MALARIA: HOW LUWERO DISTRICT IS LOSING PEOPLE, MOSQUITO NETS SHOULD BE EMBRACED BY ALL PEOPLE ESPECIALLY MOTHERS AND CHILDREN

MALARIA: HOW LUWERO DISTRICT IS LOSING PEOPLE, MOSQUITO NETS SHOULD BE EMBRACED BY ALL PEOPLE ESPECIALLY MOTHERS AND CHILDREN

By Goodluck Musinguzi

Luwero District Health Mortality and Morbidity report for the last two years show close to 160 were killed by Malaria. The report highlights Malaria as the foremost cause of death, claiming the lives of 40 males and 30 females. Among the victims, 24 males and 13 females were under the age of five.

Richard Ssimbwa, the LC3 chairperson of Luwero sub-county is worried that more people will die as the rainy season sets in. According to the report, 158,389 patients were diagnosed with malaria in the year compared to 154,493 patients who tested positive in the year 2020/21.

The report also highlighted pneumonia as the second leading cause of death, resulting in 31 fatalities, followed by peptic ulcers causing 28 deaths. An additional 27 individuals lost their lives due to hypertension. Overall, health centers reported a total of 440 deaths from various diseases.

However, the report shows a decline in malaria deaths from 99 recorded in 2021/22 to 70 deaths in 2022/23. At least 13,070 people were admitted with severe malaria in the year under review. Dr. Innocent Nkonwa, the Luwero district health officer explains that although there is a decline in malaria deaths, the disease remains the greatest challenge for the sector and more efforts are needed to eliminate it.

Nkonwa called upon the residents to embrace sleeping under mosquito nets at all times and seek treatment immediately after detecting any signs. He also called upon the National Medical Stores to ensure a timely supply of drugs to enable them to treat patients that are diagnosed with the disease.

Richard Ssimbwa, the LC 3 Chairperson of Luwero sub-county, says that malaria deaths can be prevented if residents are sensitized to stop self-medication and visit health centers in time. Ssimbwa also faulted the National Medical Stores for failing to ensure timely supplies of drugs leaving some patients to die while others resorted to self-medication.

Brenda Nabukenya, the Luwero District Woman Member of Parliament, says that she intends to petition parliament over the failure of NMS to deliver drugs to health centers, which contributed to the deaths of some patients in the year.

According to Luwero district health department, the health centers received medical supplies for four quarters out of six within the financial year. The district is also yet to receive any medical supplies since the 2023/24 financial year began. Recently, Sheila Nduhukire, the Principal Public Relations Officer of National Medical Stores blamed the delays in medical supplies on the late receipt of funds from the Ministry of Finance.

Ninety nine succumb to malaria in Luwero district

The report further indicates that pneumonia was the second killer after claiming 31 lives while Urinary Tract Infections came third after killing 20 people. Overall, 316 people died of various illnesses in different health facilities in the district.

Dr. Innocent Nkonwa, the Luwero District Health Officer explains that although malaria is preventable and treatable, it remains the top killer in the district. Nkonwa explains that several people in the district contract malaria because of ignoring preventive measures and taking the wrong dosage after testing positive.

Nkonwa adds that in the year 2022/23, they will emphasize preventive measures, which include health education, promotion of sleeping in mosquito-treated nets, prompt malaria diagnosis and treatment.

George William Namugera, the LC1 chairman of Kakookolo village, says that some deaths are a result of the failure of the Ministry of Health to give drugs to Village Health Teams to provide first-line treatment to residents. He also notes that some patients take the wrong doses because of the drug shortages at government health centers.

In the week of 13th-19th July 2020 Ministry of Health Reported that the rate this week was at 78.2%, a slight decline from 78.7% in the previous week. A total of 206,138 malaria cases were reported, an increase by 10% from the
previous week.

