As the world, especially Africa continues to grapple with , Uganda early this year started the largest Malaria vaccine rollout.
Through this, Uganda launched a malaria vaccination campaign targeting 1.1 million children under two years in 105 districts with high malaria transmission.
The R21/Matrix-M malaria vaccine is being administered in four doses, starting at 6 months of age, with plans to expand nationwide.
This campaign is the largest malaria vaccine rollout to date in terms of target districts and population.
According to officials from the Ministry of Health, Uganda remains a high-burden malaria country, with its entire population of 45.5 million at risk of being infected with malaria.
Vulnerable groups include pregnant women and children under five, with the highest transmission areas being northern Uganda (Acholi, Karamoja, Lango, and West Nile regions) and eastern Uganda (Busoga region).
As of 2022, Uganda had the 3rd highest global burden of malaria cases (5.1%) and the 8th highest level of deaths (2.9%). It also had the highest proportion of malaria cases in East and Southern Africa, accounting for 23% in 2022.
Between 2021 and 2022, the estimated number of malaria cases increased by 1.6% from 263 to 268 per 1000 of the population at risk, while deaths fell 2.3% from 0.38 to 0.37 per 1000 of the population at risk over the same period.
There is stable, perennial malaria transmission in 95% of the country, with Anopheles gambiae and An. funestus being the most common malaria vectors.
To accelerate progress towards global malaria targets, the WHO and RBM Partnership rolled out the High Burden High Impact approach in 10+1 countries which include Uganda.
The Uganda Malaria Reduction and Elimination Strategic Plan (UMRESP) 2021-2026 aims to reduce malaria infections by 50 percent, morbidity by 50 percent, and mortality by 75 percent by 2025.
The plan aims to achieve these goals through stratification to ensure appropriate tailoring of intervention mixes for the various epidemiologic contexts, universal coverage of services (including in the private sector), robust data management, social and behavioural change, multisectoral collaboration, and malaria elimination in two districts.
Although the entire population is at various levels of risk, marginalised populations are confronted with economic, social, and contextual challenges and barriers that may limit their access to malaria prevention, treatment, and control programmes.
These populations include vulnerable and underserved populations such as:
- Children under five years and pregnant women
- People living with HIV
- People with disabilities
- Inmates and other detainees
- People in closed/congregate settings
- Migrant and mobile populations
- Internally displaced populations
- Refugees and asylum seekers
- Older persons
- People affected by ethnic, geographical or cultural barriers.
To address the human rights barriers, Uganda has developed a comprehensive strategy document aimed at a malaria-free Uganda through protecting human rights, achieving gender equality, and improving health equity for all Ugandans in all their diversity – The plan is entitled: “Leaving no one behind: A national plan for achieving equity in access to HIV, TB and Malaria services in Uganda, 2020-2024.”
Malaria transmission
Plasmodium falciparum accounts for 97% of infections; both P. vivax and P. ovale are rare and do not exceed 2% of malaria cases in the country. [4]
The country experiences two malaria transmission types: stable, perennial malaria transmission which exists in 90–95% of the country, and low, unstable transmission with potential for epidemics in 5-10% of the country.
Transmission peaks are aligned with the two annual rainy seasons, which take place from March to May and from September to November.
To guide the deployment of interventions, the country has been stratified into three strata, based on epidemiologic, entomologic and socio-behavioral characteristics:[4]
- Very low burden areas (<2% malaria prevalence) about 2.4% of the population
- Urban cities (6.2m; 14.4% of total population)
- High burden (rest of the country) areas.