National Malaria Control Division - health.go.ug Annual Report July 2017 web (2)_0.pdf · IMM Integrated Management of Malaria IPD In-patient department IPTp Intermittent Preventive

Uganda Malaria Annual Report July 2017-June 2018 i

MINISTRY OF HEALTH National Malaria Control Division

July 2017 – June 2018Annual Report

Uganda Malaria Annual Report July 2017-June 2018ii

To cite this report:

Uganda Ministry of Health, National Malaria Control Division,Surveillance Monitoring & Evaluation Unit (2019), National Malaria Annual Report 2017-2018, Kampala, Uganda https://health.go.ug/publications

Uganda Malaria Annual Report July 2017-June 2018 iii

MINISTRY OF HEALTH National Malaria Control Division

July 2017 – June 2018Annual Report

Uganda Malaria Annual Report July 2017-June 2018iv

Acknowledgement

The development of the Malaria Annual Report 2017/2018 would not have been possible without the leadership of the National Malaria Control Programme and technical support from World Health Organisation. The process has been participatory involving ministry and implementing partners.

The Ministry of Health wishes to acknowledge input of the following implementing partners who provided valuable information regarding development of the report: WHO, UNICEF, Malaria Consortium, MAPD Project, RHITES-SW, RHITES-E, RHITES-EC, DFID, USAID/PMI, CDC, IDRC, Vector Link Project, TASO and Pilgrim Africa Project, CHAI,

The Ministry of Health would like to thank all the staff of the NMCP led by the Programme Manager –Dr. Jimmy Opigo along with Dr. Damian Rutazaana, Dr. Daniel Kyabayinze, Dr. Catherine Maiteki -Sebuguzi, Bosco Agaba, Rukia Nakamatte, Peter Mbabazi , Dr. Jane Nabakooza, Miti Joel, Charles Ntege, and the WHO staff: Dr. Bayo Fatunmbi, Dr. Charles Katureebe, and Mr. Paul Mbaka who supported the development, review and finalisation of the Malaria Annual Report 2017/2018.

It is my conviction that this report will provide information for redirecting our malaria control efforts towards malaria elimination in the coming years to accelerate progress towards a “malaria-free” Uganda.

Thank you all

Dr. Diana K. AtwinePermanent Secretary

Uganda Malaria Annual Report July 2017-June 2018 v

Uganda Malaria Annual Report July 2017-June 2018vi

Preface

The Ministry of Health is fast tracking efforts to reduce the burden of malaria to contribute to the wellbeing and national development of the country. Heavy investments have been made in procurement and distribution of Long-lasting nets and antimalarial medicines and diagnostics during the past years. The different health system, cultural, and socioeconomic contexts of the districts and heterogeneity of malaria in the country makes the effect of these interventions to vary. It is thus worthwhile, to know the progress over the past year at district and regional Level.

In 2017-2018 Uganda conducted a mid-term review of the Uganda Malaria Reduction Strategic Plan (UMRSP), 2014-2020. Following this review the National Malaria Control Program and stakeholders adopted a new framework to accelerate malaria reduction efforts towards pre-elimination state – dubbed the Mass Action Against Malaria (MAAM) to increase ownership of malaria control efforts by all stakeholders. To do this, continuous review of progress towards the UMRSP targets is vital.

The Malaria Annual Report 2017/2018 offers the Ministry of Health and it’s implementing Partners an opportunity to reflect on the activities implemented and their results in last financial year and see how best and innovatively they can be deployed in an effective, efficient and sustainable manner.

I request all malaria stakeholders to critically look at the performance of all indicators in the report and develop actions that will fast track malaria reduction efforts in the country.

For God and my Country

Dr. Henry G. Mwebesa,Acting Director General of Health ServicesMinistry of Health

