Wednesday 25th April 2018 was commemorated as World Malaria Day; a day to focus on the plight of malaria and the global efforts to control and curb the disease. For countries that have managed to eliminate malaria, this day most likely passed unnoticed. On the contrary, for many people in Uganda every day is Malaria day since malaria has directly or indirectly affected each one of us.
About 26 percent of Ugandans who suffered an illness in the 30 days preceding the 2016/17 Uganda national household survey reported to have suffered from Malaria. For health workers, malaria is a disease they confront on a daily basis. On average, 3 out of every 10 outpatients attended to by health workers are malaria cases while 2 out of every 10 hospital admissions are due to Malaria.
As Uganda joined the rest of the World in commemorating this years’ Malaria day under the global theme “Ready to beat Malaria”, it is time for us to reflect as a country on how we can scale up effective malaria prevention strategies that will help us kick malaria out of Uganda for good.
Indoor Residual Spraying (IRS) is an effective yet ignored solution to malaria
As the old adage says, ‘prevention is better than cure’. Indeed, prevention of malaria as opposed to case management (treating malaria) remains a more effective and cheaper strategy towards reducing the morbidity and mortality associated with the deadly yet preventable disease. Whereas Uganda advocates for use of insecticide treated nets (ITNs) and indoor residual spraying (IRS) as the primary vector control methods, IRS has received relatively little attention in terms of prioritization and funding.
Even though there is overwhelming evidence on the effectiveness of IRS in malaria prevention in both high and low endemic areas; the national IRS coverage is only about 4.9 percent against 62 percent for ITNs. In the past, IRS almost eradicated Malaria in South Western Uganda in the 1950s and it also greatly suppressed transmission to very low levels and reduced the burden of malaria in the 10 IRS pilot districts in Northern Uganda during 2009-2014.
However in 2014, the IRS was phased out from these pilot districts and emphasis was diverted to 14 other districts in Northern and Eastern Uganda. Following IRS discontinuation, an increase in malaria cases was reported in all the 10 districts. The resurgence of malaria outbreaks in these regions despite the high coverage of ITNs clearly demonstrated the beneficial effect of IRS in the malaria fight. Additionally, huge successes have already been registered in the new 14 IRS districts through a consistent reduction in the incidence of malaria.
Despite this glaring evidence of the effectiveness of IRS, coverage remains dismal. The 2014-2020 Malaria Reduction Strategic Plan had targeted to scale up and sustain IRS in 50 districts from the initial 10 districts by 2020. However, the 2017 MPRP mid-term review shows that there has been no progress in terms of scale-up apart from switching intervention districts. The cost associated with the implementation of IRS continues to be cited as a hindrance to the scale up but one wonders, is treatment of malaria the cheaper option?
Clarion call
Without urgent action, the major gains that Uganda has registered in the fight against Malaria over time are under threat. As we mark World Malaria Day, there is a need to critically rethink the implementation of IRS in Uganda through prioritization, increased domestic funding and expanded coverage. For a long time, implementation of IRS has been project based. For sustainability, ownership and cost cutting, there is a need to promote district capacity to implement IRS as opposed to project based IRS implementation.
Gemma Ahaibwe is a Research Fellow at EPRC and also a MakSPH – SPEED Project researcher
Important reference
- Mid Term Review of the Malaria Prevention and Reduction Plan (MPRP) 2014-2020.
- Uganda Bureau of Statistics (UBOS) and ICF International 2015 Uganda Malaria Indicator Survey 2014-15. Kampala, Uganda, and Rockville, Maryland, USA: UBOS and ICF International.