According to WHO, Uganda has the world’s highest malaria incidence rate of 478 cases per 1,000 population per year. It is also the leading cause of sickness and death in Uganda and is responsible for up to 40 percent of all outpatient visits, 25 percent of hospital admissions and 14 percent of all hospital deaths. The malaria death rate in Uganda is estimated to be between 70,000 and 100,000 deaths per year; a toll that exceeds that of HIV/AIDS.
Uganda is currently experiencing a new burden of malaria since January 2022 with cases rising higher by the end of the year. At the peak, more than 300,000 were reported cases every week.
Background
Overview of Malaria in Uganda (2014 – 2020
Malaria is a major public health problem associated with slow socio-economic development and poverty and the most frequently reported disease at both public and private health facilities in Uganda. Clinically diagnosed malaria is the leading cause of morbidity and mortality, accounting for 30-50% of outpatient visits at health facilities, 15-20% of all hospital admissions, and up to 20% of all hospital deaths. 27.2% of inpatient deaths among children under five years of age are due to malaria. A significant percentage of deaths occur at home and are not reported by the facility-based Health Management Information System (HMIS).
Malaria is endemic in approximately 95% of the country, affecting over 90% of the population of 3 million. The remaining 5% of the country consists of unstable and epidemic-prone transmission areas in the highlands of the south- and mid-west, along the eastern border with Rwanda, and the north-eastern border with Sudan. The 2009 Malaria Indicator Survey (MIS) reported high prevalence of malaria parasites in children <5 years of age ranging from 5% in Kampala to 63% in mid northern region, with a national average of 45%.
Uganda has the sixth highest number of annual deaths from malaria in Africa, as well as some of the highest reported malaria transmission rates in the world, with approximately 16 million cases reported in 2013 and over 10,500 deaths annually. In addition, malaria has an indirect impact on the economy and development in general. The socio-economic impact of malaria includes out-of-pocket expenditure for consultation fees, drugs, transport and subsistence at a distant health facility. These costs are estimated to be between USD 0.41 and USD 3.88 per person per month (equivalent to USD 1.88 and USD 26 per household). Household expenditure for malaria treatment is also a high burden to the Ugandan population, consuming a larger proportion of the incomes in the poorest households.
Malaria has a significant negative impact on the economy of Uganda due to loss of workdays because of sickness, decreased productivity, and decreased school attendance. A single episode of malaria costs a family on average 9 US dollars, or 3% of their annual income. Workers suffering from malaria may be unable to work for an estimated 5-20 days per episode. Given that many people are infected multiple times a year, this has substantial financial consequences to families. A poor family in a malaria endemic area may spend up to 25% of the household income on malaria prevention and treatment. Industries and agriculture also suffer due to loss of person-hours and decreased worker productivity. Investors are generally wary of investing in countries where malaria rates are high, leading to a loss in investment opportunities. Further, severe malaria impairs children’s learning and cognitive ability by as much as 60%, consequently affecting the performance of Uganda’s universal primary and secondary education programs.
The intention of the Government of Uganda to totally eliminate malaria from Uganda through preventive methods. However, based on the World Health Organization (WHO) guidelines, Uganda is still at the first stage of controlling malaria. Consequently, intensified efforts are first needed to reduce the malaria burden. In line with the 2000 Abuja declaration, Uganda’s domestic financial contribution for malaria reduction needs to increase if this reduction strategy is to succeed.
Combating malaria requires a multi-sectoral approach and the roles of other sectors needs to be harnessed in order to prevent and control malaria in the country. And this is where End Poverty Uganda, becomes relevant to support the Governments and other players’ efforts in this cause.
Know about Malaria
Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes. People with malaria often experience fever, chills, and flu-like illness.
The good news is; it is preventable and curable.
The bad news is; Left untreated, Malaria patients may develop severe complications and die.
What is malaria and how is it transmitted?
Malaria is a life-threatening disease primarily found in tropical countries. It is both preventable and curable. However, without prompt diagnosis and effective treatment, a case of uncomplicated malaria can progress to a severe form of the disease, which is often fatal without treatment.
