25 February – With 100 percent of its population at risk of malaria and 15,632 deaths from malaria occurring last year, Uganda faces many challenges. Chief among these are high malaria transmission, key health system challenges and limited knowledge of disease prevention practices.
To address these challenges, the five year Pioneer Project developed effective methods of reducing malaria-related illnesses and deaths in partnership with the Ministry of Health and through existing structures at all levels - from central institutions to community health structures. The result was a holistic approach that focused on health system strengthening which was rolled out across five districts of mid-western Uganda: Hoima, Kibaale, Buliisa, Kiboga and Kyankwanzi.
Thanks to Malaria Consortium’s technical expertise in the area, the organisation was able to link with other existing projects in the region and to develop integrated strategies that address malaria and other communicable diseases, achieving maximum impact.
Prevention is paramount in fighting malaria
Between 2009 and 2010 the Pioneer Project, together with the Ministry of Health, carried out the first ever universal coverage mass distribution of long lasting insecticide treated nets (LLINs) across four of the five project districts (excluding Kibaale). This increased the percentage of households that owned a mosquito net in the area from 37 percent in 2009 to 92 percent six months after the campaign.
Three years after the Pioneer distribution, retention and use in the area were still three times higher than World Health Organization (WHO) baseline figures. This success can be attributed to the project’s ongoing behaviour change communications campaign.
Besides net distribution, Malaria Consortium held regular surveys (collecting and examining mosquitoes) to evaluate the impact of the interventions on mosquito density and behaviour, as well as malaria transmission intensity. The findings showed an overall reduction in the population density of mosquitoes and infectious bites across all four districts. These results confirm that mass nets distributions, combined with other malaria control interventions in the region, reduced the malaria transmission over the project’s lifespan.
Timely access to effective diagnosis and appropriate treatment
Malaria Consortium’s project initiatives introduced malaria rapid diagnostic tests (mRDTs) across all health centres in the five districts lacking microscopy equipment and trained health workers on its correct use. Health workers are now testing first for malaria and treating only confirmed cases with antimalarials. They are also taking more care to carry out a proper diagnosis for other common illnesses like infections and respiratory illnesses. Their performance was assessed by regular mentoring and hands-on supervision and the district health authorities have been developed to continue this regular supervision.
“Previously, every patient with fever was thought to have malaria,” said Mutumba Abdul, Secretary for Health in Kiboga, “But now health workers know that not every fever is malaria. With the introduction of mRDTs, they have learnt to ask for testing and want to know what is really wrong with them.”
Linking with Malaria Consortium’s integrated community case management (iCCM) project in the same region allowed the organisation to increase the availability and quality of key health services for children under five in their own communities and helped address cases of malaria, pneumonia and diarrhoea. Village health teams also received training on the administration of rectal artesunate as pre-referral treatment for severe malaria. Rectal artesunate is a life-saving treatment for young children especially in remote areas where access to healthcare is limited. During the project, 342,052 children had access to the rectal artesunate treatment at community level.
‘Keep Good Health, Enjoy Life’
Increasing access to nets, accurate diagnostic tools and pre-referral treatment is crucial in combating malaria. However, for the interventions to become sustainable and achieve lasting impact, essential healthy practices need to be adopted. The Pioneer Project’s communications campaign provided communities with correct information on malaria transmission and prevention and contributed to improved health seeking behaviours and actions for malaria control.
Key messages in the ‘Keep Good Health, Enjoy Life’ campaign included prevention by using LLINs every day, addressing illnesses during the onset of symptoms, access to correct diagnosis and emergency treatment in the community through trained village health teams and referral for care at health centres.
The Pioneer Project built sustainability into its activities by focusing on national and district level systems strengthening and ensuring that findings and lessons learnt were made available to those involved in the implementation and scale up of malaria control interventions.
Advocacy efforts have promoted a political and implementation environment that favours effective malaria control interventions, including their scale up. Successes include the integration of Pioneer Project learning into national guidelines for training and roll-out of mRDTs and inputs into broader policy documents like the National Malaria Reduction Strategy, especially in the areas of prevention and vector control.
Malaria Consortium is now advocating for the development of combined continuous distribution channels to widen coverage by replacement nets after the mass distribution campaign.
More recently, Malaria Consortium and Comic Relief teamed up to renovate a dilapidated health centre in Tororo district, as the focus of Red Nose Day 2015. You can read more about Operation Health here.
Keywords: Advocacy and policy | Facility health services | Health system strengthening | Community delivery | Diagnosis | Treatment | Public health communications | Vector control | Preventive treatments