Overview of the Malaria

Programme in Uganda

Dr Jimmy Opigo
Assistant Commissioner Health Services
National Malaria Control Division, MOH
 Global malaria control history
 Malaria occupies a unique place in the annals
of history. It has killed princes and paupers.
 In the 20th century, 150 - 300 million deaths
were registered (2-5%) (Carter and Mendis,
2002).
 Mainly affects the poor of Sub Saharan Africa,
Asia, Amazon basin, and other tropical
regions
 40% of the world's population still lives in
areas where malaria is transmitted.
 Important discoveries
Charles Louis Alphonse Laveran on October 20, 1880,
discovered the malaria parasite by microscopy and later
its 4 stages (Awarded a Nobel prize in 1907)
August 20, 1897 Ronald Ross discovered the malaria
parasite in an anopheles mosquito that had fed on an
infected patient
In 1948 H. E. Shortt, Garnham, and colleagues at the
Ross Institute of LSHTM detected malaria parasites in the
liver
Anti-malarial medicines discovery:
Þ Quinine (1820),
Þ Chloroquine (1934),
Þ Sulphodoxne (1967),
Þ Pyrimethamine, Mefloquine (1975),
Þ Arteminsinin (2002)
 Global malaria control history
 1955-1969: Global Malaria Elimination Programme
 Countries certified as malaria free
 1955-1972: 15 countries and one territory
 1972-1987: 7countries and one territory
 1987-2007: NONE
 During the Post GMP period there was reduced
prioritization of malaria in terms of financing,
research, and capacity building
 Global actors started to rebuild momentum in the
1990’s – 2000’s
 2000 Emerged again as a PH priority in global health
discourse
 Malaria milestones 2000-2020
 
 Report Part Title: Malaria milestones, 2000–
2020 
 Report Title: World malaria report 2020
 Report Subtitle: 20 years of global progress and
challenges
 Report Author(s): World Health Organization
 Published by: World Health Organization (2020)
 Stable URL:
https://www.jstor.org/stable/resrep27867.8 
 WHO and RBM launch HBHI in November 2018

Impact
Reduction in mortality & morbidity
Outcome
Implementation of prioritized operational plans derived from
evidence-informed national malaria strategic plans
Output Output Output Output

Better guidance

Coordinated
Political will

information
4 mutually

response
Strategic
reinforcing
response
elements
I II III IV

Effective Health System

Multisectoral response
 Guiding principles for the HBHI approach
Highest burden countries1 are the focus of the
first wave of the approach Guiding principles

Burkina Faso Country-owned, country-led approach,

aligned with the GTS, SDGs, national
Cameroon health goals, strategies and priorities

DRC

Ghana Better coordinated support from in-

country and external partners paired with
Mali increased transparency to ensure efficient
responses
Mozambique

Niger
Commitment from partners to share and
Nigeria jointly analyse data
Uganda
Support for enhanced domestic and
Tanzania international resource mobilization
India2

1 11 countries with highest burden of malaria concentrate 70% of cases and deaths
2 All of the 10 highest burden African countries reported increases in malaria cases over the previous year, ranging from an estimated 131,000 more cases in Cameroon to 1.3 million additional cases in Nigeria. Only
India marked progress in reducing its disease burden, registering a 24% decrease compared to 2016.
100 year of malaria control in Uganda
 Strategies and approaches 2018 to date
 High Burden High Impact
 Mass Action Against Malaria launched by HE YKM April
2019
 Malaria control and Elimination Policy Guideline (2019)
 Malaria Programme Review (2019)
 Uganda Malaria Reduction and Elimination Strategic
Plan 2021-2025
Þ By 2025, reduce malaria infection and morbidity by 50%
and malaria related mortality by 75% of 2019 levels.
 Training Needs Assessment
Þ Results triggered the development of this course for
malaria control managers at all levels
 10

Key Interventions

Integrated vector Management

LLIN distribution- Mass and routine Surveillance Monitoring and evaluation
campaign country wide Reporting
Indoor Residual Spraying-Larval Source
Data quality assessment
Entomological Surveillance
Case management Therapeutic Efficacy Studies
ICCM- Community case management o
Management at facilities of
uncomplicated and severe malaria
Provision of IPT for Malaria in
Emergency Preparedness and response
Pregnancy Epidemic detection
Epidemic Response
Behavior Change Communication Epidemic preparedness
Chase Malaria Campaign
Community dialogues, Mass media,
Interpersonal Communication.