The following districts are experiencing malaria upsurges : Abim, Agago, Amudat, Bugweri, Buyende, Isingiro, Kalangala,Kotido, Moroto, Nabilatuk, Nakapiripirit and Yumbe Test positivity rate remained at 57.5%. The highest test positivity rates were reported in Agago (79.1%), Nabilatuk (76.8%), Kwani (76.7%), Koboko (76.5%) and Lamwo (74.8)

Wave 2 of the Universal LLIN campaign is slated to start next week and will cover 35 districts in South West and Central Uganda. The districts to be covered include Bukomansimbi, Kalungu, Kiboga, Kyotera, Kyankwanzi, Luwero, Lwengo, Lyantonde, Masaka, Mityana, Mpigi, Nakaseke, Buhweju,Bushenyi, Bunyagabu, Isingiro, Kabale, Rubanda, Kabarole, Kanungu, Kasese, Kakumiro, Kiruhura, Kisoro, Kyenjojo, Mbarara, Mitooma, Ntungamo, Rubirizi, Rukiga,
Rukungiri, Sheema, Bundibujo, Ntoroko, Kalangala, Rwampara, Kitagwenda, Kazo.

District Health Officers of districts with consistently low reporting rates should be called to ensure that they support their districts to report complete data on time.

Districts with upsurges should scale up prevention measures and sensitization in the community.

Districts should embrace real time malaria data use to inform their programming.

The District health office should support facilities to ensure there is sufficient stock of malaria commodities to ensure continuity of malaria services amidst the COVID-19 Pandemic

The malaria deaths reported in each district should be audited so as to identify the possible reasons for the death so as to set up measures to prevent similar events in the future

Interventions especially in prevention to lower the incidence of malaria in the population need to be put in place given the high test positivity rate.

Health workers should be supported to adhere to the test and treat policy especially in

Wave 2 of the Universal LLIN campaign is slated to start next week and will cover 35 districts in South West and Central Uganda.

Uganda has made great progress in reducing malaria transmission from 42% in 2009 to 9% in 2018. Despite this, in 2021 Uganda had the 3rd highest global burden of malaria cases (5.1%) and the 7th highest level of deaths (3.2%). It also had the highest proportion of malaria cases in East and Southern Africa of 23 % in 2021.

Between 2020 and 2021, the estimated number of malaria cases remained stable at  284 per 1000 of the population at risk, while deaths fell 6.1% from 0.46 to 0.43 per 1000 of the population at risk over the same period. [2]  There is stable, perennial malaria transmission in 95 percent of the country, with Anopheles gambiae s.l. and An. funestus s.l. the most common malaria vectors.

In 2018 there was a lower-than-expected number of malaria cases because there was no seasonal transmission peak between week 20 and 30, and mass distribution of nets was completed in early 2018. In 2019, on the other hand, malaria cases increased in comparison to 2018 as the transmission peak was untypically long due to increased rains and ageing of mosquito nets distributed in 2017/2018. Progress regarding children is promising. Data from the 2018 Malaria indicator survey (MIS) revealed that 4% of children aged 6–59 months were severely anaemic in 2018 versus 6% in 2016. Furthermore, 87% of children with fever were able to seek care in 2018, an increase from 81% in 2016.

To accelerate progress towards global malaria targets, WHO and RBM Partnership has rolled out the High Burden High Impact approach in 10+1 countries which include Uganda.The Uganda Malaria Reduction and Elimination Strategic Plan 2021-2025 aims to reduce malaria infections by 50 percent, morbidity by 50 percent and mortality by 75 percent by 2025. The Plan aims to achieve these goals through stratification to ensure appropriate tailoring of intervention mixes for the various epidemiologic contexts, universal coverage of services (including in the private sector), robust data management and social behavioural change, multisectoral collaboration, and malaria elimination in two districts.

Although the entire population is at various levels of risk, marginalised populations are confronted with economic, social and contextual challenges and barriers that may limit their access to malaria prevention, treatment and control programmes. These populations include vulnerable and underserved populations such as:

  • Children under five years and pregnant women
  • People living with HIV
  • People with disabilities
  • Inmates and other detainees
  • People in closed/congregate settings
  • Migrant and mobile populations
  • Internally displaced populations
  • Refugees and asylum seekers
  • Older persons
  • People affected by ethnic, geographical or cultural barriers.