Uganda Malaria Annual Report July 2017-June 2018 vii

List of Abbreviations

ACT Artemisinin-based Combination Therapy

AL Artemether- Lumefantrine

ALMA African Leaders Malaria Alliance

ANC Antenatal Care

AMFm Affordable Medicines Facility for malaria

CDC Communicable Disease Control

CSO Civil Society Organization

DFID Department for International Development

MFP District Malaria Focal Person

DHS Demographic Health Survey

DHIS 2 District Health Information System 2

EPR Epidemic Preparedness and Response

EIR Entomological Inoculation Rate

EQA External Quality Assurance

FBO Faith-Based Organization

GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria

GOU Government of Uganda

HBMF Home-Based Management of Fever

HMIS Health Management Information System

HSD Health Sub-district

HPAC Health Policy Advisory Committee

HW Health Worker

iCCM Integrated Community Case Management

IDSR Integrated Disease Surveillance and Response

IMM Integrated Management of Malaria

IPD In-patient department

IPTp Intermittent Preventive Treatment in pregnancy

IRS Indoor Residual Spraying

ITN Insecticide Treated Net

IVM Integrated Vector Management

JMS Joint Medical Stores

LLIN Long Lasting Insecticidal Net

MAAM Mass Action Against Malaria

M&E Monitoring and Evaluation

Uganda Malaria Annual Report July 2017-June 2018viii

MCH Maternal and Child Health

MDG Millennium Development Goals

MIS Malaria Indicator Survey

MSP Malaria Strategic Plan

MTR Mid-Term Review

MoH Ministry of Health

MoU Memorandum of Understanding

NDP National Development Plan

NGO Non-Governmental Organization

NHP National Health Policy

NMCP/D National Malaria Control Program/Division

NMS National Medical Stores

NRH National Referral Hospital

OPD Outpatient Department

PFP Private for Profit

PNFP Private Not-for-profit

PSM Procurement and Supply Management

QA Quality Assurance

RBM Roll Back Malaria

RDTs Rapid Diagnostic Tests

RRH Regional Referral Hospital

SBCC Social Behaviour Change Communication

TWG Technical Working Group

UMIS Uganda Malaria Indicator Survey

UMRSP Uganda Malaria Reduction Strategic Plan

UNBS Uganda National Bureau of Standards

UNICEF United Nations Children’s Fund

USD United States Dollars

USAID United States Agency for International Development

VHT/CHW Village Health Team/Community health worker

WHO World Health Organization

Uganda Malaria Annual Report July 2017-June 2018 ix

Table of Contents

Acknowledgement ............................................................................................................................... iv

PREFACE .............................................................................................................................................. vi

List of Abbreviations ........................................................................................................................... vii

Table of Figures .....................................................................................................................................x

Definition of terms ............................................................................................................................... xi

Executive Summary ............................................................................................................................. xii

1. Introduction .......................................................................................................................................1

2. Current situation of malaria in Uganda ............................................................................................2

2.1 Progress towards malaria burden-reduction targets .................................................................2

2.1.1 Impact on malaria incidence and mortality .........................................................................2

2.1.2 Implementation of intervention ...........................................................................................7

2.1.2.1 Integrated Vector management ........................................................................................7

2.1.2.2 Case Management ...........................................................................................................11

2.1.2.3 Behaviour change Communication BCC .......................................................................19

2.1.2.4 Programme Management................................................................................................22

2.1.2.5 Surveillance Monitoring and Evaluation ..........................................................................24

2.2 Challenges and lesson learnt .....................................................................................................29

3. Status of malaria epidemics in Uganda ...........................................................................................30

4. Conclusions and Recommendations ..............................................................................................33

ANNEX 1: Special Projects ................................................................................................................35

ANNEX 2: Uganda district profiles ....................................................................................................37

ANNEX 3: District Malaria Profiles ....................................................................................................52

Uganda Malaria Annual Report July 2017-June 2018x

Table of Figures

Figure 1: Key Indicator scores ........................................................................................................... xiii

Figure 3: Graph showing Malaria mortality for the 3 years 2016-2018 ..............................................2

Figure 4 : Graph showing changes in Key Malaria Impact Indicator stratified for region in Uganda ..3

Figure 5: Trends in Malaria Incidence Rate ..........................................................................................4

Figure 6 : Malaria Incidence Rate ..........................................................................................................4

Figure 7 : Key Malaria Impact Indicator by region ...............................................................................5

Figure 8: Test positivity rate 2015-2018 ..............................................................................................5

Figure 9: Map showing Trends in Malaria test Positivity Rate in the last 3 reporting periods............6

Figure 10: Changes in Key Malaria Test Positivity Rates (Impact Indicator) by region between FY2015 and FY2017/18................................................................................................................................................6

Figure 11: Graph showing Malaria as a share of OPD, IPD and Death for FY2016/17 and FY2017/18 ............................................................................................... ................................................7

Figure 12: Graph showing number of suspected malaria tests and treated in Uganda over a period of three years 2015-2018 ...................................................................................................................11

Figure 13: Proportion of Suspected cases tested with diagnostic for FY 15/16-FY17/18 .............12

Figure 14: Annual blood examination rate and Test positivity rate 2010-2017 ...............................12

Figure 14: Malaria OPD numbers for FYs 2015-2081 .......................................................................13

Figure 15: ACT doses distributed and consumed for the FY 2016-17 compared to FY2017-18 ...13

Figure 16: Trend in Malaria death among inpatients ..........................................................................14

Figure 17: Graph showing malaria death for different age groups ....................................................14

Figure 18: Trends of Malaria case fatality in health facilities ..............................................................15

Figure 19: Proportion of pregnant women attending ANC1 who have received 2 or more dozes of iPTp ......................................................................................................................................................15

Figure 20: Preventin of Malaria in pregnancy for the past three year period FY-2015-2018 .........16

Figure 21: Map showing where ICCM is implemented in Uganda ....................................................18

Figure 22: Summary of Health Facilities submitting monthly and weekly surveillance reports .......25

Figure 23: Trends of IPT3 for the year 2017-2018 ............................................................................26

Figure 24: Map showing the coverage / Location of sentinel surveillance sites in Uganda .............27

Figure 25: Example of a ‘Normal Channel graph’ at Health Facility in Kisoro district .....................30

Uganda Malaria Annual Report July 2017-June 2018 xi

Definition of terms

Malaria incidence: Number of newly diagnosed malaria cases during a defined period for a specified population.

Malaria Mortality rates: Number of deaths from malaria per unit of population during a defined period.

Malaria prevalence: Proportion of a specified population with malaria infection at one time

Transmission intensity: The frequency with which people living in an area are bitten by anopheline mosquitoes carrying human malaria sporozoites. Transmission intensity is often expressed as the annual entomological inoculation rate, which is the average number of inoculations with malaria parasites estimated to be received by one person in a given period. Because of the difficulty of measuring entomological inoculation rate, parasite rate in young children is often used as a proxy for transmission intensity. High transmission: are characterized by an annual parasite incidence of about 450 or more cases per 1000 population and a P. falciparum prevalence rate of ≥35%.

