The Changing Landscape of Malaria Case Management in Uganda: Decades of Struggle with Evolving Malaria Case Management Strategies and Drug Policies
Ambrose O Talisuna1,2,3,4*, Jane Achan3,8, Albert Peter Okui5, Adoke Yeka3,8, Fred Kato5, John Bosco Agaba5, Seraphine Adibaku5, John Bosco Rwakimari6, Sarah Staedke3,7, Grant Dorsey3,10, Moses R Kamya3,8 and Fred Wabwire- Mangen3,9
- *Corresponding Author:
- Ambrose O Talisuna
Centre for Tropical Medicine
Nuffield Department of Clinical Medicine
University of Oxford, CCVTM
Oxford OX3 7LJ, UK
Tel: +254 724-220-2
E-mail: [email protected]
Received Date: March 27, 2014; Accepted Date: May 20, 2014; Published Date: May 27, 2014
Citation: Ambrose OT, Jane A, Albert PO, Adoke Y, Fred K, et al. (2014) The Changing Landscape of Malaria Case Management in Uganda: Decades of Struggle with Evolving Malaria Case Management Strategies and Drug Policies. Malar Chemoth Cont 3:117. doi: 10.4172/2090-2778.1000117
Copyright: © Ambrose OT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Uganda has some of the highest reported malaria transmission rates in the world. Methods: We reviewed published and un-published reports to provide a historical perspective and evolution of malaria case management strategies/policies in Uganda. Review findings: In the 1990s, uncomplicated malaria treatment was hampered by widespread parasite resistance to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP). Paradoxically, faced with this challenge, the country changed the first-line regimen, in 2000, to CQ+SP and adopted home based management of fever (HBMF) for children < 5 years old. HBMF increased the proportion accessing CQ+SP within 24 hours from 7% in 2001 to 39% in 2003. However, after another policy shift, in 2004, to Artemether-Lumefantrine (AL), HBMF is to date implemented in only 34 of 112 districts. The private sector supports first treatment contact for 40-50% of fevers. However, engaging private sector providers remains challenging. Consequently, by 2011, only 30% of febrile children took AL on the same/next day after symptom onset. In 2011 there was a policy shift from presumptive treatment to parasite-based diagnosis. Following the policy change, the proportion of tests by rapid diagnostic tests (RDTs) increased to about 55% compared to 30% by microscopy. However a major challenge remains clinician’s adherence to test results. Reassuringly, AL remains efficacious. In 13 studies conducted between 2002 and 2010, the median PCR corrected day 28 efficacy was 98% (range: 71.9%–100%). However, counterfeit medicines remain a threat and the lack of an effective phamacovigilance system is concerning. A recent study demonstrated that 39% of sampled artemisinin combination therapies were counterfeits. Conclusion: Despite an increase in official development assistance over the last decade, by 2013 there remained gaps in national ambitions for universal access to prompt and effective treatment. A major challenge is the low profile of the national malaria control programme within the ministry of health structure which limits its capacity to coordinate multiple stakeholders. Secondly, there is a need for decentralized planning and implementation with greater involvement of the zonal, district, health facility and community levels. Finally, it will be critical to engage the challenging but very important private sector.