Uganda has been at war battling with the COVID-19 pandemic since 21 March 2020. The country’s worries about the virus are justified; COVID-19 infections can easily overwhelm the health system due to an increased demand for services and disruption of essential health service delivery at both facility and community levels. This places vulnerable populations at risk of dying from other preventable and/or treatable conditions.
To contain the spread of COVID-19, the Government of Uganda, very early on, put in place tight control measures aimed at keeping infections in check. Institutions of learning were closed, as were places of worship, shopping malls, public and private transport, bringing the country to near total lock-down. However, while useful in preventing the spread of the virus, the restriction of movement also has the potential to adversely affect health service delivery.
Malaria: A tale in numbers
Malaria is the leading cause of illness and death in Uganda, gravely impacting health and productivity. A total of 13.4 million cases of malaria were confirmed in Uganda in 2019. Four thousand of these ended in death. Graph below shows trends in malaria epidemiology data for period of January to April for 2019 and 2020 with average reporting rates of 99 per cent and 81 per cent respectively
These statistics clearly underline the need to increase focus on malaria management amidst the COVID-19 pandemic.
An added complication is the fact that malaria and COVID-19 bear some similarities in the way they present. The early symptoms of COVID-19, including fever, muscle pain and fatigue, might be mistaken for malaria and other similar infections, leading to challenges in early diagnosis and management.
Keeping an eye on both balls
It is evident that during this time, any effective health intervention must combine measures to prevent COVID-19 with managing the impact of existing malaria infections.
To this end, UNICEF, working in collaboration with the Malaria Consortium and the Ministry of Health (MOH), supported the development of the “Guidance on Continuity of Essential Health Services during the COVID-19 outbreak”. These guidelines spelt out clear procedures for the provision of essential health services, especially regarding malaria. The guidelines emphasized the need to promote social distancing during the provision of services, as well as the use of appropriate Personal Protection Equipment (PPE) for infection control.
UNICEF and partners have continued to provide technical support to MOH regional and district teams in order to ensure that the provision of health services remains uninterrupted during the lock–down period. This is done through participation in district task force meetings and routine support supervision to health facilities and the community. Districts have been supported in the preparation of COVID-19 isolation and quarantine centres and in the adherence to entry restrictions in border districts.
With funding from DFID, UNICEF, in collaboration with the Malaria Consortium, under the Strengthening Uganda’s Response to Malaria (SURMa) programme, has worked closely with health officials in 27 districts to resume the implementation of key malaria-related activities. All patients, including pregnant women that presented with a fever, were screened at medical facilities, appropriately triaged, comprehensively assessed (through history taking, physical exam and laboratory investigation) and treated based on findings. The SURMa programme has supported the continued availability of key essential medicines and diagnostics at health facilities, with redistribution of supplies where necessary.
In conformity with the guidelines, hand-washing with soap, use of gloves, facial masks, social distancing (at least one metre between patient and health worker) were maintained during service provision.
In addition, all quarantine centres have been supplied with tools to diagnose malaria diagnostic as well as anti-malarial medicines to ensure everyone is screened and those found to have malaria effectively managed in the isolation and quarantine centres.
Integrated Community Case Management (iCCM) of malaria, diarrhoea and pneumonia by Community Health Workers plays a vital role in ensuring that under-fives can access quality care in the shortest time possible, thereby decongesting health facilities and saving lives. UNICEF reprogrammed funds within SURMa project activities to procure PPEs for the Village Health Teams (VHTs) so they can continue to provide care, while maintaining social distancing.
The SURMa programme supported the provision of bicycles to parish coordinators who help in the redistribution of iCCM medicines from health facilities to the VHTs in communities who are finding it difficult to access health facilities due to the transport restrictions.
Long-lasting insecticide treated nets were distributed through the routine Antenatal Care (ANC) and Expanded Program on Immunisation (EPI). Nets were also provided to special groups like market vendors and truck drivers who had been directed by the Government to sleep at their workplaces during the lock-down period.
Social and behaviour change communication (SBCC)activities on malaria have been integrated with COVID-19 messaging, with the SURMa programme supporting radio drives as well as provision of Information Education and Communication (IEC) materials on COVID-19 and malaria management to heath facilities and VHTs in order to support dissemination to household level.
The Community Access to Rectal Artesunate for Malaria (CARAMAL) project reprogrammed some of the funds already disbursed to districts to conduct door-to-door sensitisation of households on malaria and COVID-19.
Activities that require mass gatherings have been suspended. However, mentorships and support supervision on malaria have continued virtually through E-platforms or over phone to ensure quality of care.