Moderate transmission: areas have an annual parasite incidence of 250–450 cases per 1000 population and a prevalence of P. falciparum/P. vivax malaria of 10–35%. Low transmission: have an annual parasite incidence of 100–250 cases per 1000 population and a prevalence of P. falciparum/P. vivax of 1–10%. It should be noted that the incidence of cases or infections is a more useful measure in geographical units in which the prevalence is low, given the difficulty of measuring prevalence accurately at low levels. Very low transmission: areas have an annual parasite incidence of < 100 cases per 1000 population and a prevalence of P. falciparum/P. vivax malaria > 0 but < 1%

Malaria control: Reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts. Continued interventions are required to sustain control.

Malaria elimination: Interruption of local transmission (reducing the rate of malaria cases to zero) of a specified malaria parasite in a defined geographical area as a result of deliberate activities. Continued measures to prevent re-establishment of transmission are required.

Malaria eradication: Permanent reduction to zero of the worldwide incidence of infection caused by human malaria parasites as a result of deliberate efforts. Once eradication has been achieved, intervention measures are no longer needed.

Malaria Stratifications: Classification of geographical areas or localities according to epidemiological, entomological, ecological, social and economic determinants for the purpose of guiding malaria interventions.

Population at risk: Population living in a geographical area where locally acquired malaria cases have occurred in the past 3 years.

Uganda Malaria Annual Report July 2017-June 2018xii

Executive Summary

Uganda is one of the ten countries in sub-Saharan Africa that account for approximately 70% of global malaria cases and deaths. Uganda is a malaria endemic country with active transmission in 99% of the country. Whereas all people in Uganda are at risk of contracting malaria, children under-5 years of age and pregnant women are the most vulnerable. The 2016 UDHS estimated the prevalence of malaria by rapid diagnostic test in Uganda at 30% among children under the age of 5 years. Strengthened political commitment, financing and programmatic action are urgently needed to get malaria responses back on track towards pre-elimination by 2020 in line with the country’s malaria reduction and strategic plan.

The primary objective of this report is to document the current malaria situation and report on the progress in the period July 2017-June 2018. The results are based on health facility data collected through DHIS2 system as well as from program and partner activity reports and other records. The report highlights the progress or lack of in comparison with the previous year (2016-2017), presented as percentage changes, proportions and actual numbers in graphs. The results are presented at National, Regional and District level.

Malaria deaths reduced by 52% (3,503 compared to 7,298 reported death) during the reporting period. Malaria contributed 5% (n=2046) of the total deaths at health facilities down from 11% (4522) in the year 2016-17. The incidence of malaria reduced by 27% (191 vs 272 cases per 1000 population. However, malaria incidence in Karamoja and West Nile increased by over 30%. The five districts of Yumbe, Moyo, Adjumani, Lamwo and Namayingo reported malaria incidence greater than 450 cases per 1000 population. Test positivity rate (number positive /number tests) decreased by 10% points (from 49% FY2016/17 to 39% FY2017/18, and the proportion of malaria in the OPD decreased by 16% (from 67%-51%).

IRS was conducted in 15 districts in Eastern Uganda and the mid-Northern Uganda with support from DFID and USAID/PMI with Vector Link as the implementing agency. IRS in the 11 districts of mid-northern Uganda was conducted by the government of Uganda with support from by Global Fund as part of an epidemic response. Ministry of Health distributed over 26.5 million LLINs country wide through a universal campaign achieving an average operational coverage of over 95%. Through routine LLINs distribution, 1.2 million nets were given to pregnant women and children under-5 years during antenatal care and through the young child clinics. An additional 616,238 were given out through school distribution channels. Refugee populations were prioritized, and plans were made to provide 500,000 LLINs in West Nile and Bunyoro region.

The program should fast track the Mass Action Against Malaria (MAAM) approach not only to sustain the gains acquired in last financial year but accelerate the path towards achievement of UMRSP targets and eventual elimination of malaria.

Progress by UMRSP performance Monitoring Framework

Uganda Malaria Annual Report July 2017-June 2018 xiii

Table 1: Summary of key malaria indicators

Malaria mortality Rate

Incidence of Confirmed Malaria

Test positivity Rate

Confirmed Malaria cases as Proportion

of all OPD

Malaria deaths as proportion of all

deaths

9 191 39 20 5Deaths per

100000 pop.Confirmed Case/

1000 popPercent

(%)Percent

(%)Percent

(%)

Key Indicator scores

Key Indicator scores

Indicator Score Indicator Score

Incidence % of facilities reporting

Mortality RDT stock-out

% test negative treated ACT Stock-out

TPR TWG meeting

Testing rate RBM meetings

IPTp

Key

On Track to attaining UMRSP Target

Little or no progress made

Likely

Uganda Malaria Annual Report July 2017-June 2018xiv

Permanent secretary of the Ministry of health with the US Global Malaria Coordinator on his visit to Uganda, 14th May 2018, Kampala

Uganda Malaria Annual Report July 2017-June 2018 1

1. Introduction

The Uganda Ministry of Health National Malaria Control Division (NMCD) is a Ministry of Health division responsible for implementing all malaria control and management efforts in Uganda. It is currently implementing a five-year strategy aimed reducing the burden of malaria in Uganda. Uganda is a malaria endemic country and the Ministry of Health estimated that there is active transmission in 99% of the country and all people in Uganda are at risk of contracting malaria. The most vulnerable group in terms of malaria in Uganda are children under-5 years of age and pregnant women being particularly at high risk. The 2014Malaria Indicator found the prevalence of malaria in Uganda to be 19% by microscopy and 30% by rapid diagnostic test among children under the age of 5 years. This was comparable to the rapid diagnostic test prevalence found in 2016 by the Uganda Demographic health survey of 30%.

