Indoor spraying or treated long-lasting mosquito nets?

By Richard Ssempala

The government, through the Ministry of Health and development partners, undertook a nation-wide campaign to distribute mosquito nets to all households in Uganda.

The move was intended to control the spread of malaria, a disease which, according to the World Health Organisation, claims more lives than HIV/AIDS.

Also, the initiative was aimed at reducing mortality and morbidity due to malaria, which is still the single largest killer disease in Uganda, especially among pregnant women and children under five years. 

As of now, the campaign is estimated to have achieved over 95 per cent coverage, with a total of 23,743,822 bed nets distributed.

While the estimated malaria mortality rates dropped by more than 60 per cent between 2001 and 2015 globally, the disease still remains a major cause of death among children, according to the 2016 WHO statistics.  It should be noted, however, that malaria is a preventable and curable disease.

Why fight malaria?

The economic and social benefits of eradicating malaria, especially in a malaria-endemic country like Uganda, are enormous. They include an increase in labour productivity brought about by an increase in the number of days at work, an increase in school attendance rates among pupils, a reduction in the burden on already constrained health facilities, and an increase in government resources that would cater for the malaria patients.

Recently, on 5 April 2018, the president of Uganda launched an initiative enthusiastically started by the Members of Parliament and partner organisations called Mass Action against Malaria (MAAM). Under this initiative, different commitments were made; for instance, a malaria-free Uganda and malaria-free constituencies, among others.

With this kind of political will, there is hope that by using the best strategy for controlling the disease, especially through tackling its cause, which is the mosquito, eradication of malaria will be achieved.

Given this scenario, there is need to look at the best and most effective way of controlling malaria. Generally, the government has been distributing mosquito nets, but we have not seen the incidence of the disease decreasing. This state of affairs, therefore, requires consideration of another method.

A study was done on the effectiveness of indoor residual spraying (IRS) in Gulu district, northern Uganda by the Makerere University School of Public Health under its SPEED project. The study established that the incidence of malaria abruptly reduced upon the implementation of IRS but later on increased after the government abandoned the programme.

Residents affirmed that the method was effective and mostly cost-effective if it is implemented by local people. This contradicts the long-held view, especially by donors, that IRS would be expensive to implement in Uganda.

There is need to both critically weigh the strengths of each method and  compute the cost of malaria to the household as well as to the country as whole. Thus, as the country strives to attain middle-income status, there is need to adopt a strategy that will ensure the elimination of malaria in the country both in order to protect the citizens and to reduce the amount of resources that the government spends on making antimalarial drugs available in health facilities.

Writer is the knowledge management officer of SPEED project, Makerere University School of Public Health