Increasing Public Knowledge about Malaria in Uganda By

Increasing Public Knowledge about Malaria in Uganda By Shakilah Nakyanzi Graduate Student, Walden University MPH Program 2 nd November 2014

Learning Objectives Malaria- the bigger picture Malaria in Uganda Diagnosis Case Management Malaria prevention Existing gaps Way forward: -

Malaria Worldwide • Vector-borne disease caused by plasmodium • Transmitted by an anopheles mosquito. • Anopheles gambiae is the major vector in Africa -Breeds in different areas: - Rice fields, tire tracks and irrigation water. • Species of plasmodium; P. falciparum, p. vivax, P. malariae and P. ovale (WHO, 2012; Pullan et al, 2010). • About 219 million people infected worldwide in 2010 (WHO, 2012) World Health Organization: World Malaria Report 2012 www. who. int/malaria Pullan et al. : Plasmodium infection and its risk factors in eastern Uganda. Malaria Journal 2010 9: 2. http: //www. biomedcentral. com/content/pdf/1475 -2875 -9 -2. pdf Source; CDC, Anopheles mosquito, Common habitats; rice fields, tire tracks and irrigation water

Malaria worldwide…cont • • Mortality of 660, 000 deaths 90% mortality occur in Africa 80% are in Sub-Saharan Africa Six highest burdened countries in the African region; Nigeria, DRC, Tanzania. Uganda, Mozambique and Ivory Coast • These account for about 103 million (47%) malaria cases. • Scaling up of malaria control interventions is a global concern. • Malaria remains inextricably linked with poverty. World Health Organization: World Malaria Report 2012 www. who. int/malaria

Malaria In Uganda 12 million clinically treated cases in year (Pullan et al, 2010) Annual Child mortality is between 70, 000 and 100, 000 (WHO, 2012) 350 deaths on a daily basis 65% maternal morbidity and mortality (WHO, 2012) Leads to anemia and low birth weight 90 to 95% transmission attributed to climate and heavy rainfall Source: Abt Associates

The Burden of Malaria in Uganda has the third largest malaria burden in Africa and the sixth largest in the world (Malaria Consortium, 2011) Population in rural areas contribute to 87% of the burden of disease (WHO, 2010) Annual maternal deaths of 10, 000 8% to 14% of all low birth weight 3% to 8% of all infant deaths (UN-Roll Back Malaria). Increased drug resistance (WHO, 2010) Economic effects: - restricts the productivity of our population at household level and community level. “Malaria-related expenses account for 34% of total expenditure for the poorest sections of the country” (DID, 2011). Malaria also puts a heavy burden on the health system Malaria Consortium. “Malaria Consortium in Uganda”. 2011. http: //www. malariaconsortium. org/pages/uganda. htm The World Health Organization. “World Malaria Report 2010: Uganda”. http: //www. who. int/malaria/publications/country-profiles/profile_uga_en. pdf Department for International Development. Where we work: Uganda-Key Facts. 2011. http: //www. dfid. gov. uk/Where-we-work/Africa-Eastern— Southern/Uganda/Key-facts

Risk Factors • • • Age Pregnant status Distance of households to rice-growing areas Widespread poverty in rural areas Lack of knowledge on how to prevent and treat malaria Limited healthcare access (DID, 2011) Department for International Development. Where we work: Uganda-Key Facts. 2011. http: //www. dfid. gov. uk/Where-we-work/Africa-Eastern —Southern/Uganda/Key-facts/ Roll Back Malaria. 2001 -2010 United Nations Decade to Roll Back Malaria in Pregnancy. http: //www. rbm. who. int/cmc_upload/0/000/015/369/RBMInfosheet_4. htm The World Health Organization. “World Malaria Report 2010: Uganda”. http: //www. who. int/malaria/publications/countryprofiles/profile_uga_en. pdf

Diagnosis Early recognition of malaria allows timely treatment and prevents further spread of infection in the community. (WHO, 2012) Delay in malaria diagnosis and treatment can cause death. (DID, 2011; WHO, 2012). Diagnosis can be; symptomatically, clinically using rapid diagnostic test and microscopy. Symptomatic diagnosis and the use of RDTs are the most common in rural communities. Microscopy is common in high level public and private health facilities. Department for International Development. Where we work: Uganda-Key Facts. 2011. http: //www. dfid. gov. uk/Where-wework/Africa-Eastern—Southern/Uganda/Key-facts/ The World Health Organization. “World Malaria Report 2010: Uganda”. http: //www. who. int/malaria/publications/countryprofiles/profile_uga_en. pdf

Case Management of uncomplicated malaria - First line treatment (ACT), with Arthemether/Lumefantrine (COARTEM) • Management of sever/complicated malaria - Second line treatment, an alternative ACT (Artesunate/ Amodiaquine), quinine + tetracycline or doxycycline or clindamycin. (WHO, 2006) • A variety of antimalarial drugs are recommended: - - Artesunate i. v. or i. m, artemether i. m. and quinine (i. v. infusion or i. m. injection) • ACTs are recommended for all uncomplicated malaria cases (WHO, 2006; UNMCP) • New treatment had more than > 95% cure rate according to most clinical trials (WHO, 2006) World Health Organisation; Malaria treatment (Current WHO recommendations & guidelines, 2006 http: //rbm. who. int/mmss/ Uganda National Malaria Control Program health. go. ug/mcp/index 2. html