This report provides a summary of the progress in malaria control efforts in FY 2017-2018in Uganda. The report uses health facility data received by the Ministry of Health division of health information and available in its DHIS2 system as well as activity reports and other records. The report covers the period July 2017 to June 2018, although data from previous periods 2015/6 and 2016/17is used to contextualize data and for trend analyses. The primary objectives of this report are to track progress, highlight achievements and bottlenecks that need to be fixed and guide the NMCPs planning and implementation going forward.

The Uganda Malaria Reduction Strategic Plan (UMRSP 2014 – 2020) envisions a malaria free Uganda by 2030 with the following goals: The three goals set for the Uganda malaria Reduction Strategic plan (UMRSP) are;

• By 2020, reduce annual malaria deaths from the 2013 levels (30 per 100,000) to less than 1 death per 100,000 population, reduce malaria morbidity from 150 to 30 cases per 1,000 population

• By reduce malaria parasite prevalence (by microscopy) from 19% to less than 7%.

In line with the UMRSP goals there are six objectives: • Achieve and sustain protection of at least 85% of the population at risk through recommended

malaria prevention measures (vector management);

• Achieve and sustain at least 90% of malaria cases in the public and private sectors and community level receive prompt treatment according to national guidelines (case management);

• Ensure least 85% of the population practices correct malaria prevention and management measures (IEC/BCC);

• The program is able to manage and coordinate multi-sectoral malaria reduction efforts at all levels (program management);

• All health facilities and District Health Offices report routinely and timely on malaria program performance (SME-OR)

Uganda Malaria Annual Report July 2017-June 20182

2. Current situation of malaria in Uganda

Uganda estimates that nearly all the approximately 39 million people living in Uganda were at risk of malaria infection in the FY 2017/18. The country has made significant strides in its efforts to control malaria with the number of malaria cases and deaths reported in the financial year 2017/18 reducing by 27% and 52% respectively compared to the FY 2016/17.

2.1 Progress towards malaria burden-reduction targetsOf the 122 districts in Uganda 8 had incidence of malaria in the FY 2017/18 between 0 and 50 cases per 1000 population are classified as low endemicity while the rest are high burden districts. There were no areas in the country classified as being in elimination phase for malaria.

2.1.1 Impact on malaria incidence and mortality

2.1.1.1 Malaria mortality In the FY 2017/18, 3503 malaria-related deaths were report in Uganda, a 52% reduction compared to figure reported in FY2016/17. This resulted in a reduction in the annual malaria mortality rate from 19.3 deaths per 100000 population in FY 16/17 to 9 deaths per 100000 population in FY 17/18, a 54% reduction. See Fig. 3 below.

District that reported the highest malaria deaths in the period under review included; Lira, Soroti, Kyotera, Hoima, Masaka, Kabarole, Kasese and Arua. The UMRSP targets of less than one death per 100000 population is yet to be achieved.

Malaria Mortality Rate

Figure 2: Graph showing Malaria mortality for the 3 years 2016-2018

Figure 4 shows reduction in malaria deaths by health region between FY16/17 and FY17/18. With exception of Kampala where there was a 46% increase in malaria related deaths, all other regions reported reductions in malaria related deaths with the largest reduction being reported in the Kigezi region.


Changes in Key Malaria Impact Indicator by region between FY2015/16 and FY2017/18

Figure 3 : Graph showing changes in Key Malaria Impact Indicator stratified for region in Uganda

2.1.1.2 Malaria IncidenceIn the financial year 2017/18, the reported incidence of malaria was 191 case per 1000 population compared to 272 case per 1000 population in FY 2016/17. However, five district (Yumbe, Moyo, Adjumani, Lamwo and Namayingo) reported malaria incidence greater than 450 cases per 1000 population. Figure 6 gives a summary of malaria incidence.

The distribution of malaria incidence by district is given in figure 5 below. We observe that while in FY 16/17 the whole mid northern part of Uganda had the highest incidence of malaria, in FY 17/18 we observe the highest incidence in parts of west Nile, and Nwoya district. It should be noted that most districts reported reduction in malaria incidence rate.


Trends in Malaria Incidence RateFY15/16 FY16/17 FY17/18

Figure 4: Trends in Malaria Incidence Rate

Compared to FY 2016/17, in FY 2017/18, the eight districts of Moyo, Yumbe, Kaabong, Kotido, Moroto, Abim and Arua, reported increase in incidence of malaria in excess of 50 cases per 1000 population. Thirteen districts also reported increase in incidence of malaria between 1 and 50 cases per 1000 population. All other district reported reduction in incidence of malaria (see Fig. 5).