To address the human rights barriers, Uganda has developed a comprehensive strategy document aimed at malaria-free Uganda through protecting human rights, achieving gender equality, and improving health equity for all Ugandans in all their diversity – Leaving no one behind: A national plan for achieving equity in access to HIV, TB and Malaria services in Uganda, 2020-2024.

Malaria transmission

Plasmodium falciparum accounts for 98% of infections; both P. vivax and P. ovale are rare and do not exceed 2% of malaria cases in the country.

The country experiences two malaria transmission types:

  • Stable, perennial malaria transmission which exists in 90–95 % of the country
  • Low and unstable transmission with potential for epidemics in 5-10% of the country.

Transmission peaks are aligned with the two annual rainy seasons, which take place from March to May and from September to November.[3] To guide the deployment of interventions, the country has been stratified into three strata, based on epidemiologic, entomologic and socio-behavioral characteristics:

  • Very low burden areas (<2% malaria prevalence) about 2.4% of the population
  • Urban cities (6.2m; 14.4% of total population)
  • High burden (rest of the country) areas.

Case management

For severe malaria, intravenous or intramuscular artesunate is the recommended treatment for all adults and children. When artesunate is not available, parenteral artemether or quinine can be used.  Once a patient is able to tolerate oral medication, and after at least 24 hours of parenteral therapy, treatment should be completed with a full course of an oral first-line artemisinin combination therapy (ACT).

For pre-referral intervention before transfer to an appropriate level of care, a single intramuscular dose of artesunate, intramuscular artemether, or intramuscular quinine can be used. At the community and lower-level health facilities, or where injections are not available, a single dose of rectal artesunate can be used as pre-referral intervention for children under six years of age only.

Between 2020–22, the total need for injection artesunate is estimated to be 7,002,881 ampules.[1] These are being financed by PMI (700, 288 ampoules) and the Global Fund (6,302,593 ampoules. For pre-referral intervention in suspected severe malaria cases, the total estimated quantity of rectal artesunate is 706,243 suppositories.

Malaria in pregnancy

Uganda has adopted the WHO guidelines for Intermittent preventive treatment in pregnancy (IPTp), which includes a treatment dose of sulfadoxine-pyrimethamine (SP) for HIV negative women at each scheduled antenatal care (ANC) visit starting at 13 weeks gestational age, with a minimum of four weeks between doses, and a recommended minimum of three doses (IPTp3). SP is recommended to be administered as directly observed therapy (DOT).

Between 2016 and 2018, however, the proportion of pregnant women who received two or more doses of intermittent preventive treatment during their last pregnancy (IPTp) in the last two years increased from 46% to 72%, and the proportion who received three or more doses increased from 17% to 41%.  In 2018, 83% of households reported having at least one insecticide-treated bednet (ITN). This was an improvement over 2016 (78% of households) although lower than reported in 2014 (90%). Between 2016–2018, there was a slight increase in the use of mosquito nets by pregnant women (64% in 2016, 65% in 2018) and a slight decline in use by children under five years of age (62% in 2016, 60% in 2018); in both cases, usage had declined since 2014 (75% for pregnant women; 74% for children under five years of age).

Seasonal malaria chemoprevention

Uganda’s  NMCD does not currently implement seasonal malaria chemoprevention (SMC) to reduce malaria transmission because transmission is not highly seasonal (60% of cases do not occur within a four-month period). However, there is a pilot SMC program in Karamoja region, which has one rainy season unlike the other regions of the country with two rainy seasons.

Malaria Consortium, in collaboration with NMCD, is carrying out the pilot with funding from GiveWell. The study team has indicated that SMC with sulfadoxine-pyrimethamine + amodiaquine (SPAQ) could potentially provide benefits in Uganda where there is relatively high prevalence of resistance to SP.

