allAfrica.com: Uganda: The Fight Against Malaria Requires Concerted Effort (Page 1 of 1)

IT claims lives more than any other ailment, yet for decades, malaria still remains elusive. It takes toll on people's lives and its effect is hugely felt in the economy. April 25, was Malaria Day. The fight goes on as scientists battle to find a permanent solution to this global threat.

Online records of the Centre for Disease Control and Prevention describe malaria as being as old as mankind. The word 'malaria' traces its roots in Italy where it was initially thought the disease was caused by bad air from the swamps in Rome.

Malaria was consequently coined from Italian words 'mala aria' which means bad air. Additional research later revealed the disease was more than just bad air, but the name malaria was retained.

In spite of the years of research, malaria still poses a great threat globally. Up to 3,000,000 people die annually worldwide with most of the deathe in Sub-Saharan Africa. In Uganda, about 400 lives are lost every day from malaria or malaria-related ailments.

This means at least 20 lives lost every hour. The most vulnerable groups are children under five, expectant mothers and people living with HIV/AIDS.

The World Health Organisation (WHO) estimates that between 70,000 and 110,000 children die as a direct result of malaria each year. In pregnancy, malaria may cause maternal anaemia, premature births, low weight babies (which contributes to infant mortality), still births, and miscarriages.

All these health effects have an economic implication. A 2004 study by WHO and Ministry of Health shows Uganda spends $658m (sh1 trillion) per year on malaria.

According to the Ministry of Health, 'malaria has a great impact on the economic development of the individual, the family, the community and the nation.' It is estimated that a family may spend up to 25% of its income on malaria treatment and prevention.

"Since it takes around three weeks for a person to recover, and given that the breadwinner in the family may get two to three attacks every year, the time lost has a heavy toll on our growing economy," says Dr Myers Lugemwa, the international health specialist.

A study in Apac, Kampala and Rukungiri districts showed that malaria was responsible for up to 54% absenteeism from work per month. Household surveys in Kabarole and Bundibugyo districts show that the direct cost for treatment for an episode of suspected malaria averages sh4,500 in urban settings and sh2,000 in rural populations.

According to Lugemwa, Apac has the highest infection rate in the world, with 1,600 infected mosquitoes biting one person in a year. Given the economic impact of malaria on household and workforce, malaria and poverty are intimately connected.

According to a report published by the Centre for International Development at Harvard, October 1998, malaria-infested communities have been recognised as impoverished. The report states that malaria-infested countries are not only poor, but have also registered a dismal economic growth over the past quarter century.

The health ministry records state that the economic burden of malaria is felt beyond the health sector. In industry and agricultural enterprises like tea estates, malaria accounts for more than 50% of the man-hours lost.

Education sector is equally hard-hit with about 60% of school children's learning ability being impaired by malaria.

In Uganda, the fight against malaria has gained momentum with the Uganda and US governments putting it at the top of their priority list.

The US Agency for International Development, in conjunction with the US Department of Health and Human Services through the President's Malaria Initiative is helping Uganda develop capacity to effectively deal with malaria.

The battle against malaria, however, faced an immense setback when the Global Fund suspended five grants totalling more than $200m (sh340b) in August 2005.

This followed an independent investigation that revealed a serious mismanagement of funds. The suspension of grants was lifted in November after the Government restructured the way funds are handled.

According to Lugemwa, the fight against malaria should be focused on prevention than cure. "Malaria causes complications to the kidney, spleen and the brain. The cost of treatment cannot be quantified.

The cost might end up in death and you cannot quantify loss of life," he says. The majority of malaria cases in Uganda are caused by the malaria parasite, Plasmodium falciparum.

According to the World Malaria Report 2005, this parasite has developed resistance to most anti-malarial drugs. The health ministry has, therefore, changed the treatment policy from Chloroquine or Fansidar to artemisinin-based combination therapy. The adult dose for this cost sh15,000 and it is provided free of charge at public hospitals.

Lugemwa emphasises the need for malaria prevention using a combination of insecticide treated nets, indoor residual spraying and environmental management. He says harnessing the climate as a strategy through environmental protection would help.

Since the effect of malaria cuts across all sectors of the nation, its fight calls for concerted effort and should not be left to the health sector alone.

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