Uganda MIS shows progress – is it enough?

The Uganda Malaria Indicator Survey for 2009 is now available for reading. The report helpfully provides charts that distinguish levels of key indicators from the 2006 Uganda Demographic and Health Survey with the current data. While there has been clear progress, most indicators fall below the 80% targets set by the Roll Back Malaria Partnership for 2010.

uganda-mis-2009-nets.jpgThe chart of the right shows that sleeping under any insecticide treated bed net the night prior to interview tripled for children under five years of age and quadrupled for pregnant women, the 2009 levels do not achieve RBM goals.  Even when one looks only at households that actually possess these treated nets, one finds that use is less than ideal.

The report provides some reasons for low net usage…

The most common reason cited for non-usage was that the net was not hung (58 percent of households), especially in North East region (99 percent). Sixteen percent reported that the net was not used because it was too hot, and 11 percent said the net had too many holes or was too old.

There were also wide variations in ownership and use across different parts of the country, meaning that program managers need to look more indepth at possible regional factors that discourage access to and use of nets.

The East African countries were among the pioneers to introduce intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women.  Again we see that RBM targets are far from being met in Uganda, although progress over 2006 is evident.

  • 16% of pregnant women got two doses in 2006
  • 45% got one dose in 2009
  • 32% got two doses in 2009
  • 95% of pregnant women attended ANC with a skilled provider at least once in 2009

Clearly problems of procurement, supply and stock keeping and missed opportunities are preventing achievement of this goal.

The malaria case management picture was not cheering. Among children under five years of age with a reported fever in the two weeks before the survey …

  • 60% took any antimalarial drug
  • 23% of took an ACT
  • 14% took ACT same or next day
  • Chloroquine and SP were still being used

Uganda is not in a unique situation. Even countries benefiting from the Global Fund, the US President’s Malaria Initiative and other major partners like Unicef, DfID and the WOld Bank are having a challenging time with managing commodities, improving service quality and attracting clients to avail themselves of malaria services.

2010 ends in 17 days. How many places will have achieved the RBM 80% targets? More importantly, what can the international partnership do to meet the needs?

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