The UMRS target for inpatient malaria cases per 10000 population is 5 for the FY 2017/18. The reported number of inpatient malaria cases per 10000 population moved from 219 in FY16/17 to 128 in FY 2017/2018, a 42% reduction. (See fig. 6).

Malaria Incidence Rate

Figure 5 : Malaria Incidence Rate

Figure 7 show percentage reduction in malaria incidence by health region. We observe that in West-Nile and the Karamoja region, there were reported increases in the malaria incidence rate. All other regions reported a reduction in the incidence of malaria. The Acholi and Lango regions reported the highest reductions in the incidence of malaria.



Figure 6 : Key Malaria Impact Indicator by region

2.1.1.3 Test positivity rateReported Test Positivity Rate (TPR) in Uganda reduced from 49% in the FY2016/17 to 39% in FY2017/18, a 25-percentage reduction. The reported reduction in TPR was observed in all regions of the country except Karamoja. Following the 2015 malaria epidemic in northern Uganda, test positivity rate (TPR) in this area remained high than 60% for the FY 2015/16 and FY 2016/17. However, in the FY2017/18 we observed major reduction in TPR in this region. In Busoga and western Uganda, reported TPR for the FY 2017/18 mostly ranged between 30% and 50%.

Test positivity rate FY2016/17 and FY2017/18

Figure 7: Test positivity rate 2015-2018

Figure 9 below, shows district level distribution in TPR, we observe significant reductions in TPR across most districts.


Trends in Malaria test Positivity RateFY15/16 FY16/17 FY17/18

Figure 8: Map showing Trends in Malaria test Positivity Rate in the last 3 reporting periods

Figure 10 below gives a summary of changes in TPR by region. We observe that Karamoja region was the only district that reported an overall increase in TPR. The most significant reductions in TPR were observed in the Acholi and Teso regions of the country.


Figure 9: Changes in Key Malaria Test Positivity Rates (Impact Indicator) by region between FY2015/16 and FY2017/18


2.1.1.4 Malaria Burden to the Health SystemMalaria continues to contribute a significant proportion of the health facility cases and deaths in Uganda.

Malaria as a share of OPD, IPD and Death for FY2016/17 and FY2017/18

Figure 10: Graph showing Malaria as a share of OPD, IPD and Death for FY2016/17 and FY2017/18

The UMRSP 2014-2020, FY2017/18 target for malaria deaths as a share of total deaths is 10%. Fig. 11 above gives a summary of malaria as a share of OPD and IPD cases as a share of all cause deaths. In the FY2017/18, malaria contributed 5% of the total reported deaths at health facilities across the country down from 11% in the FY 2016/17, meeting and surpassing the UMRS target for the period. In the same period, malaria share of inpatient cases reduced to 19% from 29% in FY2016/17, a 34% drop in share. Confirmed malaria contribution 20% of all OPD cases in FY 2016/17 down from 23% in FY 2017/18 (see Fig. 11).

2.1.2 Implementation of intervention

2.1.2.1 Integrated Vector managementUnder this strategy, the ministry of Health aims to achieve and sustaining protection of at least 85% of the country’s population at risk through recommended malaria prevention measures.

In Uganda, the main interventions within integrated vector management are Indoor residual spraying (IRS) and use of LLINs.

By the end of 2017 the MoH had achieved over 88% coverage by LLIN through its routine distribution and an LLIN mass campaign. In the districts where distributions have taken place operational coverage was estimated to be over 98%.

In Uganda, the main interventions within integrated vector management are Indoor residual spraying (IRS) and use of LLINs. During FY 2017/18, the country also implemented larval source management on a pilot basis. The distribution of LLINs is both through routine channels and LLIN mass distribution campaigns. The Abuja target for LLIN and/or IRS coverage is 60%. To have a protective effect, coverage of net ownership and use should be above 80%. However, the 2016 Uganda demographic and health survey found that in 2016, 67% of children under-5 years and 70% of pregnant women slept under an ITN and/or in a dwelling that had been sprayed in the past 6 months which is far below the recommended target.


For the FY 2017/18 the NMCP planned to spray inside houses with an effective insecticide (IRS): conduct IRS in 15 high burden districts in North and Eastern Uganda to rapidly reduce parasite burden; Achieve and sustain universal coverage with LLINs (1 net for every 2 persons in a household) through the distribution of 24 million nets; and Conduct environmental and entomological Monitoring. It also planned to update key strategies and guidelines as well as conduct training on entomological monitoring and surveillance.

Indoor Residual Spraying (IRS)In the FY2017/18, the MOH with support from partners sprayed 1.3 million housing units with an efficacious insecticide called Actelic protecting 17% of Uganda’s population. However, the level of protection was far below the UMRSP target for this year of at least 30% of the population protected.

IRS was conducted in 15 districts in Eastern Uganda and the Lango region including the districts of; Amolator, Alebtong, Butaleja, Butebo, Dokolo, Palisa, Namutumba, Budaka, Serere, Bujiri, Kibuku, Otuke, Lira, Kaberamaido, and Tororo sprayed with Actellic 30S insecticide with support from USAID/PMI and DFID. The MOH sprayed 1,280,593 (94.9 %) of the 1,348,862 houses found in the 15 districts, and protected 4,339,137 (96.6 percent) people out of the total population found (4,553,942). The protected population included 120,847 children under five and 886,137 pregnant women.

