STUDIES ESTIMATED ANNUAL NUMBER OF DEATH ATTRIBUTED TO MALARIA IN UGANDA RANGE 70,000-100,000(MOH,2004)
By Goodluck Musinguzi
Covid19 has not killed a single Ugandan yet malaria cases diagnosed and treated increased by 56% between January and April in 2020 which is not good news at all.
According to Ministry of Health report of 2004, Malaria death ranged between 70,000 to 100,000 before it was reduced considerably in 2018.
Uganda’s Ministry of Health had devised a plan of dealing with malaria cases this year but Coronavirus pandemic caused a lock down.
They were not able to start as scheduled but now that the lock down has been partially lifted, they are continuing as planned.
Dr Diana Atwine, Ministry of Health most powerful Civil Servant said “We will be distributing over 27,000,000 nets to all districts in Uganda. We expect to complete this exercise by the end of this calendar year”
Following the outbreak of COVID-19 , the Ministry of Health has noted the following changes in essential health service utilization and delivery.
The number of Malaria cases diagnosed and treated increased by 56% between January and april 2019 which is not good news at all.
Malaria remains Uganda’s leading cause of morbidity and mortality leading to serious economic and social consequences. Malaria is highly endemic in over 95% of the country, with all year round transmission.
Information indicated that malaria accounted for about 25-40% before it jumped 56% of all out-patient visits to health facilities, 20% of admissions and 14 % of in-patient deaths (Ministry of Health, 2004).
Children below five years are most affected by malaria; nearly half of hospital inpatient paediatric deaths are due to malaria (Ministry of Health, 2004). This is a highly regrettable situation because Malaria is a preventable disease.
Many factors have contributed to this high burden of malaria in Uganda, including; limited access to personal protection measures from mosquito bites, limited access to adequate treatment in the formal health facilities and increased resistance of malaria parasites to the previously cheap and effective anti-malarial drugs resulting in increased treatment failures.
Insecticide-treated nets (ITNs) have been shown to reduce the burden of malaria in children by providing personal protection from the mosquito vectors. Regular use of ITNs by young children can reduce the overall risk of dying by 20%, and the number of clinical malaria episodes by 50% (WHO, 2002).
The Ministry of Health (MoH) mosquito net policy recommends free net distribution to 27 million people funded by Global Fund. This crucial intervention is capable of having meaningful results, if implemented on a large scale.
Malaria prevention and control intervention were identified as one of the important areas for focus for impact.
Dr Diana Atwine said “We have flagged-off distribution of Mosquito Nets to districts pending official launch. For the first time Global Fund and partners are entirely using government systems to implement a programme of this nature. We are grateful for the confidence developed and pledge optimal performance”.
We were not able to start as scheduled because of the lock down but now that it has been partially lifted, we can continue as planned. We will be distributing over 27,000,000 nets to all districts in Uganda. We expect to complete this exercise by the end of this calendar year.
The first wave will go to 25 districts. The 25 districts were selected depending on the disease burden. We are starting with districts that were affected by flooding in the Easterm region and those, most especially in Northern Uganda, that have recorded higher cases of malaria.
We have developed ICT capacity to account for every single mosquito net given to every single household through a robust mobile phone reporting system. For all batches delivered to districts and down to subcounties, a detailed message will be sent to key stakeholders from National to Local area level for follow up.
In 2018, a statement from the health ministry said , the registration exercise would be conducted by LC1 chairpersons and village health team members dressed in a Chase Malaria T-shirt and a name tag for easy identification.
“They moved from house-to-house to register the number of people in each household”.
The campaign achieved over 100% coverage, with millions of bed nets distributed, protecting a total of 44,713,517 persons in 109 Districts countrywide.
The statement also highlighted that the campaign is premised on the background that large-scale long-lasting insecticide treated mosquito net distributions is a key component of the national malaria prevention initiative. The nets are effective, user-friendly and a low-cost intervention to protect communities against malaria.
“In populations with mosquito nets, insecticide treated nets have been shown to reduce all-cause child mortality by about 20%. They decrease clinical cases of malaria by about 50% and severe malaria by 45%,” read the statement.
Government started fumigating areas around city markets as well as distribute mosquito nets to vendors sleeping there in the early days of the lock down.
Launching the program at Nakawa market then, the Health Ministry Permanent Secretary, Dr. Diana Atwine said as the country battles the COVID 19 pandemic, they realised that there is another risk, malaria.
The campaign stems from a directive by President Yoweri Kaguta Museveni to vendors to sleep in the market to eliminate the risk of taking the coronavirus to their homes or picking it from their homes and bringing it to markets.
He also directed the Health Ministry to work with local governments to distribute mosquito nets to vendors and fumigate areas around the market. Atwine says they will provide nets and fumigate all markets in Kampala, Wakiso and Mukono districts in line with the presidential directive.
Atwine says they are working with KCCA to desilt nearby channels that have also become breeding grounds for mosquito. Jimmy Opigo, the Assistant Commissioner Malaria Control Program says it is important to prevent malaria especially now since doctors are occupied with COVID-19.
The Ministry had planned to conduct a nationwide distribution of the mosquito nets but this wasn’t possible because of COVID 19. Opigo says they are consulting to see how best they can distribute nets effectively in this period without aiding the spread of the coronavirus.
He says they have over 10 million nets in their stores from which they will pick some to give to the vendors sleeping in markets.
Dr. Alfred Mubangizi, the Acting Assistant Commissioner Vector Borne and Neglected Tropical Diseases, says they will be spraying all breeding areas around markets to kill the larvae and adult mosquitoes in markets. The team conducting the spray is using pirates, a plants based chemical to spray the mosquitoes.
Nur Nakassi, a dealer in potatoes and cassava in Nakawa market says she has been sleeping in the market since the president issued the directive more than two weeks back. Nakassi, a resident of Kireka, says it has been hard sleeping on hard surface covering and linking stalls.
She welcomed the presidential directive to give them mosquito nets, saying there are so many mosquitoes that made sleeping in the market harder.
Nakawa market the first to be fumigated will be handled on Sunday. The surroundings including identified breeding areas like bushes will be sprayed during day and the market in the nights