In Uganda, of the estimated 13 million people who contracted malaria in 2021, more than 19,600 died (WHO). The country, with the fifth-highest malaria burden in the world, is guided by its Malaria Reduction Strategic Plan, which calls for a rapid and synchronized scale-up of cost-effective interventions to achieve universal coverage of malaria prevention and treatment.
The USAID-funded U.S. President’s Malaria Initiative (PMI) Malaria Reduction Activity in Uganda works with the Ministry of Health’s National Malaria Control Division to increase uptake of proven interventions. MRA focuses on hard-to-reach populations through community-based approaches, ultimately strengthening the malaria health system and decreasing malaria deaths. The Activity trained village health team (VHT) members across the country to reach the goals of malaria prevention at the community level. One of those VHT members is Stella Abonyo (who doubles as a coordinator, supervising 16 other VHT members) in Amolatar District in the Lango Region of northern Uganda. Of Amolatar’s approximately 178,000 people, 36,000 are children under 5. In January 2023, Amolatar registered more than 7,000 uncomplicated malaria cases, of which 20 percent were children under 5 years. In this interview with JSI, Stella reflects on the importance of prevention interventions and how they help decrease malaria deaths.
Please give our readers a brief overview of the malaria situation in Amolatar District.
In the past five years, the malaria situation has oscillated between high case numbers and a drop in new infections. Between 2018 and 2019, indoor residual spraying (coating the walls and other surfaces of a house with a residual insecticide) in the district decreased malaria. This made communities more relaxed, so they did not practice other malaria control and prevention measures. Amolatar is a heavily swampy district with constant flooding. Before long, due to the laxity in prevention, cases began to rise and there was a malaria upsurge between 2020 and 2021.
I oversee 80 households in my village. In 2021, I would see 10–15 children a day for malaria-related illness. It was so bad that my three-month malaria commodity supply would be depleted within three weeks.
What do you enjoy most about your work?
The government recognizes VHTs as a health care cadre, which means that community members trust us. We make sure pregnant mothers and vulnerable people know how to reduce malaria at home. We give them advice, such as using bed nets every night and removing stagnant water and high bushes/plants around the home, and encourage them to bring children inside earlier in the evening. We teach them to mend their bed nets.
While this is a volunteer role, I have learned a lot through the MRA trainings. I have hands-on experience in malaria prevention and control, testing, and treatment in children.
What I have learned I do not just use for other people in my village; I do the same for my family, as well. I have no recollection of when my children and I last suffered malaria, but it was before I became a VHT member.
In your opinion, what approaches are helping malaria prevention despite overall challenges?
The household mass action against malaria model(1) is great. We go from house-to-house sensitizing family members and demonstrating net use and repair and clearing breeding reservoirs. I am presently monitoring 28 homes that have taken these actions. I visit weekly, and am seeing a reduction in the frequency of malaria episodes in these homes.
Community dialogues are another great way to sensitize people to malaria prevention. We demonstrate net use, encourage women to attend antenatal care, and urge people, especially men, to go for malaria tests before embarking on treatment, which most times is self-medication. Before MRA started promoting these dialogues, we used social gathering platforms like cultural events, funerals, and weddings to talk to people about malaria.
Plus, the test-and-treat community outreaches are great for weeding out asymptomatic malaria cases that act as silent reservoirs for the parasite. During the outreaches, everyone who tests positive is treated whether they have signs or not. When parasite hosts are eliminated, new infections are reduced.
Finally, the integrated community case management (iCCM)(2) strategy has been key in reducing and preventing severe malaria cases in children under five. iCCM provides a full package. We have knowledge and skills on all aspects of disease control, diagnosis, and treatment.
Talk to us about ways to improve malaria morbidity and sustain interventions.
Index testing for households that are frequently affected by malaria improves malaria management. We [VHTs], with the health facilities identify families that consistently test positive for malaria, and go to those households and test and treat everyone. This way we eliminate parasite reservoirs — asymptomatic household members.
The sustainability solution is consistent capacity building and support for VHT work. VHTs also have monthly meetings to discuss malaria issues. We are committed to serving our communities and we reach every household.
To follow the work of MRA and its effect on community health, visit https://www.jsi.com/project/pmi-uganda-malaria-reduction-activity-pumra/
To learn more about JSI’s Malaria work, visit https://www.jsi.com/expertise/malaria/
- A multi-sectoral approach that aims to fill gaps in malaria prevention and management by engaging various partners at from district, community, and household levels.
- A strategy to train, support, and supply community health workers with commodities to provide diagnostics and treatment for malaria, pneumonia, and diarrhea in children to families that lack access to case management at health facilities.