Malaria is not contagious and cannot spread from one person to another; the disease is transmitted through the bites of female Anopheles mosquitoes. Five species of parasites can cause malaria in humans and 2 of these species – Plasmodium falciparum and Plasmodium vivax – pose the greatest threat. There are over 400 different species of Anopheles mosquitoes and around 40, known as vector species, can transmit the disease.
This risk of infection is higher in some areas than others depending on multiple factors, including the type of local mosquitoes. It may also vary according to the season, the risk being highest during the rainy season in tropical countries.
Who is at risk of malaria?
Nearly half of the world’s population is at risk of malaria. In 2021, an estimated 247 million people contracted malaria in 85 countries. That same year, the disease claimed approximately 619 000 lives.
Some people are more susceptible to developing severe malaria than others. Infants and children under 5 years of age, pregnant women and patients with HIV/AIDS are at particular risk. Other vulnerable groups include people entering areas with intense malaria transmission who have not acquired partial immunity from long exposure to the disease, or who are not taking chemopreventive therapies, such as migrants, mobile populations and travellers.
Some people in areas where malaria is common will develop partial immunity. While it never provides complete protection, partial immunity reduces the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.
What are the symptoms and how is it diagnosed?
The first symptoms of malaria usually begin within 10–15 days after the bite from an infected mosquito. Fever, headache and chills are typically experienced, though these symptoms may be mild and difficult to recognize as malaria. In malaria endemic areas, people who have developed partial immunity may become infected but experience no symptoms (asymptomatic infections).
WHO recommends prompt diagnosis for anyone with suspected malaria. If Plasmodium falciparum malaria is not treated within 24 hours, the infection can progress to severe illness and death. Severe malaria can cause multi-organ failure in adults, while children frequently suffer from severe anaemia, respiratory distress or cerebral malaria.
Human malaria caused by other Plasmodium species can cause significant illness and occasionally life-threatening disease.
Malaria can be diagnosed using tests that determine the presence of the parasites causing the disease. There are 2 main types of tests: microscopic examination of blood smears and rapid diagnostic tests. Diagnostic testing enables health providers to distinguish malarial from other causes of febrile illnesses, facilitating appropriate treatment.
Where is malaria most prevalent?
Malaria occurs primarily in tropical and subtropical countries. The vast majority of malaria cases and deaths are found in the WHO African Region, with nearly all cases caused by the Plasmodium falciparum parasite. This parasite is also dominant in other malaria hotspots, including the WHO regions of South-East Asia, Eastern Mediterranean and Western Pacific. In the WHO Region of the Americans, the Plasmodium vivax parasite is predominant, causing 75% of malaria cases.
The threat of malaria is highest in sub-Saharan Africa, and 4 countries in that region accounted for nearly half of all malaria deaths worldwide in 2021: Nigeria (26.6%), the Democratic Republic of the Congo (12.3%), Uganda (5.1%), and Mozambique (4.1%).
What is the difference between malaria elimination and eradication?
Malaria elimination refers to the interruption of transmission in a given geographical area – typically a country.
Malaria eradication refers to the complete interruption of malaria transmission globally, in all countries.
Can malaria be eliminated?
Yes, it can. End Poverty Uganda shares the vision of WHO and the global malaria community for a world free of malaria. This vision will be achieved progressively by countries eliminating malaria from their territories and implementing effective measures to prevent re-establishment of transmission.
Malaria-endemic countries are situated at different points along the road to elimination. The rate of progress depends on the strength of the national health system, the level of investment in malaria elimination strategies and other factors, including biological determinants, the environment and the social, demographic, political and economic realities of a particular country.
Over the last 2 decades, significant progress has been achieved towards malaria elimination. According to the latest World malaria report, 27 countries had fewer than 100 cases of the disease in 2020, up from 6 countries in 2000.
Diagnosis and treatment
Early diagnosis can be accomplished through relatively inexpensive testing of blood glucose. People with type 1 diabetes need insulin injections for survival.
One of the most important ways to treat diabetes is to keep a healthy lifestyle.
Some people with type 2 diabetes will need to take medicines to help manage their blood sugar levels. These can include insulin injections or other medicine as prescribed by a qualified physician.