Programme Management
Leadership &Coordination
Supply chain management
Human resource and resource
mobilization

National Malaria Control Programme

© 2017 Ministry of Health. Republic of Uganda.
 Trends in ITN Ownership
Percent of households with at least one ITN

90
83
78

60

47

2009 UMIS 2011 UDHS 2014-15 UMIS 2016 UDHS 2018-19 UMIS

*An insecticide-treated net (ITN) is a factory-treated net that does not require any further treatment. The definition of an ITN
in previous UMIS and UDHS surveys included nets that had been soaked with insecticides within the past 12 months.
 Trends in ITN Access and Use
Percent of household population with access to an ITN and
who slept under an ITN the night before the survey

79

69 72
74
ITN use 68
55 65
49

45

32
ITN access

2009 UMIS 2011 UDHS 2014-15 UMIS 2016 UDHS 2018-19 UMIS

*An insecticide-treated net (ITN) is a factory-treated net that does not require any further treatment. The definition of an ITN
in previous UMIS and UDHS surveys included nets that had been soaked with insecticides within the past 12 months.
 Trends in IPTp
Percent of women age 15-49 with a live birth in the two years before the survey who received:

72

IPTp2+ 49
46
41
33
27 28

17 17
10
IPTp3+
2009 UMIS 2011 UDHS 2014-15 UMIS 2016 UDHS 2018-19 UMIS
*Whether or not at least 1 doses of SP/Fansidar was received during an antenatal care (ANC) visit is no longer part of the
IPTp indicators, as included in previous MIS surveys.
 Case Management of Fever in Children
Percent of children under 5 with fever in the two weeks before the survey who had:

Advice or treatment sought Blood taken from a finger/heel for testing

87 85
82

59
51

39

Total Refugee settlements IRS districts

 Treatment of Children with Fever
Among children under 5 with fever in the two weeks before the survey
who took any antimalarial medication, percent who took an ACT
95
88
84

Total Refugee settlements IRS districts

UMRSP GOALS & MTR Performance 16

By 2020, reduce annual malaria

deaths from the 2013 level to near
zero (30 to 1 per100,000)

Current: 9.0 Target:

5.33
By 2020, reduce malaria morbidity
to 30 cases per 1000 population
(150 to 30 per 1000)

Current:191 Target: 75
By 2020, reduce the malaria 42
parasite prevalence to less than 19
9
7% (19% to 7%)
2009 2014-15 2016 2018-19
Current: 19% Target: UMIS UMIS UDHS UMIS
 50,000
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2015
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2015
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2016
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Malaria Cases - WEP

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2017
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2017
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2018
2018 W28
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Moving average (Malaria Cases - WEP)

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2019

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2019

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National Weekly Malaria Cases

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Reporting Rate

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2020

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2020

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2021

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Malaria stratification & Intervention delivery approaches
 Recommendations for programme strengthening

Þ Ensure malaria remains high in the political agenda with a

sustained political will
Þ Resource mobilization (traditional and non-traditional sources)
Þ Effective decentralization of implementation to districts
Þ Leverage the MAAM approach for multisectoral engagement
and mass action
Þ Strong partnership and full engagement of the private sector
Þ Intervention targeting instead of “one size fits all”
Þ Integration of malaria service delivery within other programmes
Þ Promote community level engagement and ownership through
‟bottom-up” approaches (Advocacy and SBCC)
Þ Engage with neighbouring countries, EAC, and regional
economic commissions to address cross border malaria in line
with the Great Lakes Malaria Initiative
 Strategic re-orientations/2
 “Value for Money” – most efficient intervention mixes
and delivery approaches

 Inclusion – for all Ugandans in their diversity leaving

no one behind (MAAM)

 The ”3-Ones” principle – to be entrenched at all levels

 Cross border collaboration – in planning and

implementation including migrants and refugees

 Private Sector – strong engagement and partnership

 Challenges-1
1. Translation of political commitment into reality:
 Limited engagement and empowerment at sub-
national levels and grassroots: Delayed roll out
of Mass Action Against Malaria strategy to
empower communities to take responsibility for
malaria reduction and elimination
 Legislative actions: Uganda Parliamentary
Forum for Malaria (UPFM)
 Limited domestic resources:
Presidential Malaria Fund- Uganda;
Resource mobilisation strategy;
Multi-sectoral collaboration and action;
Private sector funding
 Challenges-2
2. Biological threats
➢ Insecticide resistance is widespread limiting the
effectiveness of tools and increasing operation costs
➢ Parasite drug resistance
➢ Parasite gene deletions
3. Fragile malaria control gains
 Re-surgence of malaria following withdrawal of
interventions like IRS
4. Emerging and re-emerging diseases
 COVID-19 increased cost of operations
 Shifted priorities (funders, product development)
 Challenges-3
5. Limited coverage of targeted interventions due to health
systems challenges
 IRS in 20 out of 50 targeted districts.
 Sub optimal use of strategic information for action
 Health System Challenges
 Limited Human Resource and skills
6. Low engagement of the private sector
7. Climate change
8. Malaria upsurges and epidemics
9. Development and urbanization
10.Cross border issues (Migration, refugees, mobile
populations)
Setting prerequisites for malaria elimination
 Rethinking malaria
Uganda as part of the “Global rethinking malaria” is
conducting a consultative process to document ongoing
country efforts towards malaria reduction and elimination
and to guide recommendations for malaria interventions.
ÞAreas of exploration include:
o What is working, what is not working, and what should be done
o Who is missing out on malaria interventions and services and
the barriers they face.
o What social and environmental factors increase people's risk of
malaria and impede equitable access to quality prevention and
care.
Implementing partners