District-led Malaria Surveillance and Response as an Effective way to Manage Malaria Upsurges Following the Withdrawal of Indoor Residual Spraying: A Case Study from Nwoya District, Northern Uganda
BackgroundMalaria remains the number one cause of morbidity and mortality in Uganda. In 2009, an indoor residual spraying (IRS) programme was implemented in 10 Northern districts, resulting in marked reductions in the malaria burden, and a prevalence of just 7 percent. IRS was withdrawn after five years and malaria prevalence among children subsequently increased dramatically from 2014-2016. This upsurge led to an increased focus on training district malaria programme staff on malaria
... ce, epidemic preparedness, and response. An increase in malaria cases was detected again in 2018 in Nwoya district. MethodsIn response to the increase in malaria cases, the District Health Team (DHT) set up multi-sectoral management taskforce and technical rapid response team (RRT). The RRT was responsible for a rapid assessment, mapping exercises and identifying possible causes. The DHT informed all relevant stakeholders of the findings, mobilised resources and developed a comprehensive response plan. Interventions were categorised as immediate (to treat cases and avert deaths), intermediate (to bring down the epidemic) and long-term (to sustain the gains achieved). Health workers from the affected areas were trained on integrated management of malaria, village health team (VHT) members were mentored on malaria epidemic response and their role in the response plan, and health facilities conducted test, treat and track outreach activities. Social behaviour change and communication (SBCC) played a key role, and the RRT monitored and ensured that there were enough malaria commodities at the facilities and for the VHTs.ResultsThe Nwoya DHT was able to detect the 2018 upsurge from the district records, raise awareness, and respond effectively in a timely manner. This district-led response led to a reduction in routinely reported malaria cases from an average of 2,513 cases per week to 1,335 cases between week 43 in 2018 and week 10 in 2019.ConclusionsMalaria upsurges usually have early warning signals and surveillance is a key health intervention to reducing their impact. Malaria surveillance and response, with precisely targeted multipronged activities, when led by local health authorities is an effective, efficient, and sustainable approach to managing such upsurges.