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Rebecca Bauer
Malaria in Uganda
From: Secretary of Health, Uganda
To: Minister of Finance, Uganda
Introduction
Malaria is the leading cause of morbidity in Uganda and is responsible for up to 40% of
all outpatient visits, 25% of all hospital admissions, and 14% of all hospital deaths.1 Currently,
95% of our population is at risk,1 and malaria kills between 70,000 and 100,000 children every
year.2 Uganda's high rates of malaria disproportionately affect young children and pregnant
women in rural areas who experience extreme poverty, limited access to healthcare services, and
lack of education.3 Malaria has negative health and economic effects, and restricts the
productivity of our population. Increased Insecticide Treated Bed Net (ITN) coverage and
education, improved access to and delivery of treatment, and emergency control of malaria are
essential to control malaria in Uganda.
Nature and Magnitude of the Problem
Malaria is the leading cause of morbidity and mortality in Uganda.1 Our country has the
world's highest malaria incidence, with a rate of 478 cases per 1000 population per year.4
Uganda has the third largest malaria burden in Africa and the sixth largest in the world.5
Currently, 95% of our population is at a highly endemic risk, and the remaining 5% of the
country is prone to malaria epidemics.6 Malaria is responsible for up to 40% of all outpatient
visits, 25% of all hospital admissions, and 14% of all hospital deaths.1 An estimated 12 million
clinical cases are treated annually in the public health system alone.7
Child deaths due to malaria are between 70,000 and 100,000 every year, a death toll that
far exceeds that of HIV/AIDS.2 Additionally, malaria affects maternal morbidity and mortality
and is attributed as a direct or indirect cause of 65% of maternal mortality and 60% of
spontaneous abortion. Additionally, 15% of life years lost to premature death are due to malaria
and families spend 25% of their income on this disease.1
Affected Populations
Children under the age of five and pregnant mothers living in rural areas are
disproportionately affected by malaria.8 Rural inhabitants contribute to 87% of the burden of
disease,8 and nearly half of all inpatient deaths among children under-five years of age are
attributed to malaria.9 Pregnant women have a greater risk of developing severe disease due to a
malaria infection than are non-pregnant adults living in the same area. The increased risk of
malaria during pregnancy is due to malaria-related anemia.10 Populations living in rural areas
have a higher rate of incidence of malaria but receive less treatment than those living in urban
areas.
Risk Factors
Age and pregnancy status are among the highest risk factors for contracting malaria.
Additional risk factors are proximity of households to rice-growing areas, extensive poverty in
rural areas, lack of knowledge on how to prevent and treat malaria, and little to no healthcare
access.3 Transmission of malaria occurs year round in most parts of Uganda,8 and our climate
and heavy rainfall greatly contribute to malaria transmission in 90 to 95% of the country.3 Rural
inhabitants have a much higher risk of malaria transmission and in some districts receive more
than 1,500 infectious bites per year.3
Malaria transmission is significantly reduced by the use of Insecticide Treated Nets
(ITN's); however, only 10% of children under five years and pregnant women sleep under
ITN's.11 Further, only 12.8% of the country as a whole use ITN's and only 34% use basic
mosquito nets;3 however, this rate is greatly reduced in rural areas where prevalence is highest.
The use of ITNs by children in urban areas far outnumbers the rates in rural areas, despite the
higher incidence of malaria.8
Ugandans are at risk for all four human Plasmodia species, with P. falciparum being the
most common and responsible for 90 to 98% of diagnosed cases and almost all cases of severe
malaria.3 The most common malaria vectors in Uganda are the Anopheles gambiae s.l. and the A.