Facility-Based Malaria Case Management Effective Malaria treatment is a top priority of Ministry of Health (UNMCP 2012, Nanyunja et al, 2011) Proper clinical diagnosis at facility level - Train health providers - Equip facilities with recent ACT guidelines and materials - Provide necessary diagnostic equipment and drugs in malaria case management. Nanyunja et al (2011) “Malaria Treatment Policy Change and Implementation: The Case of Uganda, ” Malaria Research and Treatment, vol. 2011, Article ID 683167, 14 pages, 2011. doi: 10. 4061/2011/683167 Uganda National Malaria Control Program health. go. ug/mcp/index 2. html

Home-Based Management of Fever HBMF takes place at community level. Involves selection of community volunteers and mobilizers Capacity building through training of volunteers (VHTs) Integrated community case management through; v Provision of IEC materials v Diagnostic materials (RDTs) v Provision of anti-malarial drugs to volunteers v monitoring and supervision Malaria Consortium. “Malaria Consortium in Uganda”. 2011. http: //www. malariaconsortium. org/pages/uganda. htm Source : in. SCALE Project Uganda, Malaria Consortium

Prevention/Interventions The use of ITNs /LLINs. -Its is estimated that the use of bed nets may reduce child mortality by 19% and 40 to 50 per cent reduction in infections The use of indoor residual spraying (IRS). - 153 million people world wide and 77 million people in the African region were protected from malaria using IRS in 2011. Health education campaigns to increase awareness and knowledge regarding the importance of using ITNs. Intermittent Preventive Treatment (IPT) among pregnant women. Integrated Community Case Management (i. CCM) Strengthened healthcare system. World Health Organization: World Malaria Report 2012 www. who. int/malaria Source: Uganda Water Project Source; Abt Associates, 2012

Prevention at household level Use of mosquito repellants Draining stagnant water near the house Clear bushes around the house Close doors and windows early evening Monitor bed net usage in the night (especially among children) Seek quick medical assistance in case of any signs of fever Avoid self-medication/ over-the-counter medication Ensure that children complete dosage Cooperate with Community-based health agents Give children enough fluids and maintain a balanced diet Constant monitoring of children is essential Cultural flexibility is necessary

Existing Gaps Limited funding for malaria prevention and control to reach global target. v “An estimated US$ 5. 1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria interventions. In 2011, only US$ 2. 3 billion was available, less than half of what is needed” (WHO, 2012) Decrease in the distribution of LLINs in all endemic countries (WHO, 2012) Less than 43% of children under five and 47% of pregnant women use bed nets on a regular basis (UDHS, 2011) World Health Organization: World Malaria Report 2012 www. who. int/malaria Uganda Demographic Health Survey 2011 www. ubos. org/onlinefiles/uploads/ubos/UDHS 2011. pdf

Way forward Increase funding for malaria interventions Scale up control and prevention approaches Combine efforts from international, national and private entities are required to control and eradicate malaria. Need for more health education campaigns to increase community awareness on the prevention and treatment of malaria. Improved case management at community level The use of IRS such as DDT should be given a second chance A vaccine for malaria is essential Strengthen the healthcare system Need for future Research on malaria transmission, effectiveness of ACTs and prevention approaches. World Health Organization: World Malaria Report 2012 www. who. int/malaria

References Department for International Development. Where we work: Uganda-Key Facts. 2011. http: //www. dfid. gov. uk/Where-we-work/Africa-Eastern—Southern/Uganda/Key-facts/ Malaria Consortium. “Malaria Consortium in Uganda”. 2011. http: //www. malariaconsortium. org/pages/uganda. htm Nanyunja M, Nabyonga O. J, Kato F, Kaggwa M, katureebe C, & Saweka J (2011), Malaria Treatment Policy Change and Implementation: The Case of Uganda, ” Malaria Research and Treatment, vol. 2011, Article ID 683167, 14 pages, 2011. doi: 10. 4061/2011/683167 Pullan et al. : Plasmodium infection and its risk factors in eastern Uganda. Malaria Journal 2010 9: 2. http: //www. biomedcentral. com/content/pdf/1475 -2875 -9 -2. pdf Roll Back Malaria. 2001 -2010 United Nations Decade to Roll Back Malaria in Pregnancy. http: //www. rbm. who. int/cmc_upload/0/000/015/369/RBMInfosheet_4. htm The World Health Organization. “World Malaria Report 2010: Uganda”. http: //www. who. int/malaria/publications/country-profiles/profile_uga_en. pdf World Health Organisation; Malaria treatment (Current WHO recommendations & guidelines, http: //rbm. who. int/mmss/ Uganda Demographic Health Survey 2011 www. ubos. org/onlinefiles/uploads/ubos/UDHS 2011. pdf

Sources for Further Reading Malaria: A major cause of child death and poverty in Africa. www. unicef. org/publications/index_19019. html Facts for Life – Malaria www. factsforlifeglobal. org/10/ CDC Malaria Program www. cdc. gov/mala Malaria Prevention and Treatment www. unicef. org/prescriber/eng_p 18. pdf VHT Handbook- K 4 Health https: /www. k 4 health. org/sites/default/files/VHT%20 BOOK. pdf Ngomane and de Jager ( 2012) Changes in malaria morbidity and mortality in Mpumalanga Province, South Africa (2001 - 2009): a retrospective study. Malaria Journal 2012 11: 19.