Long road to ending malaria

The vanishing of a Malaysian plane two years ago caused a pandemonium world over. Search teams from across the globe summarily joined in the search for the MH370 flight which was carrying 12 Malaysian crew members and 227 passengers from 14 nations. The succeeding events made headlines over international media platforms and every clue was meticulously examined by the top experts. The universal reaction to the missing plane without doubt eclipses the attention malaria deaths in Uganda attract. Yet over 100, 000 Ugandans die from malaria yearly. This number is an equivalent of 418 MH370 flights disappearing each year.

But while Uganda joins the rest of the world today to commemorate International Malaria Day under the theme, ‘End Malaria for Good', Ministry of Health officials reveal that getting to this pinnacle is a tall order for Uganda.

The manager, Malaria Control Programme, Dr Jimmy Opigo explains that unless strategic interventions such as mass spraying and mass drug administration are adopted, malaria will remain a public health challenge in the country.

He argues that if the country resolves to set aside a day of national spraying, malaria vectors will be eliminated and that will be the end of the scourge.

A 2013 study titled ‘The effect of indoor residual sprays on malaria and anaemia in a high-transmission area of northern Uganda' by Steinhadt LC and others reveals that carefully managed indoor residual spraying (IRS) can significantly reduce malaria burden in high-transmission setting.

Parasitemia (quantitative content of parasites in blood) prevalence among children less than five years of age was lower in the two IRS districts compared with the non-sprayed district revealed the study.

The study also shows that anaemia prevalence was also significantly lower in the two IRS districts compared to the non-sprayed districts.

According to World Health Organisation (WHO), countries in the malaria elimination phase are Algeria, Argentina, Azerbaijan, the Islamic Republic of Iran, the Republic of Korea, Saudi Arabia, Sri Lanka, Tajikistan and Turkey.

Since 2007, four countries namely the United Arab Emirates, Morocco, Turkmenistan and Armenia were certified as having eliminated malaria within their borders.

"Sustained political commitment, adequate resourcing and effective partnerships are all fundamental to the success of malaria elimination programmes," WHO states.

Uganda according to WHO is still at the control stage. The main objective at this stage is reducing malaria cases and deaths by providing access to preventive methods, diagnostic testing and treatment to the entire population at risk.

A number of interventions such as mass distribution of long lasting insecticide treated mosquito have been earmarked by government to control malaria.

Localise malaria fight

There is urgent need for the decentralisation 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 argues.

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 says there is urgent need for decentralising 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 last year wondered whether Malaria in the North was a true Malaria epidemic or resurgence.

"We are winning the war on immunisable diseases 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 adds.

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.

Rogers Twesigye, the ISMO Programme Manager under the Malaria Consortium says 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 says.

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

It 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 adds.

Dr. Mathew Emer the District Health Officer Apac district said Malaria cases in the district have 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 says 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 accounts 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.