On 17th April 2019, I attended the World Malaria Day Scientific conference at Kabira country club organised by the Ministry of Health –National Malaria Control Division. The conference title was; “It’s Household War-Chase malaria to Zero, the scientific touch”. The conference was aimed at showcasing the different scientific research work for chasing malaria to zero. This was also in preparation for the celebration of the World Malaria Day. These are all good steps to eliminating malaria in Uganda and in line with the Uganda Malaria Reduction Strategic Plan (UMRSP) 2014-2020. The UMRSP 2020 gives a number of other strategies including the use of long-lasting insecticide-treated nets (LLINs), case management and Indoor Residual Spraying among others.
However, listening in to the presentations and discussions, a lot more was on the evaluation of LLINs, the susceptibility of insecticides to Anopheles mosquitoes, dispensing antimalarials to RDT negatives patients, strategies to increase the uptake of intermittent presumptive therapy (IPT) in pregnancy and generally the efficacy of the antimalarial on the market. I kept wondering whether the gains in malaria control were solely due to the improved case management and universal coverage of LLINS; whether all the evidence generated through research was to support the subsequent strategies and interventions such as Mass Action against Malaria (MAAM) which was launched in April 2018!
Just as I started thinking of who should decide the priority malaria control interventions, multiple praises reigned on real agencies that support malaria control. Locked between joining the appreciation and our right to participation and choice, I sat in disbelief! Is malaria control a political or technical decision and or both? At what point do we determine what works, when is the research evidence needed and used in practice?
While it is scientifically agreed that Indoor Residual Spraying (IRS) is the most cost effective malaria control method because it destroys the transmission source of infection, it is never given the necessary priority as reflected by National Malaria control Annual Report 2018. However, evidence emerging from the “Supporting Policy Engagement for Evidence based Decisions (SPEED) for Universal Health Coverage in Uganda; a project funded by European Union and hosted by Makerere University School of Public Health, clearly indicates that IRS is a cheaper option compared to case management and LLINs.
Evidence suggest that IRS is cheap if the already existing human resources are redeployed, the program is implemented in a phased manner using an insecticide with long lasting effect (Actellic) to allow for the rotation of equipment; and incorporation of behaviour change communication for IRS into the already running programmes such as National Immunisation Days as cost reduction strategies will be game changers in eliminating Malaria.
As indicated in the 2018 Annual Malaria report, Karamoja, Busoga and West Nile regions have the highest prevalence of Malaria in Uganda therefore these regions require effective interventions reached at through research. For instance, in Karamoja- a pastoral community, larviciding and IRS can be convenient and cheaper compared to case management and LLINs while in Busoga region, behaviour change communication on the use of LLINs and Indoor residual spraying can be the best priorities.
Therefore, with the renewed efforts to eliminate malaria as evidenced through the MAAM approach, rational decision-making based on research evidence and increased inter-sectoral and interdisciplinary action is key. In additional, evidence based advocacy for generation of and optimal use of locally available resources for IRS will create a quick win not only to eliminating malaria but also to accelerating towards Universal Health Coverage in Uganda
Moses Kirigwajjo –Programs Officer Uganda National Health Consumers Organisation (UNHCO) and a Focal person for SPEED Project at MakSPH