The MOH also conducted IRS in 11 districts in northern Uganda as part of an epidemic response with support from the Global Fund. These districts included; Gulu, Nwoya, Oyam, Kole, Kitgum, Omoro, Pader, Lamwo, Agago, Amuru, Apac (Kwania) also sprayed with Actellic 30S insecticide. A total of 632,305 (90 %) of the 748,333 houses found in the 11 districts were sprayed, protecting an average of 90% of the targeted population.

With support from PILGRIM, the Ministry of Health also conducted IRS on a pilot basis in the two sub-counties of Toroma and Kapujan in Katakwi districts.

Spray operators for the Abt Associates-led Uganda Indoor Residual Spraying (IRS) 2 project in northern Uganda posing after training

Spray operators for the Abt Associates-led Uganda Indoor Residual Spraying (IRS) 2 project triple rinse their spray pumps at the IRS soak pit after the daily spraying.

Long Lasting insecticidal nets (LLINs)As reported in the Uganda Demographic and Health survey 2016, 62% of children under-5 years slept under an ITN while 64% of pregnant women slept under an ITN. During the FY 2017/18 the government of Uganda with support from partners conducted an LLIN mass campaign. Recent decreases in the incidence and test positivity rate of malaria in Uganda can be attributed largely to increased LLIN coverage following this just concluded mass campaign.


In the FY 2017/18, the MOH distributed over 26.5 million country wide. The goal of the UCC 2017-2018 was to improve access to LLINs in the population. Preliminary results from this exercise show high coverage rates of over 95% all districts. The MOH also continued to provide LLINs through routine distribution channels (ANC/EPI). A total of 1.2 million nets were distributed pregnant women and children under-5 years through health facilities. Following the development and subsequent approval of the school nets distribution guidelines in the FY 2017/18, The Ministry of Health with support from PMI/USAID/MAPD conducted a large scale School LLIN Distribution pilot to explore this additional routine channel to sustain the LLIN coverage post mass campaign. In May/June, the MOH distributed LLINs through public primary schools in 22 districts in 5 regions in Uganda namely: Hoima, Rwenzori, Kampala (Central 2), Masaka (Central 1), and West Nile regions. A total of 640,569 Primary one and Primary four pupils from 2727 schools were registered to receive LLINs. A total of 616,238 LLINs were distributed to registered students achieving coverage of 96% of the targeted population.

President of the republic of Uganda, YK Museveni at the closeout ceremony of the 2017/18 LLIN Mass Campaign exercise in Sheema District

Following the development subsequent approval of the school nets distribution guidelines in the FY 2017/18, the Ministry of Health plans to start distribution of nets through this channel in the FY 2018/19.

Refugee LLINs distributions:A total of 535,626 LLINs were secured with support from the global fund. Pre-distribution activities such as mobilization and pre-positioning were initiated. Actual distribution of the LLIN is planned to start in July 2018.

Larval source ManagementIn the FY 2017/18, all larval source management activities were implemented on a pilot basis. Three sites in three districts (Wakiso, Nakasongola and Nakaseke) were reached with this intervention using different chemicals at each of the three sites for comparison. By the end of the year, this pilot was still on going and the results are yet to be published.

Entomological monitoring and surveillanceThe Ministry of Health in collaboration with the PMI VectorLink Project Uganda conducts routine entomological monitoring in selected sites to provide data for decision-making. Data generated is used to justify decisions such as the type of insecticide to be used and selection of target areas for IRS. It also helps to assess the quality and impact of the vector control intervention. Tests conducted during the FY 2017/18 included the following:


• IRS quality assurance and insecticide decay rate monitoring in one sentinel site in each of the current 15 IRS districts.

• Bionomics studies to assess vector density, species composition and behaviour in five selected sites in eastern and northern Uganda Bugiri, Otuke, Tororo, Apac and Soroti

• Pre-IRS pyrethrum spray catches (PSCs) to assess indoor resting vector density and species composition prior to IRS and post-IRS PSCs to assess outcomesof IRS in one selected site in each IRS district in eastern and northern Uganda

• Insecticide resistance monitoring in 4 sentinel sites of Bugiri, Lira, Gulu and Soroti .

The results of these studies will be shared in the next reporting period.

Capacity Building The Ministry of Health NMCD with support from the DFID/UNICEF/WHO Capacity Development grant and in partnership with the MOH Vector Control Division and malaria development partners built capacity of Vector Control Officers and other staff at the Sub National level to conduct entomological surveillance, monitoring and on use of entomological data for decision making. Entomological training was conducted in 23 districts reaching 35 Vector control officers. Training was conducted in November 2017 in the Acholi/Lango Sub regions and in March 2018 in South Western region in response to the malaria epidemics in those regions.

As part of the IRS implementation in both the I5 Eastern and Northern Uganda IRS districts and the 11 Northern Uganda epidemic districts, a series of trainings employing the cascade model were conducted. Training sessions for master trainers aimed at enhancing IRS managers’ skills to implement and supervise IRS operations, and to strengthen their training and coaching capabilities. Comprehensive IRS trainings with a focus on practical training to enhance spraying techniques were conducted. Cadres of staff trained included: MOH staff, district Malaria Focal persons, Vector Control Officers, Information, Education and Communication (IEC) Officers, Environmental Health Officers, District Biostatisticians, District Supply Officers, subcounty supervisors, parish store keepers, team leaders and parish supervisors. Similarily, prior to LLIN distributions UCC and School distribution comprehensive trainings were conducted for staff managing operations at National, Subnational levels and the community/schools using approved training guidelines.

