Malaria Communities – making progress in Uganda

The Malaria Communities Program (MCP) of the US President’s Malaria Initiative gives non-governmental organizations a chance to make an impact at the local level in 15 endemic countries. Ronald Apunyo of Medical Teams International provides us an update on MCP activities in Uganda.

mcp-uganda-mti-3.jpgThe Malaria Communities Project in Uganda is currently being implemented (With funding from USAID) in Lira, Otuke, Alebtong and Dokolo Districts, part of the Lango sub-region of northern Uganda, with a population of approximately 765,458 and 166,190 households. Primary beneficiaries include 159,895 children under five years of age and 39,578 pregnant women.

According to a recent report from the World Health Organization, Uganda has the world’s highest malaria incidence, with a rate of 478 cases per 1000 population per year. Malaria is the leading cause of morbidity and mortality in Uganda and is responsible for up to 40% of all outpatient visits. Malaria is the leading cause of morbidity and mortality nation-wide, and is particularly high in the northern region, where Dokolo and Lira Districts account for 54% of the sub region’s malaria cases and only 46% of the population.

Northern Uganda is a transitional environment, and communities are in the process of resettling in their ancestral lands after 20 years of insecurity and internal displacement due to attacks from the “Lord’s Resistance Army.” The project has endevoured to fill gaps identified in Uganda Malaria Control Strategic Plan by meeting training, support and supervision needs for VHTs who have been trained by MOH and by strengthening community-level behavior change and health promotion efforts to complement PMI and National Malaria Control Program (NMCP) broader malaria prevention interventions.

mcp-uganda-mti-1.jpgThe project has had two years of uninterrupted implementation in all the Sub-counties of Dokolo district, in the past two years (Since 2009/10). The project focuses on reducing malaria-related morbidity and mortality among pregnant women and children under 5 years of age in the project areas by

  1. Increasing the percentage of pregnant women and children under 5 years of age sleeping under an LLIN each night.
  2. Increasing the percentage of pregnant women who receive 2 or more doses of IPTp during their pregnancy
  3. Increasing the percentage of children under 5 years of age with suspected malaria who receive treatment with ACT within 24 hours of onset of symptoms

A review of Dokolo district Health Management Information System between 2006/7 and 2010/11 indicates an improvement in some of the key projects target indicators pertaining to ANC attendance by pregnant women, new malaria cases in OPD IPTp uptake and stockouts of key medicines.

SUCCESSES

  • There is a steady increase in ANC fourth visit in Dokolo district since project start in 2009/2010.
  • Proportion of Pregnant women receiving IPTp2 increased from 60% to 69% between 2009/10 and 2010/11

LESSONS LEARNED

The successful use of Social and behaviour Change communications interventions in malaria control should be coupled with reliable supply of malaria commodities at the health facilities inorder to attain satisfactory results.

Use of community volunteers like female VHTs at the ANC to mobilize and conduct less technical work like providing clean water to pregnant women,observing Directly observed treatment (DOT), carrying out health education sessions and providing other support to pregnant mothers at the health units greatly reduces workload of health workers as well as waiting time of pregnant
women during ANC (a key reason why pregnant mothers do not attend ANC).

The role of community structures like the village health teams (VHTs) has made significantly positive contributions towards the fight against malaria within the communities.

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