Factors influencing malaria infection rate in Northern Uganda

Abstract

Despite the availability of effective interventions, malaria remains one of the most important diseases in Uganda, causing significant morbidity, mortality and negative socio-economic impact. According to the Uganda Malaria Indicator Survey (UMIS) report of 2015, malaria is responsible for between 30 to 50 percent of outpatient visits, 15 to 20 percent of admissions, and 9 to 14 percent of inpatient deaths. Both Indoor Residual Spraying (IRS) and Insecticide Treated Net usage if well managed, significantly reduces the rate of malaria transmission. However, indoor residual spraying has been identified to be associated with a comparatively lesser malarial infection rate than Insecticide Treated Net usage. A comparison of infection rate across 15 districts in mid northern Uganda indicates that infection rate was three times higher in the non IRS districts of Lira, Otuke, Alebtong, Dokolo and Amolatar than in the IRS districts of Apac, Kole, Oyam, Gulu and Agago which were sprayed six months prior to December 2014 UMIS data collection. In the districts without the IRS intervention, 67% of households had at least a child testing positive of malaria compared to 20% of households in districts where IRS was implemented. This study examined the relationship between malaria infection rate among children below the age of five in households exposed to either one or both malaria prevention measures (Insecticide Treated Net usage and Indoor Residual Praying). A total of 532 households with children under the age of five, were included in the study to identify the malaria preventive measure associated with least malaria prevalence rate. The study provides relevant insights in identifying factors forex plaining the 2015 malaria outbreak in northern Uganda. Using data from the Uganda Malaria Indicators survey of 2014-15 for which blood samples from children were tested for malaria parasites using Rapid Diagnostic Test (RDT) and microscopic blood smear test for malaria, five selected socio economic factors were examined and their effects on household malaria infection. A logit regression analysis revealed that the malaria infection rate in Northern Uganda is associated with housing quality (OR= 0.552* and P-vale=0.061), Households’ wealth index (OR=0.992 and P-value=0.442), spraying of dwellings (OR=0.166*** and P-Value =0.000), type of residence (OR=0.400* and P-vale=0.070), ratio of household members to number of ITNs (OR=0.748*** and P-vale =0.027) and Number of children sleeping under ITN previous night. Therefore, the malaria outbreak in the former IRS districts in Northern Uganda between April and July of 2015, few months after government’s mass distribution of ITN, had a lot to do with; i)Poor housing quality characterizing the rural northern Uganda (mainly made up of; grass thatched roofs, mud walls and dust floors) which affects longevity of the IRS chemicals especially when people smear their walls and floors. Poor housing quality also affects proper net maintenance and provide habitat for resting mosquitoes due to cracked walls and many opening in the house, ii) Other social factors that affects net use in households such as; ratio of household members to net, lack of rooms and beds leave people with option of sharing nets. As a recommendation therefore, for any large malaria control programme, it is important that; (i) Continuous mass malaria sensitization and awareness campaign tailored to specific demographic and cultural sections of the community is implemented to enhance adoptive and behavioral change, (ii) further research on efficacy different between irritant and non-irritant insecticides used be considered in ensuring that most effective method or chemical is used, (iii) and lastly; malaria eradication can never be achieved without improved housing or dwellings. This is due to a number of health factors associated with good dwelling