Malaria outbreak: Lango sub-region is in the eye of the storm

Although the Ugandan government has made significant progress in the fight against malaria in recent years, more needs to be done.

By Odongo Patrick Lango

Lango, December 13, 2022: Malaria remains a major public health concern in Uganda, with an estimated 20 million cases each year. It is the leading cause of outpatient visits to health facilities, putting a strain on an already overburdened health system. 

Despite having some of the most effective malaria interventions, such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS), Uganda’s implementation has been hampered by a lack of resources and responsiveness by the duty-bearers at national and international levels.

Although the Ugandan government has made significant progress in the fight against malaria in recent years, more needs to be done. Raising household awareness of malaria prevention and control measures is critical to ensuring that communities understand the importance of using LLINs, IRS, and other preventative measures.

To that end, the government should devote more resources to community outreaches, particularly in remote and difficult-to-reach areas, to ensure that the vulnerable are informed and equipped with the tools they need to protect themselves from the disease.

Furthermore, it is critical to strengthen health systems to provide high-quality malaria diagnosis and treatment services.

This necessitates the government investing in health worker training — both in private and public facilities — as well as improving laboratory and diagnostic services, stockpiling malaria commodities, and strengthening information and reporting systems for evidence-based decision-making.

Malaria, unfortunately, is making a serious and deadly comeback and is now wreaking havoc in the Lango sub-region. In this sub-region, the disease has been steadily increasing over the last four years, with a positivity rate approaching 90%. The burden on local health systems is enormous, exacerbated by the after-effects of the COVID-19 pandemic.

For example, due to the misfortune of geography, new malaria cases in Dokolo District, one of the malaria endemic districts, have more than tripled. Dokolo has an average of 2000 malaria cases per month.

However, the number of positive cases increased to 7000 per month in the July-September 2022 quarter. This has not only resulted in the outstripping of meagre health resources but has also put a significant strain on an already overburdened health system.

Because of the focus on containing the Ebola epidemic in western Uganda, the current malaria outbreak in the Lango sub-region has not received the due attention it deserves.

As a result, health resources on the ground are stretched thin, and families are forced to pay out-of-pocket at private health clinics that usually lack the necessary diagnostic and case management capabilities.

Furthermore, a lack of funds and supplies has hampered the Integrated Community Case Management (iCCM) program, which trains and equips community health workers to provide diagnostics and treatment for illnesses such as malaria.

Furthermore, the current malaria outbreak has been exacerbated by the region’s lack of a coordinated and responsive surveillance system capable of tracking the ebbs and flows of malaria cases.

The national surveillance and response system is facility-based, with a lack of surveillance coverage in remote communities, a lack of data integration from sources other than government health facilities, such as private health facilities, schools, and community health workers, and a weak health information architecture to capture and report detailed granular malaria data for leaders and managers to effectively pin the hotspots where the majority of malaria cases are arising from.

For example, while many VHTs and private health facilities use an integrated community case management (iCCM) approach to treating children under the age of five, however, these malaria cases are never captured in the national surveillance system because the majority of VHTs do not report to the DHIS2, the national health information system.

Although health facilities are capable of conducting hotspot mapping of villages and parishes with high malaria positivity rates, they are limited in their ability to conduct community outreaches to implement community-based malaria prevention and control measures due to a lack of funds and central support.

The Ministry of Health has been using a hands-off approach leaving districts and facilities in the region to fend for themselves despite the difficulties.  

The current malaria outbreak in the Lango sub-region endangers the lives and well-being of approximately 3 million people. It is not too late for the Ministry of Health, the World Health Organization, and the Global Fund to rise to the occasion and provide aeaningful leadership and response. Standing idly by and shielding their eyes from these problems is not the best option.

The writer is the Head of Programs at Lango Youth Development Network’s (LAYDNET)

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