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Tuesday, December 1, 2015

Uganda cannot eliminate Malaria like the Comoros


















By Esther Nakkazi

Uganda launched the Uganda 2014-15 Uganda Malaria Indicator Survey (UMIS) officially on Friday, 6th November at Hotel Africana. Dr. Elioda Tumwesigye was the guest of honour at the launch and he was elated about the results.

Finally, Uganda made progress reducing malaria prevalence from 43% five years ago to now 19% . Treated insecticide bed net coverage now stands at 90% and net use over 70% thanks to non profit organisations like Malaria Consortium.

Dr Tumwesigye told us that he had been to South Africa for a conference recently and listened to a presentation from Comoros Island, where the presenter eloquently elaborated how they eliminated malaria. His wish now is that Uganda should emulate the Comoros and eliminate malaria.

Is the malaria parasite more intelligent than the people working on it, he asked the Ugandan scientists.

But before we have a delegation of Ugandan scientists jumping onto the plane headed for the Comoros to ‘study’ and emulate its example, here are the facts about why the Comoros malaria success story cannot happen to Uganda.

The Comoros is an island and in 2010 they gave almost an entire population anti-malarials in a three year programme to eliminate the parasite that causes malaria thereby preventing transmission of the disease.

In order to spread malaria, a mosquito has to feed off a human who is infected and then when it bites it injects the infectious sporozoites into another human.

So on an island where population movements can be controlled, if about 90 percent of the population swallows the anti-malarial drugs the mosquitoes can bite people who are not infected and hence not transmit malaria. With time if the infected are few the vector cannot spread the disease.

But in Uganda how can you limit people’s movements? Someone with malaria will come from Apac to visit a relative in Kampala and a mosquito will bite him and pass on malaria to the Kampala host. In other wards, you cannot restrict people’s movements even if we are land locked.

Secondly, if we grant Dr. Tumwesigye the benefit of doubt and Uganda eliminates malaria, that means an entire population’s immunity will be lost. In this scenario if someone visited from a neighbouring country and a Ugandan got infected they would die very fast because it would be a ‘new’ disease in the body. Uganda would also be prone to a malaria epidemic.

Also the 2012 Comoros Demographic Survey (DHS) showed that 6 in 10 households owned at least 1 mosquito treated net. The data from the Malaria Indicator Survey (MIS) conducted in 2011 showed that 8.9% of children under 5 tested positive for malaria. Compared to Uganda in 2009, malaria prevalence was 42% and in 2014-15 it is now 19%. Comoros is a low prevalence country in comparison to Uganda.

Finally, there is no magic bullet for the control of malaria just as there is no single example from a country that Uganda can emulate. Only let us continue to combine all the prevention methods, sleeping under a mosquito net, treatment, indoor residue spraying and a vaccine when it comes along.

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