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Responding to a malaria outbreak in a highly burdened Eastern Uganda district

Despite wide implementation of malaria prevention measures such as indoor residue spraying, Long-lasting insecticide treated nets, and mass distribution campaigns, Uganda has the 3rd highest burden of malaria cases globally, accounting for 5% of all the world’s cases with 38.8 million malaria cases.

In February 2021, the Ministry of Health identified an upsurge in malaria cases in Iganga District, Eastern Uganda, exceeding expected limits (compared with malaria normal channels).  Using data extracted from the District Health Information System (DHIS2) and Subcounty populations, a team that comprised of fellows from the Uganda Public Health Fellowship (PHFP) led by Ms Immaculate Atuhaire, took part in the response in Iganga, calculating the attack rates per subcounty. The calculated attack rates showed that Nabitende Subcounty was the most affected with an Attack Rate of 14/100 compared to other sub counties. The team thus investigated Nabitende Subcounty to determine the magnitude of the problem, identify risk factors for transmission, and recommend evidence-based control measures. This Malaria outbreak in Nabitende Sub-county was facilitated by proximity of households to mosquito breeding sites, which included swamps, and agricultural fields (rice, sugarcane and banana). The change in agricultural practice, from sugarcane to rice farming might have also facilitated the outbreak.

Public health actions

The team implemented some immediate control measures in the affected communities and homesteads, and these included: Draining of pots and containers that were found to have stagnant water; we conducted health education about the importance of eliminating active and potential breeding sites for mosquitoes around homes; Emphasizing the need for proper and consistent use of treated mosquito nets; Sensitization of the community members and community leaders on malaria and its prevention by using simple cost-effective strategies like wearing long sleeve clothes in evenings, closing windows and doors early, repurposing of old/damaged nets into curtains.