Fight against Malaria needs localisation at district level

There is urgent need for the decentralization of the Malaria programme in districts as the disease has proved to be bigger than HIV and immunisable diseases combined, Dr. Jimmy Opigo the Programme Manager National Malaria Control Programme has said.

According to Opigo, contribution on Malaria in the districts is currently minimal saying reports indicate that there are up to 16 million cases annually of the disease and 40 million cases on the outlook compared to HIV that registers one million cases a year.

He said there is urgent need for decentralizing the Malaria programme to communicate its vision, mission and why it exists, because treatment, diagnosis and case reporting is all done at district level.

Currently, malaria experts are identifying the underlying problem as to why new cases of the disease continue to rise despite several interventions that have been put in place.

The experts who held a review meeting on the Malaria outbreak in Northern Uganda at the beginning of this month wondered whether Malaria in the North was a true Malaria epidemic or resurgence.

"We are winning the war on HIV and immunisation because the action and ownership has been taken up by districts. If we continue the current mode of managing the programme, we will not go far," Opigo added.

He was speaking at an Improving Severe Malaria Outcome (ISMO) project results dissemination meeting organized by the Malaria Consortium, Clinton Health Access Initiatives in collaboration with Ministry of Health at Hotel Africana, on Wednesday.

Rogers Twesigye discussing the malaria situation during the meeting. Photo by Mary Kansiime

Since its outbreak in April last year, the disease predominantly in the Acholi and Lango sub regions affected 1,005,632 people, killing 658, according to the Ministry of Health (MOH).

Today, an estimated 3 million people are at risk of Malaria in the region given its chronic nature as it has shown no sign of receding despite interventions.

Presenting findings on the 'Use of intrarectal and injectable artesunate as treatment for severe malaria at different levels of care during the referral process in three districts of Kiboga, Kyankwanzi and Hoima, Rogers Twesigye, the ISMO Programme Manager under the Malaria Consortium said treatment at Lower Health Facility and by Village Health Teams was still limited and that more patients received Quinine as post admission treatment compared to those who received Injectable artesunate.

"8.8% patients referred from public health facilities were less likely to have received Ir. AS, 18.9% from Community Health Workers and 63.9% form private clinics," Twesigye said.  

Injectable artesunate according to the World Health Organisation was the recommended medicine for the treatment of severe malaria in Uganda since 2011.

Twesigye said at lower health facilities including the community level where treatment for severe malaria is not available, rectal artesunate (Ir. AS) is used as pre-referral treatment.

Ir. AS interrupts disease progression, by rapidly reducing the parasite load thereby reducing mortality and permanent disability.

In Uganda severe malaria is responsible for 35% of hospital admissions, 9-14% hospital deaths most of which are in children below five years.

"There is need to sensitization health workers on the current guidelines of managing patients with severe malaria," He said.

Dr. Mathew Emer the District Health Officer Apac district said Malaria cases in the district had slightly gone down from 900 to 700 cases recently, saying they use Artemisinin-based combination therapy such as coartem to treat patients.

However after the Malaria resurgence in Northern Uganda, he said the district suffered stock out of drugs that caused some health workers to use old stock of Quinine to treat some malaria cases. The National Medical Stores as of last week stocked the district with Malaria drugs.

Malaria has been the leading cause of sickness and death in Uganda for several decades, claiming over 320 lives daily.

It accounted for 40% of inpatient deaths in financial year 2009/2010 and 31% deaths in 2012/2013, according to the annual health sector performance report 2013. The disease consumes over 10% of the MOH budget and 25% of household incomes. The country according to MOH has been losing over sh658m annually to malaria-related costs.

Statistics from WHO show that since 2000, global investments in many types of malaria control are estimated to have resulted in a 47% drop in the disease's global mortality rate and a 58% decrease in the mortality rate among African children.