Characterizing Comprehensive Malaria Prevention Activities Among Households Using Context Specific Methods to Inform Ending Malaria, TB and HIV by 2030 in Greater Masaka Region

According to the World Health Organization (WHO), there are 16 people who die due to malaria every day. There are 5 Plasmodium parasite species that cause malaria in humans and 2 of these species – P. falciparum and P. vivax – pose the greatest threat. P. falciparum is the deadliest malaria parasite and the most prevalent on the African continent. P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa.  The other malaria species which can infect humans are P. malariae, P. ovale and P. knowlesi.

According to research findings, anecdotal and Key Informant responses, ending Malaria goes beyond merely distributing insecticide treated mosquito nets. It involves financial readiness (Apouey et al, 2018), community members' malaria disease management practices at the household level, community, ability to access healthcare services, distance to hospitals, personal protection measures used at the household level and malaria transmission prevention methods relating to vector control in place. This lesson is shared from our experiences drawn from working in Kimaanya-Kyabakuza Division of Masaka City in Greater Masaka Region of Uganda between March-August 2023.

Our mission is to adapt and appropriate international aspirations such as the World Malaria Day and the Breastfeeding Week Goals into local activities.

Using estimates from the Uganda Bureau of Statistics (UBOS), there are about 35,000 households in Kimaanya-Kabonera Division presently, of these about 6,000 are Female/Women Headed Households. For this particular task, we worked with 50 Community Owned Persons and reached 1,500 households where we provided malaria prevention-services as well as parenting skills to address Gender-based biases and violence; stigma-related contexts in households with young parents; promoting livelihood investment; and championing engagement in ending Malaria, TB and HIV by 2030 among members of these households.

There is so much we can learn from ending malaria that can be applied to approaches to end TB and HIV. According to WHO, an integrated approach to end malaria using vector control strategies should be based on the biology of the mosquito, the epidemiology of the parasite, and human behaviour patterns is needed to prevent continued upsurge in malaria in the endemic areas. There are lessons we can pick up from malaria prevention which can be applied and integrated in other interventions.  These are also corroborated in studies by Oketch el al, 2008, Tizifa et al, 2018, Awasthi KR et al, 2022 and Musoke et al, 2023.

The lessons include: empowering communities to engage fully in reaching out to households and providing early diagnosis and prompt treatment; sleeping under long-lasting insecticidal nets, screening in windows and ventilators, removing mosquito breeding sites, and closing of doors early in the evenings; plan and implement selective and sustainable preventive measures, including vector control; intermittent preventive treatment for pregnant women (IPTp);  detect, contain or prevent epidemics; develop paradigms for presumptive diagnosis by champions, influencers, mothers or rural health workers; provide treatment in home and clinic; strengthen local capacities in basic and applied research to permit and promote the regular assessment of a country's malaria situation, in particular the ecological, social, and economic determinants of the disease; expand use of ITN's, encourage partnerships, train personnel to promote prevention continuum; exploring various interventions used, mainly combinations of two or three malaria prevention methods including insecticide-treated nets (ITNs), indoor residual spraying (IRS), topical repellents, insecticide sprays, microbial larvicides; house improvements including screening, insecticide-treated wall hangings, and screening of eaves; The most common methods used in integrated malaria prevention were ITNs and IRS, followed by ITNs and topical repellents; at the national levels there is need to provide training opportunities for local scientists, regular planning on regional basis. This is also corroborated by research and studies in malaria prevention.

In establishing enduring integrated anti-malaria systems and structures one realizes that we cannot avoid addressing such issues like housing condition; food security; physical status of the household members; livelihood; climate-smart approaches; and biodiversity conservation.

There are predictors that set up the sequence of events leading to poor adherence to anti-malarial medication. These same predictors apply in situations where TB and HIV prevention interventions are taking place.

Addressing these predictors makes it easier to implement, second-line drugs if the need arises; it also makes it easier to plan against false positives and addressing myths; establish cross-cutting national implementation strategies; make it easier to refer those who are eligible for targeted care such as persons with disabilities who may also be pregnant and children under 5 year olds; and creating a critical mass of  systems and structures including personnel who can promote contexts for good health and wellbeing.

Indeed, there is so much that goes into activities to end Malaria. We hope these lessons shared from our experiences working in Kimaanya-Kyabakuza Division of Masaka City in Greater Masaka Region of Uganda between March-August 2023 can be a source of inspiration for your organisation too as we bring down to zero malaria deaths which are now put at 16 per day in Uganda. Malaria prevention knowledge and skills can be used to intervene against TB and HIV too.