Executive summary
Malaria is the leading cause of morbidity and mortality in Uganda, accounting for up to 12 million confirmed cases and 14,400 deaths in 2017 alone. Despite huge investments for prevention and control, Uganda is still far from malaria elimination. A malaria outbreak investigation in Nwoya district in 2018 revealed that using integrated malaria prevention methods was associated with reduced malaria transmission and illness. Therefore, developing behavior change communication messages sensitizing masses to close windows and doors early in the evenings and to clear all stagnant water around homesteads will enhance malaria elimination efforts.
Introduction
Malaria is the leading cause of morbidity and mortality in Uganda, accounting for up to 12 million confirmed cases and 14,400 deaths in 2017 alone, and total investment for malaria prevention and control strategies at $93.9 million1. The whole population is at risk of malaria all year round. To counter the burden of malaria, the Government of Uganda through the Ministry of Health (MoH) has emphasized both prevention, through sleeping under insecticide-treated bed nets as Long Lasting Insecticide Treated Nets (LLINs), and seeking testing and treating services promptly2 as the main behavioral change messages to the public.
Despite the heavy investments and implementation of prevention strategies by National Malaria Control Division (NMCD) of MoH and partners, Uganda is still far from malaria elimination. The limited gains in malaria control call for advocacy of other cost-effective behavioral change messages on integrated malaria prevention approaches to supplement the existing strategies. Methods promoted in the integrated approach include: screening in windows, ventilators and eaves; closing of windows and doors early in the evenings; removing mosquito breeding sites such as stagnant water; and use of LLINs3.
Context and Importance of the problem
A recent investigation into an outbreak of malaria in malaria-endemic Nwoya District in March to May 2018 revealed that applying of integrated malaria prevention methods was associated with reduced malaria transmission and illness. In the analytical case-control study, 55% of case-patients and 18% of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% of case-patients and 51% of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% of case-patients and 15% of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9).
Critique of Policy Options
The World Health Organization (WHO) recommends use of integrated vector management for malaria control4 and case management, which has shown promise in contributing to reducing the burden of the disease5. Other malaria prevention methods such as screening in ventilators (openings on houses that allow in fresh air) and draining stagnant pools of water have led to reduction of mosquito populations near homes, limited their entry into houses, and therefore prevented bites from the malaria vector.
Policy recommendations
Behavior change communication messages targeted for the general public should encompass cost-effective and easy to apply methods that can contribute to reduction of malaria transmission. The NMCD of MoH, through the Department of Health Information of MoH, should come up with messages sensitizing masses to close windows and doors early in the evenings; wearing long sleeve clothes to prevent fast contact with mosquitoes; and clearing all stagnant water and removing empty vessels around homesteads.
References
1. World Health Organization. WORLD MALARIA RE-PORT 2018.
2. Yeka, A. et al. Malaria in Uganda: Challenges to control on the long road to elimination. I. Epidemiology and current control efforts. Acta Trop. 121, 184–195 (2012).
3. Musoke, D., Karani, G., Ndejjo, R., Okui, P. & Musoke, M. B. Experiences of households using integrated malaria prevention in two rural communities in Wakiso district, Uganda: a qualitative study. Malar. J. 15, 313 (2016).
4. World Health Organization. Global Strategic Frame-work for Integrated Vector Management World Health Organization. (2004).
5. Okech, B. A. et al. Use of integrated malaria management reduces malaria in Kenya. PLoS One 3, e4050 (2008).