Policies and guidelinesIn the FY 2017/18 the Ministry of Health National Malaria Control Division, through the IVM Thematic working group and with support from malaria development partners developed policy documents and guidelines to streamline vector control and insecticide resistance management in Uganda. Documents developed, approved and printed include the following

• Integrated Vector Management Strategy for Malaria Reduction in Uganda, February 2017

• Integrated Vector Management Implementation Guidelines for Uganda, February 2017

• Insecticide Resistance Management Plan for malaria vectors in Uganda, May 2017

• School-based long-lasting insecticidal nets distribution guidelines, January 2018

In the FY 2018/19 the NMCD and malaria development partners will disseminate, distribute and operationalize the policy guidelines developed.


2.1.2.2 Case Management This strategic objective aims to ensure that at least 90% of all malaria cases in the public and private sectors as well as in the community receive prompt diagnosis and treatment according to the national malaria policy.

In FY 2017/18, the NMCP planned the following activities: 1) Strengthen health worker capacities for correct management of malaria through trainings and support supervision of health workers in IMM and clinical audits; Conduct clinical audits in selected health facilities; 2) Strengthen the quality assurance and quality control of malaria parasitological diagnosis element by updating and disseminating the parasite-based diagnosis guidelines; and 3) Ensure availability of Quality Assured Anti-malarial medicines.

While improvements have been observed, there continues to be challenges with testing all fever cases, treating all malaria test positives, treating test negatives, among others. (see figure 12 below).

Malaria Testing rate, % test negative treated, and not tested cases treated

Figure 11: Graph showing number of suspected malaria tests and treated in Uganda over a period of three years 2015-2018

Parasitological confirmation of suspected casesUganda is currently implemented the Test-Treat-Track policy. In line with this policy, is the provision of treatment only after a confirmed diagnosis of malaria, implying that all individuals suspected of having malaria must have a parasitological test. According to WHO, confirmation of suspected malaria cases is critical in not only in ensuring that the correct treatment is prescribed but also in ensuring accurate quantification and mapping of malaria incidence and the spatial distribution of malaria cases. The UMRSP target for the percentage of suspected malaria cases that had a parasitological test for the FY2017/18 is 80%.


Malaria Testing rate

Figure 12: Proportion of Suspected cases tested with diagnostic for FY 15/16-FY17/18

The testing rate and Annual Blood Examination rate decreased as a hitch in RDT supplies was experienced in the last two quarters of the financial year. The non-tested treated decreased by 60%. However, the test negatives treated increased by 18%.

Annual blood examination rate and Test positivity rate

Figure 13: Annual blood examination rate and Test positivity rate 2010-2017

Treatment of uncomplicated malariaIn the FY 2017/18, there were 20 doses of ACT were distributed for malaria treatment down from 31.7 million in FY16/17, a 37% reduction. About half of all OPD cases were due to malaria in FY17/18 down from 67% in FY16/17 representing a 24% decrease. During the FY 2017/18, 32% of the malaria cases were clinical diagnosis compared to the UMRSP for the financial of 25% target.


Malaria OPD cases

Figure 14: Malaria OPD numbers for FYs 2015-2081

This reduction in cases led to a reduction in ACTs consumed by almost 9.5 million doses in this financial year compared to last year resulting in overstock of malaria commodities in many facilities.

ACT doses Distributed and Consumed

Figure 15: ACT doses distributed and consumed for the FY 2016-17 compared to FY2017-18

Treatment of severe malariaSimilar to the observed reduction in the reported number of outpatient malaria cases between FY2016/17 and FY2017/18, there was a reduction in the reported number of inpatient malaria cases and malaria deaths. The reported number of inpatient malaria cases reduced from about 826000 in FY 2016/17 to just over 497000 in the FY 2017/18 representing 40% reduction.. The number of deaths reduced from 7260 in the FY2016/17 to 3503 (see Fig.15).


Malaria IPD cases and deaths

Figure 16: Trend in Malaria death among inpatients

A breakdown of the reported number of malaria deaths shows similar trends in the number of reported deaths among children Under-5 years of age and pregnant women. In the FY2017/18, malaria deaths in children under 5 years reduced to 2046 from 4522 in FY2016/17 and 5014 in FY 2015/16. Among pregnant women malaria related deaths reduced from 426 in FY2015/16 to 274 in FY 2016/17 and finally 179 in the FY 2017/18.

As observed earlier, a consistent supply of anti-malarial medicines, improvements in confirmation of malaria among other recently scaled up interventions were critical in ensuring this marked reduction in malaria deaths.

Malaria mortality

Figure 17: Graph showing malaria death for different age groups


The Ministry of Health continues to provide quality service to inpatient malaria cases with minimal case fatality rate reported in the last three financial years. Since the FY 2015/16 reported case fatality rate has remained below one percent. Case fatality rate in the Fy2017/18 was 0.7% a slight reduction from the 0.9% reported in FY2015/16 and FY2016/17 (see Fig. 18 below).