Insecticide-treated nets

Ownership of at least one ITN has generally increased over time. Households owning at least one ITN increased from 47% in 2009 to 83% in 2018–2019. Full household ITN coverage, as measured by the percent of households with at least one ITN for every two people in the household, increased from 16% in 2009 to 54%in 2018–2019.[3] Uganda conducted a mass ITN coverage campaign from June 2020 to March 2021. The  ITN ownership (households owning at least one ITN) levels nationally were estimated to increase to at least 90%.[3]

ITN use by children increased from 33% in 2009 to 60 % in 2018–2019. Use of ITNs by pregnant women increased from 44% in 2009 to 65%in 2018–2019. However, between 2016 and 2018–2019, there was a slight decline in ITN use among children under five years of age over the same period (62% to 60%).[3]

Gender disparities

Gender-based disparities and social customs have created hurdles for accessing malaria related services. A key example of this is that health seeking decisions are often taken by male family heads of family and this could lead to delays in seeking treatment. In addition, there are instances where only men are sleeping under ITNs at the expense of children or pregnant women. Steps to tackle these challenges include attainment and maintenance of universal coverage of bed nets.

Survey data also reveals that severe anaemia (mostly due to malaria) continues to be a public health problem in Uganda. For severe malaria in pregnancy, intravenous artesunate is recommended as the first-line treatment and quinine as the alternative. All malaria in pregnancy cases are noted in antenatal care registers and reported in health management information system platforms such as District Health and Information Systems databases. The Integrated Management of Malaria curriculum includes management of uncomplicated and severe malaria, management of malaria in pregnancy, and parasite-based diagnosis with rapid diagnostic tests or microscopy, including how to manage a patient with fever and a negative rapid diagnostic test (RDT) or microscopy result.

The World Health Organisation’s Global Malaria Programme has developed an easily adaptable repository structure in District Health Information Systems , with guidance on relevant data elements and indicators, their definitions and computation to cover key thematic areas. So far, work to develop these databases has started in the Gambia, Ghana, Mozambique, Nigeria, Uganda and the United Republic of Tanzania.

Malaria Training

Health workers at all levels (including the private sector) were trained in integrated management of malaria (IMM) in 102 of 112 districts (10,500 HWs), including training in the management of severe malaria. Clinical audits for severe malaria were performed in 34 of 112 districts.

About Goodluck Musinguzi

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21 comments

  1. parrotsav.com
    역 승강장 설정도 무리한 곳이 많다.

  2. ttbslot.com
    Chen Zhong은 알아볼 수 없을 정도로 구타를 당했고 그의 피부는 찢어졌습니다.

  3. ttbslot.com
    Xishan에서도 Ye Qiu 선장은 많은 사람들의 존경의 대상이되었습니다.

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    이 세상에서 왕자를 단련시키는 것보다 더 중요한 것은.

  5. qiyezp.com
    이른 아침부터… 그런 일방적인 학살은… 결코 멈추지 않았습니다.

  6. qiyezp.com
    Hongzhi 황제의 마음 깊은 곳에서 생각이 떠올랐다.

  7. onair2tv.com
    Nai Rentai의 눈에는 빛이 있었고, 이 순간 그의 전임자들이 그를 홀린 것 같았습니다.

  8. donmhomes.com
    情報がとても整理されていて、理解しやすかったです。

  9. ilogidis.com
    장마오는 평소에 말이 많은 사람이었는데, 지금은 갑자기 침묵을 지켰다.

  10. sandyterrace.com
    이때는 더욱 조심하고 입을 다무는 것이 좋다.

  11. qiyezp.com
    Fang Jifan은 화를 내며 말했습니다. “손님이 있으면 손님이 생길 것입니다. 내 일이 아닙니다.”

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  15. qiyezp.com
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    내 아들이 이것을 황태자 전하께 드렸는데…

  18. sandyterrace.com
    누군가 말했다: “여기에 사례가 있습니다. 시도해 보시겠습니까…”

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  21. largestcatbreed.com
    “네.” 이에 대해 팡지판은 기뻐했다.

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