Dr. Henry Katamba is a Specialist for Monitoring and Evaluation with the National Malaria Control Programme in Uganda. We met to find out his views on the current successes in fighting malaria in Uganda, and the impact The Coca-ColaAfrica Foundation and NetsforLife® have on the Ugandan communities.
Battling the biggest health risk in Uganda
Malaria as a disease is the biggest cause of mortality in Uganda, and one of the top ten biggest health burdens in the country. It is mainly affecting pregnant women and children below the age of five, with most severe cases and deaths in these groups.
In 2012, we had a total of over 25 million cases of malaria, out of which more than 11,2 million in-patient cases, people who had to be admitted in the hospitals to be treated due to severity of their condition. This is at a huge cost to families and the country as a whole, a very serious burden in a population of about 32 million.
Response structure that we have in place is a National Malaria Control Programme, headed by the Programme Manager under the Commissioner for Communicable Diseases. The Programme Manager is supported by specialists in Integrated Community Case Management, Vector Control and Monitoring and Evaluation. All the activities are coordinated by National Malaria Strategic Plan, and I am one of the three Specialists in charge of Monitoring and Evaluation.
We have the National Referral Hospital and the Regional Referral Hospitals. Below this level we have District Hospitals. They are all capable of managing the most severe cases of malaria.
Health Centre 4 is equipped with a theatre and a Medical Officer heading it, and can at least provide emergency obstetrics care. Health Centre 3 can manage admission of the malaria patient, and Health Centre 2 will be able to provide only out-patient care. We are only just starting to enable and train Village Health Teams who can identify signs and symptoms of basic and severe malaria, and administer the first dose and thereafter refer the patient for further treatment.
In treatment of malaria it is imperative to start within the first twenty-four hours, for a success in treatment.
We want everyone to get involved in the fight against malaria, supported by our strategic partners
The major international partner is PEPFAR, as well as the Global Fund. Our biggest local partner is Church of Uganda, who have invested a lot in the facilities especially in the rural places which are hard to reach and very populous. Church of Uganda maintains these facilities and services, as well as other community services that they provide, mainly in agriculture and health. One of the projects we worked very closely on together is NetsforLife®.
One of the interventions in the prevention of malaria that we have in the Ministry of Health is coverage of our population with long-lasting insecticide treated nets, especially for the population of under five and pregnant women.
The last demographic health survey done in 2011 shows that 60% of households in Uganda have at least one insecticide treated net; 43% of the pregnant women and 47% of children under five were sleeping under the insecticide-treated nets.
NetsforLife® was very active in the Dioceses under Church of Uganda, and we have found out that the actual use of the nets in the areas of NetsforLife® activity was much higher than in the rest of the country. The figures were way above the national average.
We tried to find out what is it that NetsforLife® is doing that is different from the way we manage distribution of nets. We have found out that their entire intervention in their areas of coverage is community led; they brought the communities on board.
Their follow-up is determined. They actually demonstrate the hanging of the net, and they go further to provide interpersonal communication with the households receiving the nets in regards to their use and the misconceptions about the use of the net.
NetsforLife® also went to follow up at the household level after six months, ensuring that the beneficiaries are using the nets properly. In both public and private facilities in their area of operation the cases of malaria are much lower than elsewhere in the country. This shows that if you have very good compliance in the community, you are likely to break the cycle of transmission.
I feel this is something that changed and contributed to the success of their communication. In the rest of the country we were using broadcast media under the assumption that people will listen. The lessons we have learnt from NetsforLife® are that we have to invest in interpersonal communication, and also have a form of post-distribution follow-up and monitoring.
We used our combined experiences to create the way forward in fighting malaria
National Malaria Policy now indicates that each malaria case that reports for treatment has to be confirmed. We are also able to invest in increased coverage down to Village Health Teams with rapid diagnostic tests, and implement the Policy. Currently we have 60% of malaria cases tested and confirmed.
The mentality of the community also needs to change. Babies up to the age of one year on average have one to three bouts of malaria, mainly because the parents take long to bring a child to a health facility. We have lived with malaria for so long that we have become complacent, and the costs of health care especially in rural places are not easy to manage.
This is why we count on our Village Health Teams, who will be able to take action if they find a sick child at home. They can diagnose the case through a rapid test, then administer the first dose and refer the patient for treatment.
Village Health Teams base their practices for malaria diagnosis and treatment on lessons we have learnt from NetsforLife® and other partners. We are moving towards the universal coverage with a net for every two people within any household. The challenge will be the 112 districts and the costs, and we appreciate lessons learnt from our partners, who demonstrate best practices on which we can build our future campaigns and interventions.
Dr. Henry Katamba is a Specialist for Monitoring and Evaluation with the National Malaria Control Programme in Uganda.