Introduction
Malaria Youth Champions Uganda (MYCU) is a team of highly motivated youth and young professionals who are determined to contribute their talent, time and energies to the fight against malaria, a disease that continues to ravage Uganda through disease, disability, death and exacerbated poverty to households and communities around the country.
Uganda is one of the highest malaria-burdened countries in the world. In 2022 it accounted for the 3rd highest number of cases and the 8th highest number of deaths globally. The Ministry of Health’s National Malaria Control Division (NMCD) leads Uganda’s malaria response with support from partners. The malaria response is stipulated in the Uganda Malaria Reduction and Elimination Strategic Plan (UMRESP 2021-2024) and includes the implementation of several interventions including prompt diagnosis and treatment with artemisinin-based combination therapy for case management and: indoor residual spraying, mass and routine distribution of insecticidal treated bed nets, chemoprevention in high-risk populations, larviciding among others, for prevention.
Over the past 3 years, Malaria Consortium, in partnership with the NMCD, has been implementing Seasonal Malaria Chemoprevention (SMC) in eight districts in Karamoja region, a high-burden region where transmission is highly seasonal. The goal of SMC is to reduce the burden of malaria (cases and deaths) in children in this region. SMC entails intermittent delivery of a complete therapeutic dose of Sulfadoxine-pyrimethamine + Amodiaquine (SPAQ) to children aged 3 months to 5 years just before transmission season.
MYCU participation in SMC in Moroto District
MYCU was invited by Malaria Consortium to participate in an SMC campaign in August 2023. A team of 5 MYCU members joined 5 teams conducting the implementation in Moroto District and were tasked with supervising and studying the process of SPAQ administration. Each team consisted of an MYCU supervisor, a Supervisor from Malaria Consortium, a native health worker conversant with the language, and a driver. Village Health Teams (VHTs) distributed the SPAQ in the communities
“MYCU is now more empowered to advocate for malaria control more broadly and SMC in particular, to continue providing practical support to the NMCD and its partners, and to mobilize communities to better understand and take up life-saving interventions. MYCU is looking forward to taking part in more malaria control activities at all levels to support a malaria-free Uganda.”
MYCU roles in SMC implementation
Seven sub counties of Nadunget, Loputuk, Rupa, Tapac, Katikekile, Northern and Southern Divisions received SMC during the 2023 August Cycle.
a) Field Activities
MYCU reviewed VHT records and children’s charts to verify that SPAQ had been given and estimated the SMC coverage attained.
The team held both in-depth interviews and focused group discussions with mothers, aimed at verifying whether children had received the medicine as well as assessing both acceptability and attitudes of the natives towards SMC.
The team also assisted VHTs in ensuring safe administration of SPAQ i.e. use of boiled water and clean utensils as well as identification of children ineligible for SPAQ mostly due to febrile illnesses necessitating referrals to the Health Centers.
The MYCU team guided VHTs in filling records such as daily tally sheets for SPAQ accountability and the SMC Health Facility Daily Summary Form with details of a number of children referred to the health center due to a current malaria episode, those re-dozed with SPAQ and those receiving SPAQ for their first time.
b) Health Facility Activities
MYCU members reviewed malaria-specific outpatient records for 2 years prior to SMC in comparison with records following the implementation of the Program. Additionally, the team summarized and analyzed data from the August cycle as delivered to the central facilities by the different VHTs.
Observations from SMC fieldwork
Approximately 255,000 children in the 7 sub-counties received SPAQ in the 2023 August Cycle.
From focused group discussions, it was observed that most households visited were receptive to the intervention because of the reduction in children`s illness and hospital visits previously attributed to severe malaria episodes. The acceptability of SPAQ in some households is highly attributed to palatability of the medicines. A steady average reduction in malaria cases among children was also appreciated over the period of 2 years, with the success presumably attributed to the SMC program.
From the in-depth conversations with caretakers unreceptive to SPAQ, reasons for unacceptability were identified. Examples include:
A mother of a 2-year-old child who had never received SPAQ because of her husband`s objections to the program. This was because he was yet to understand the concept of taking SPAQ for malaria prophylaxis. The MYCU team explained to the mother exactly how SPAQ protects children from severe forms of malaria evidenced by the severity trends of children in her neighborhood that suffer from the malaria compared to before the SMC program.
Refusals of SPAQ among educated community members was mostly attributed to their ability to afford antimalarial medications for their children diagnosed with malaria rather than seek prophylactic SPAQ.
For approximately 6 uneducated community members, refusal was mostly because of the observed side effects of worsening fevers, reddening of eyes, skin rashes, vomiting, and sometimes loss of appetite by children after receiving SPAQ.
Conclusion
Participation in SMC implementation provided an opportunity for the youth to experience the implementation of one of the important tools for burden reduction and progress towards elimination in Uganda’s malaria control and elimination tool kit. This experience provided improved technical knowledge of malaria control, practical knowledge of community-based intervention deployment and SMC as an intervention, and a better understanding of malaria epidemiology in high-burden rural settings. After completion of the activity, MYCU initiated a malaria SMC knowledge and awareness month-long campaign on X, formerly known as Twitter, as an information and advocacy strategy in support of continued and expanded SMC in the Karamoja Region. The campaign attracted 2,496 views, 41 reposts, 2 quotes, and 13 engaging and appreciative comments for the SPAQ intervention. Examples of responses included questions from viewers who wanted to get a better understanding of what SPAQ is. , MYCU successfully attained the “X” Publicity Goal of at least 1000 views and 20 reposts.
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