Kampala, Uganda | URN | Health workers have questioned why government health programmes such as free bed net distribution, spraying, and other interventions do not include schools, and yet over 50 percent of the country’s population is below 15 years of age, and the majority are in school.
Speaking to URN after three high school students in Kampala succumbed to complications of malaria, Dr Jane Achan, a Child Health Expert and Principal Research Advisor at the Malaria Consortium, said the current surge of malaria among older children is not just unique to Uganda but is happening elsewhere in Africa due to immunity issues arising from the fact that infection rates among this age group have largely been low.
Achan, who says that the recent deaths were due to gaps in early detection, explains that there’s what they technically refer to as uncomplicated hyperparasitemia, where a large proportion of one’s red blood cells are infected by malaria parasites but they do not physically show any symptoms of severe disease. Such patients quickly progress into severe illness without one noticing if they don’t do accurate testing.
“With such a case, you don’t just focus on giving someone anti-malarial drugs but employ other interventions. For these children, they most probably gave them drugs and sent them away. We need to understand what protocols school nurses are using for managing malaria”
Earlier on Wednesday afternoon, Dr Elizabeth Nanjego, a Pediatrician and Member of the Uganda Pediatric Association, told a meeting held virtually that the surge in severe malaria in a low transmission area like Kampala, where prevalence of the disease is about one percent against the 13 percent national average, speaks to an error the government made to exclude schools from targeted mass interventions.
She said older children stay outdoors longer in the evening than the vulnerable groups such as younger children of five years and below and pregnant mothers, whom interventions such as vaccination, bed nets and chemoprevention focus on. For the government to reduce transmission and do away with surprises such as the recent surge, Nanjego advises unlearning certain practices and embracing evidence-based care.
Over the years, Uganda has managed to put in place multiple measures to reduce transmission of the disease, including Indoor Residual Spraying in high-risk areas, vaccination, medicine changes, and chemoprevention among vulnerable groups; however, the country remains the third highest affected in Africa, coming after Nigeria and the Democratic Republic of Congo (DRC).
Half of all outpatient visits at hospitals in Uganda are due to malaria, and the pediatrician warns that healthcare managers need to note that, unlike other age groups, malaria strikes differently among older children and adolescents, and that early recognition makes the difference between survival, progressing to severe disease, and death. She says about ten percent of the severe cases die despite the kind of intervention.
Another renowned malaria researcher, Dr Richard Idro, who lectures at Makerere University, told URN that a high number of children born and raised in Kampala may have never had a positive malaria test, and this means they have no immunity against the disease. “They grow up almost like Bazungu who come from Europe to visit Uganda. Because they are non-immune, when they get infected with malaria, it manifests with involvement of multiple organ failure”.
Now, relaying fears that the current malaria medications may not be working, the scientists said there is currently no such evidence. Achan says recent studies done in Uganda show Artemisinin-based Combination Therapies (ACTs) remain largely effective for both complicated and uncomplicated malaria. How she says, what needs to be studied is how the drugs are being dispensed.
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