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Malaria is endemic throughout the whole of Uganda with stable and high-risk transmission in 95% of the country. People can contract malaria year-round with the highest risk periods occurring following the rainy seasons in April-May and again in October-November. Increasing the awareness of the causes, symptoms, and impact of malaria is a national priority. 22% of women did not know that mosquitoes transmit malaria and 23% were unaware that children with fever should be taken immediately to a health facility for testing and treatment.

While everyone can get malaria, children under the age of 5 years old, pregnant women, low-income and rural communities, and refugees are the most vulnerable.

• According to the 2018-2019 Malaria Indicator Survey, 9% of Ugandan children under the age of 5 tested positive for malaria on microscopy (16.9% tested positive with rapid diagnostic tests). Young children, who have a less developed immune system and are more vulnerable to the effects of fever and anaemia, are more likely to develop sever malaria symptoms and die. Globally, two-thirds of malaria deaths are children under the age of 5 years old.
• Pregnant women are unable to be treated with the most effective medicines and, thus, face an increased risk of serious malaria and death. To be protected, pregnant women are supposed to receive intermittent preventative treatment for malaria (IPTp) at least three times during antenatal care visits. However, only 41% of pregnant women received their full treatment between 2016-2018.
• Malaria is increasingly a disease associated with rural areas and poverty. Malaria prevalence in the lowest quintile of wealth is 17 times higher than among the highest quintile and nearly double the second lowest quintile.
• Malaria is three times more prevalent in rural areas than in urban areas with even greater regional differences. For example, 34% of children tested positive for malaria in Karamoja versus less than 1% in Kampala. People in rural areas are half as likely to know of key risks factors and how to prevent malaria.
• Although women in refugee settlements are more likely to know of the risks of malaria, refugee children are twice as likely to test positive for malaria with rapid diagnostic tests

The primary tool for preventing malaria is sleeping under an insecticide-treated mosquito net (ITN). Sleeping under an ITN every night significantly reduces the risk of transmission. The government conducts a campaign every three years to distribute ITNs to every household. There is currently a mass distribution campaign ongoing with each household to receive one ITN for every two residents. ITNs are also routinely distributed to pregnant women through antenatal care visits and through schools to protect the most vulnerable children. However, only 60% of children and 65% of pregnant women surveyed slept under an ITN the night before.

The country also conducts indoor residual spraying (IRS) (currently in 15 districts) which involves spraying safe insecticides on walls within houses. This must be done annually and is prioritized in certain high-risk districts.

Environmental management, including destruction of mosquito breeding sites, spraying larvicides to breeding sites, and planting mosquito repellent plants like; Neem trees, Lemon grass, and others.

Persons with fever, particularly children, should seek testing and treatment from a community health worker or the nearest health facility. Health workers will either use a rapid diagnostic test (RDT) or use slide microscopy to confirm the presence of malaria. Those who test positive for malaria receive anti-malarial treatment, to kill the parasite.

Individuals who delay testing and receiving treatment may experience severe malaria and require hospitalization and additional treatment.

Everyone has a responsibility to do their part to fight malaria, such as sleeping under an ITN every night and seeking treatment as soon as they have a fever or other symptoms of malaria.

At the national level, the National Malaria Control Division (NMCD) of the Ministry of Health is responsible for developing and overseeing the implementation of the national malaria strategic plan. The NMCD is also responsible for setting national guidelines for preventing and treating malaria and works closely with its partners, such as the US President’s Malaria Initiative and World Health Organization, ALMA among others.

Malaria is seen as a routine part of health, as opposed to a national crisis affecting Uganda’s social and economic development. Malaria causes 37% of workforce absenteeism. This absenteeism is equivalent to 89 thousand workers removed from work. To overcome this, there needs to be groundswell of advocacy targeting leaders and individuals at all levels and across all sectors to ensure that malaria is understood, that ending malaria is seen a strategic development priority, and that all sectors take action to prevent workers and their families from getting sick. Fortunately, the return on investment is US$36 for every US$1 invested globally.

The cost of combatting malaria is very high. Uganda`s Malaria three-year budget (2014-2017) was US$615 million of which US$206 million (33%) was unfunded. Closing this budget gap through increased resources (in-kind and financial) and identifying innovative and more efficient solutions is critical to achieving the objectives of the national malaria strategic plan. Furthermore, 95% of current funding is from donors, who increasingly expect greater domestic contributions.

Financial need will be increased by; shrinking of development assistance for health, climate change, increasing insecticide resistance also pose significant threats. In the recent past, the changes in rainfall pattern has resulted in Malaria outbreaks and increased transmission. Furthermore, mosquitoes are increasingly likely to be resistant to the main insecticides used by the NMCD. Ending malaria now is the most effective solution to avoid increased costs over the longer term.

First and foremost, the global and national attention to Covid-19 has over shadowed the health management scope in all areas including malaria. Access to treatment for individuals with malaria may be interrupted because patients may stop seeking treatment at health facilities out of fear of getting COVID-19. Additionally, the patient-load at health facilities may increase significantly with the spread of COVID-19, affecting ability of the health system to adequately manage patients. This will significantly increase the risk of severe malaria and death. The high burden of malaria reduces the capacity of the health sector to address other diseases, such as COVID-19.

Advocacy for malaria to be a strategic priority across all sectors—public, private, and civil society—and at all levels from the head of state down to the head of household;

Resources and action, both in-kind and financial, to close the budget gap and enable the full implementation of the national malaria strategic plan;

Technical assistance to improve the sustainability of the fight against malaria; and

Mutual accountability for making and implementing impactful commitments that will help achieve a malaria-free Uganda.