Taking malaria fight to water sources

Kigezi region in South Western Uganda and  Elgon Region in the East, have for long been known as low malaria areas, unlike northern Uganda  notorious for high malaria cases, but that is fast changing.

Environmental degradation and population movement in these regions have sadly increased cases of malaria in the population in these areas, according to Dr Jimmy Opigo.

"These used to be cold places and practically had no malaria but that is not the case anymore," Dr Opigo who is programme manager of National Malarial Control programme at the Ministry of Health reveals.

He explains environmental degradation has brought climate change "there is a change of the eco system, temperatures have risen enabling mosquitoes to increasingly survive and breed in these regions hence the increase in malaria cases" Opigo explains.   

Last year there was an outbreak in Kisoro district, Kigezi region. Opigo says in addition to environmental degradation, population movement has also contributed to malaria increase in these regions.

People leave Kisoro, Kabale, areas of Kigezi to go and farm in Bunyoro region in mid-western Uganda which has high rate of malaria and return with malaria parasites in their bodies.

To fight malaria

On January 24, 2019 Egypt and Uganda signed a Memorandum of Understanding (MoU) on Larval Source Management (LSM).

The Minister of Health, Ruth Aceng at the signing the MoU explained that LSM would  introduce  chemicals into water bodies including stagnant water places or swamps where mosquito larvae breeds.

Larviciding involves the applying of pesticides to water sources (breeding habitats for mosquitoes) to kill mosquito larvae. Aceng explained that larvicides stop the larvae from becoming adult mosquitoes.

According to Dr Opigo LSM is focusing on eliminating mosquitoes at its young stage in water bodies where they breed.

He explains that mosquito lay eggs in water, which hatch into larvae, then turn into pupae and then an adult mosquito which then flies away biting people and causing malaria infection.

"Larval Source Management denies the mosquitoes a breeding ground, it destroys them at source," Opigo explains

He says managing mosquitoes at the source is the biggest challenge "you can't find all breeding grounds except the fixed water bodies, even marks of animal hooves and leaves collect water and become breeding grounds for mosquitoes," he explains.

He says using LSM now known as mosquito breeding grounds have been marked and larvicide put there to kill mosquito larvae.  

The same is being done for large water bodies, they are also adding larvicide, putting it in water to kill larva, so that there is not enough adult mosquitoes developing to transmit mosquito parasites that cause malaria.

The LSM this year (2019) is introduced in Kigezi region and next year (2020) will be introduced in northern Uganda.

Just in case you are worried about the introduction of larvicide into water bodies "they are not toxic" explains Dr Opigo.

He explains they are made from natural plant extracts and the potential of toxicity to fish or human beings is so small.  "The fish is safe and people can also use this water" Dr Opigo says.

Combining malaria control

According to Dr Opigo Indoor residual spraying (IRS) to control malaria pandemic in the communities though effective is very expensive.

Now the Ministry of Health has brought on board LMS which is an outdoor Malaria control tool. Opigo says LMS is a complimentary tool.

It is being used jointly with IRS and treated mosquito bed nets which are indoor malaria control tools to manage malaria.

"You can still use your bed net even if we spray water sources. Combining the outdoor and indoor malaria control tools will see malaria drastically decline in these regions and the country," he says.  

 In Uganda Malaria is the leading, most widespread and serious communicable disease. It is a major public health burden, and is endemic in approximately 95% of the country.

But Dr Opigo says there is already a downward trend in malaria in Uganda. According to the Ministry of Health, malaria prevalence in Uganda dropped from 42% in 2009 to the current level of 19%.

"We have a 30% case drop, we used to report 50 million cases of Malaria now we report nine million three hundred thousand cases.

We have stock piles of anti-malarial medicine in every facility in this country, we are working to reduce procurement but maintain just enough stock because there can be an outbreak," Opigo says

Though last year there was a malaria outbreak in Kigezi region, cases of malaria are still at less than 5%.

With the introduction of LSM in kigezi region, then Northern Uganda and after having it rolled out across the country in a phased manner, Uganda hopes to hugely reduce cases of malaria.

"We want our tourists to be safe, tourists will not want to come in areas with malaria but for now tourism is among the top income earning sectors for the country hence the intervention," Opigo says.

But other key beneficiaries include the vulnerable group's especially pregnant women, school going children and children under five years.