Matilda Akello, a resident of Opeta parish, Aboke Sub-county in Kole District, has taken her child twice to the health centre in the last three months. In both incidents, the child was diagnosed with malaria, a disease caused by a parasite transmitted by female anopheles mosquitoes.
“It has been costly to take the child for treatment at the health facility. Unfortunately, I was advised to buy medicines from the local pharmacy because anti-malarial drugs were not available,” she says.
Akello shares her experience with other women across northern Uganda, where the burden of malaria is still high.
The Ministry of Health, in an attempt to control malaria incidences, introduced Indoor Residual Spraying (IRS) in 10 districts in 2008. However, recent reports indicate that there is an increase in malaria rates in some of the former IRS districts.
Andrew Ayo, Kole District malaria focal point person, says as of May 2016, more than 90 per cent of out patient department (OPD) attendance was attributed to malaria, with 1,976 tested and treated. “In 2014, when IRS had just ended in Kole, OPD attendance for malaria was less than 15 per cent,” he says.
The increase in malaria cases has also been reported in Gulu, Apac and Oyam districts.
Strategies to end malaria
The burden of malaria is not unique to Uganda. Indeed malaria, which can be traced back to Denmark – about 100 years ago, remains a threat to the wellbeing of millions of people in many parts of the world, especially affecting children and women. It is also a major obstacle to economic progress in the country.
As the scientific community continues the battle against malaria, the elimination of the disease transmitting mosquitoes remains one of the key strategies that have worked elsewhere with remarkable success.
Dr Patrick Buchan Ocen, the district health officer (DHO) Lira, where the IRS is in its sixth phase, says targeting the female anopheles mosquitoes with IRS will reduce the parasitic load in the environment in the long run.
“With this strategy combined with use of insecticide treated nets, the malaria incidence will come down,” he says.
“What we learnt from Kole is that malaria is increasing because people abandoned the use of insecticide treated mosquito nets after the area was sprayed.”
Dr Ocen observes, from a policy perspective, it is now clear that an effective malaria fight will have to involve multiple interventions combined with long term efforts to understand the disease.
One of the tried and tested methods has been the removal of mosquito breeding sites. The draining of swamps caused malaria to disappear from much of southern United States and Italy. Within a decade of use of insecticide treated nets, northern Tanzania changed from being one of the most intense malaria transmission areas to being almost malaria free.
Dwelington Engur, the senior health educator for Kole, agrees that draining swamps is an effective means of reducing the population of mosquitoes.
“We have embarked on health education and social mobilisation. We are calling on the people to destroy mosquito breeding sites and to sleep under insecticide-treated nets to avoid contact with mosquitoes,” he says.
facts
Malaria is caused by a single celled parasite of the genus plasmodium. Five species of the parasite can infect humans. Malaria is transmitted by female anopheles mosquitos feeding on human blood.
If the mosquito carries malaria parasite, sporozoites are released into the skin during feeding. From there, they rapidly migrate to the liver, where they invade liver cells and multiply extensively. After about 10 days, thousands of daughter parasites emerge from infected liver cells. Each rapidly invade an erythrocyte, a red cell, initiating what is known as the asexual multiplication cycle that brings with it all the clinical signs of malaria. In Uganda, malaria kills 100,000 people annually, majority of them children.
drug resistance
After years of rolling back control of malaria, policy makers and scientist are now talking about the elimination of the disease. The fact that malaria is on the decrease in many parts of the world has given hope that it shall be eliminated- just as small pox which was eradicated in 1979. However, the drug used to treat malaria is increasingly threatened by emerging drug resistance.
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