very timely. The data generated will inform the design and deployment of the intensified strategies towards malaria elimination by 2030, as it is a commitment by the government of Uganda. I call upon all of us to strive for a malaria-free Uganda and a malaria-free community.” Dr Mucunguzi highlighted ongoing efforts in Kamwenge: “We are currently using management strategies, whoever is found sick we ensure to treat that person, use of mosquito nets, and encourage closure of doors and windows early as well as draining stagnant water near homes.”
Vaccination
Dr Jimmy Opigo, head of the malaria control programme at the Ministry of Health, emphasises the malaria vaccine as a key intervention to accelerate the drive to eliminate malaria. The government rolled out free malaria vaccinations for children in high-transmission areas this month. But Norvik Hospital in Kampala was already offering malaria vaccinations at Shs45,000 per dose, with four doses needed for full protection. Dr Opigo, however, emphasises that the use of malaria vaccination does not stop the need to adhere to preventive measures like sleeping under a mosquito net and clearing breeding grounds of mosquitoes.
The vaccine is meant to prevent severe malaria, and its effectiveness does not reach 100 percent. A 2024 report by Marie Gorreti Zalwango from the Uganda National Institute of Public Health identifies West Nile and Acholi as high-transmission regions, Lango, Karamoja, Teso, Bukedi, and Busoga as medium, and South Central, North Central, Kampala, Ankole, Tooro, Bugisu, Bunyoro, and Kigezi as low or very low.
Genetically modified mosquitoes
Besides the above interventions, the Uganda Virus Research Institute is hosting the research initiative by Target Malaria, which aims to breed and introduce genetically modified mosquitoes (GMMs) to stem the population of malaria-transmitting mosquitoes. This, they say, could have a significant impact on the drive to eliminate the disease. Ms Krystal Birungi, an insect scientist (entomologist) at Target Malaria Project, said they have already started baseline studies where they aim to understand the characteristics of wild (normal) mosquitoes before they embark on breeding and introducing GMMs. “We are using gene drive that would be aimed at reducing the mosquito numbers in the wild, thereby interrupting malaria transmission and saving lives.
Currently, we are in the early stages; we are doing baseline studies whereby we look at what exists in the wild –how do the mosquitoes that we have behave? What species do we have? How do they mate? How is their seasonality? How do they spread and disperse?” she said. Ms Birungi further explains that in the gene drive, they have two areas of focus -reducing the fertility of female mosquitoes and changing the sex ratio of hatched larvae. Female mosquitoes are the ones that bite. “Now, we would like to change it so that of the 300 mosquitoes produced, 295 are male mosquitoes; male mosquitoes don't bite, they don't spread malaria. But also, it means you have fewer female mosquitoes to lay eggs," she revealed.
Challenges
The Ministry noted inconsistent use of Insecticide-Treated Nets (ITNs), with household ownership dropping from 90 percent in 2014-15 to 83 percent in 2018-19. The proportion of households with one ITN per two people also declined from 62 percent to 54 percent over the same period. Low domestic funding remains a hurdle, with interventions often reliant on partners like the Global Fund, Unicef, and the US government. Dr Aceng noted, “We need to focus more resources and energies towards health promotion and disease prevention, especially the malaria programme. The government spends, on average, over $160m (Shs596b) annually on malaria. This comes from the government and various partners.” Deputy Speaker Thomas Tayebwa, on the other hand, urged stronger community involvement. “We must mobilise our communities to join the war against malaria. Let’s sensitise our people to stop using mosquito nets for fishing, harvesting coffee, making ‘malwa’, and trapping Nsenene/Eswa. Others use nets as mattresses, etc. This must stop,” he stated. “It doesn’t have to be about money all the time. Let’s clear all the bushes around our homes. Let’s use plants in our homes that are mosquito repellents,” he added.