Funestus and without the use of ITN's and Indoor Residual Spraying (IRS), the population
remains at high risk.3 Additionally, due to the widespread use of sub-standard or counterfeit
drugs, resistance to anti-malarial drugs is an increasing problem, and those without proper care
risk drug resistance.3
Economic and Social Consequences
Malaria poses a significant risk to our country’s overall health and economy. Malaria has
negative economic effects for the national economy due to lack of production, and at the
household level causes an immense burden, particularly for the poorest households, by reducing
the number of days a patient can work by seven per episode and additional costs relating to
care.3 Malaria-related expenses account for 34% of total expenditure for the poorest sections of
the country.3 This also creates a heavy burden upon the health system, with malaria accounting
for up to 40% of all outpatient visits, 25% of all hospital admissions, and 14% of all hospital
deaths.1
Malaria infections received by pregnant women result in adverse pregnancy outcomes,
including spontaneous abortion, neonatal death, and low birth weight, and is estimated to cause
as many as 10,000 maternal deaths each year, 8% to 14% of all low birth weight babies, and 3%
to 8% of all infant deaths.10 Other malaria related complications during pregnancy lead to
reduced neurocognitive function in the child, which can lower educational attainment, depress
literacy rates, and damage long-term health and labor productivity,12 which further affects our
economic growth.
Priority Action Steps
The control over malaria in Uganda is dependent on prompt diagnosis and treatment, as
well as the implementation of preventative measures. The use of Insecticide Treated Nets (ITNs)
and Long-Lasting Insecticide Nets (LLINs), Indoor Residual Spraying (IRS), and Intermittent
Preventive Treatment (IPT) of pregnant women will address this issue and lower our high rates
of malaria. Additionally, education regarding the importance of sleeping under Insecticide
Treated Nets and other methods of prevention must be addressed.
Additionally, we must introduce health systems which ensure the increased coverage of
first-line and effective Artemisinin Combination Therapy (ACT) treatments of malaria, as well
as perform case management to ensure early diagnosis and that medications are used efficiently.
These steps will result in healthier outcomes for Uganda and improve the productivity of our
population.
Bibliography
1
Uganda Ministry of Health (unpublished).
2
Lynch KI, Beach R, Asamoa K, Adeya G, Nambooze J and Janowsky E. President's Malaria
Initiative, Rapid Assessment Report - Uganda, 2005
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http://www.dfid.gov.uk/Where-we-work/Africa-Eastern—Southern/Uganda/Key-facts/
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Organization WH. World Malaria Report, 2005. Geneva, Switzerland: World Health
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Malaria Consortium. “Malaria Consortium in Uganda”. 2011.
http://www.malariaconsortium.org/pages/uganda.htm
5
6
Miriam Nanyunja, Juliet Nabyonga Orem, Frederick Kato, Mugagga Kaggwa, Charles
Katureebe, and Joaquim Saweka, “Malaria Treatment Policy Change and Implementation: The
Case of Uganda,” Malaria Research and Treatment, vol. 2011, Article ID 683167, 14 pages,
2011. doi:10.4061/2011/683167
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Pullan et al.: Plasmodium infection and its risk factors in eastern Uganda. Malaria Journal
2010 9:2. http://www.biomedcentral.com/content/pdf/1475-2875-9-2.pdf
The World Health Organization. “World Malaria Report 2010: Uganda”.
http://www.who.int/malaria/publications/country-profiles/profile_uga_en.pdf
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9
President's Malaria Initiative. Country Profile. President's Malaria Initiative (PMI): Uganda.
April 2011. http://www.pmi.gov/countries/profiles/uganda_profile.pdf
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Roll Back Malaria. 2001-2010 United Nations Decade to Roll Back Malaria. Malaria in
Pregnancy. http://www.rbm.who.int/cmc_upload/0/000/015/369/RBMInfosheet_4.htm
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UNICEF. United Nations. Economic and Social Council. 13 July 2009. United Nations
Children's Fund: Uganda. http://www.unicef.org/about/execboard/files/09-PL27-Uganda-ODSEnglish.pdf
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Barofsky, J,. Chase, C., Anekwe, T., Farzadfar, F. Harvard Initiative for Global Health. The
economic effects of malaria eradication: Evidence from an intervention in Uganda. May 2011.
http://www.hsph.harvard.edu/pgda/WorkingPapers/2011/PGDA_WP_70.pdf