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Study: Aggressive Malaria Approach Needed

In Tororo lab identifying mosquitos (Credit: Maxwell Kilama)
In Tororo lab identifying mosquitos (Credit: Maxwell Kilama)

The World Health Organization has reported the number of malaria cases is declining, while deaths have fallen dramatically in recent years. But a new study says malaria cases are not declining everywhere. For example, cases are increasing in parts of rural Uganda.

Medicine and Hygiene – calls for a more aggressive and sustained approach to malaria. Dr. Philip Rosenthal, one of the researchers, said, “We conducted surveillance at three sites in Uganda and showed over the last few years that the incidence of the disease has actually been increasing at two rural surveillance sites, while it was decreasing at a more urban site.”

Rosenthal is a professor in the Department of Medicine at the University of California San Francisco.

He said, “We know that overall reports from around the world have shown decreasing incidence of malaria, but we know that the incidence varies greatly around the world. And our results are representative of just one area, which is one of the most highly endemic countries for malaria in Africa, Uganda.”

The increase in cases in rural areas came despite the recommended response.

“As is the case for all countries in Africa, Uganda uses the newer recommended regimens to treat malaria. Those are called artemisinin-based combination therapies and those are quite widely distributed. In addition, there has been quite heavy use of bednets. I will mention that since this time of surveillance the country has continued further rollout of bednets. So the coverage in the country is increasing and obviously that should help with control of malaria,” he said.

Dr. Rosenthal said it’s going to take a while to see the full benefits of treatment and prevention in the hardest hit places.

“Now, the increase is probably not the important message. The important message is the lack of a decrease. Malaria will vary from year to year due to many factors, some of which we understand -- such as rainfall -- and others, which we don’t understand. And so a year to year small variation is not worth taking too seriously. But the more important message is clearly it has not been going down over the last few years in these rural areas of Uganda.”

He said that bednets, treatment and the spraying of homes with insecticide are important methods for controlling malaria.But he adds the intensity of those efforts is vital, saying they must be more widespread and continuous.

“It’s not that difficult to get improvement with aggressive interventions in controlling mosquitoes, but it’s hard to sustain those improvements. And further investment for sure would allow us to hit harder across Africa in bringing malaria down and also accomplishing what is more challenging, which is to keep it down,” he said

He said sometimes aggressive approaches are only temporary and jump from region to region. That allows mosquitoes and breeding conditions to return to earlier levels.

The Ugandan study does not recommend how much more money should be invested for a sustained and aggressive approach. The Roll Back Malaria Campaign reports funding levels peaked at $1.5 billion a year around 2007. However, it said that’s just one quarter of what’s needed to achieve universal coverage.