Trends in case fatality rate

Figure 18: Trends of Malaria case fatality in health facilities

Prevention and Management of Malaria in PregnancyThe malaria in pregnancy policy guidelines implies a 3-pronged approach: 1. All pregnant women should access intermittent presumptive treatment (IPTp), 2. Use LLINs and 3. Access to appropriate treatment of a pregnant malaria case. The Uganda Malaria reduction strategy target states that by the Fy2017/18, 79% of pregnant women attending ANC 1 receiving one or more doses of IPTp. However, the reported proportion of pregnant women attending ANC-1 receiving one or more doses of IPTp in the FY 2017/18 was 68%, a slight increase from 57% in the FY 2016/17 representing a 20% overall increase (see Fig 19 below).

Proportion of pregnant women attending ANC1 who have received 2 or more dozes of iPTp

Figure 19: Proportion of pregnant women attending ANC1 who have received 2 or more dozes of iPTp

The Ministry of Health guidelines require that LLIN should be distributed to pregnant women during their ANC-1. It is therefore important that pregnant women attend their ANC-1 visit during the first trimester of pregnancy to ensure that protection with ITNs is as early as possible.


Prevention of Malria in Pregnancy (MiP)

Figure 20: Preventin of Malaria in pregnancy for the past three year period FY-2015-2018

During the FY2017, there 1.7 million pregnant women attending ANC-1 of these, 19% of the pregnant women who attended ANC-1 did so in their first trimester of pregnancy. Attendance of ANC-1 in the first trimester has remained constant in the last three financial years. See Figure 20 above. While the number of women attending ANC-1 has increased in each Financial Year since FY 2015/16, the number and proportion of women receiving LLIN has reduced. In the FY2017/18, the proportion of pregnant women receiving LLIN was 50% down from 58% in FY 2016/17 and 71% in FY 2015/16. See figure above. In the FY2017/18, 1.4 million pregnant women received IPTp1 and 1.2 million pregnant women received IPT2.

In the FY 2017/18, there were 228371 OPD malaria in pregnancy cases down from 290949 in the FY 2016/17. The IPD malaria in pregnancy cases reduced from 88960 cases in FY 2016/17 to FY 2017/18. See Figure below.


Trends in MiP OPD, IPD

Integrated Community Case Management - iCCMIn the FY2017/18, the Ministry of Health conducted iCCM in 96 districts with 70 districts covered by the public sector and the remaining 26 private sector. The two sectors implementing iCCM current do it differently. While the public sector implementing partners (UNICEF, TASO, Malaria Consortium, Save the Children) cover whole districts, the coverage of private sector is partial and majorly in towns. The partners supporting iCCM in the private sector include; CHAI, World Vision, BRAC, Living Goods, Plan International, Children Investment Fund Foundation and Mbarara University of Science and Technology.


ICCM coverage in Uganda

Source:Figure 21: Map showing where ICCM is implemented in Uganda

Capacity Building There were several supportive supervision visits to the health facilities, integrated malaria management (IMM) trainings and Clinical Audits conducted as means of capacity building. The NMCP with support from partners conducted intergretaed management of malaria (IMM) trainings in 34 out the targeted 46 districts. The training reached 625 health workers from 673 health facilities. It also conducted iCCM support supervision and monitoring in 26 districts, trained 17860 VHTs and harmonized the ICCM reporting tools for VHTs with support MoH division of health information. The programme conducted a training of 9/12 ToTs on clinical audits and conducted clinical audits at 111 health facilities in 17 districts. It also trained 1,646 health workers in integrated management of childhood illnesses – including malaria. The programme finalized the IMM training manual for the private sector. It also finalised and disseminated the IPTp guidelines to selected districts and stakeholders (details in the MIP section).

During the year, the NMCP conducted training for 302 out of the target 800 health workers use of RDT for testing. External Quality Assessment guidelines and the QA/QC manual were finalised and printed. The programme also initiated the process for establishing a malaria reference laboratory for Uganda. External quality assurance for diagnostics (Blood slides and RDTs) was conducted along with laboratory mentorship in 8/20 targeted laboratories in the country.


Table 2: Details of Health worker in IMM and VHTs trained

Implementing Partner

No of H/W trained in IMCI

No of VHT trained

No of facilities attached to VHTs

No of villages receiving iCCM

UNICEF 14,619 291

SCI 67 989 375

Malaria Consortium 481 12,629 382 6,276

GF PACE 538 6,693 322 3,551

GF PILGRIM 216 3,775 108 1,731

GF UHMG 328 6,433 174 3,744

IRC 42 2,774 78

MUST 16 24 5 5

TOTAL 1,646 47,936 991 380

Development of Policies, guidelines and SoPs- The Malaria Policy was updated to incorporate IPT3. (Mothers must have a minimum of 3 doses

of Intermittent Presumptive treatment).

- The iCCM guidelines have been updated to add a community supply chain management to improve management and accountability of commodities at the community level

- The following malaria diagnostics guidelines where finalised and printed:

o National Quality Assurance: Guidelines for Malaria Diagnostics 2017

o Training Guidelines for Malaria Diagnosis 2007

o Implementation guidelines for Malaria parasite-based diagnosis in Uganda 2007

2.1.2.3 Behaviour change Communication BCCThrough this strategy, the NMCP aims at having at least 85% of the population practicing correct malaria prevention and management measures. The 2016 UDHS found that 80.7% of children with fever sought treatment for fever. The survey also found that over 90% of the Uganda population have knowledge on malaria and its prevention. However, while knowledge is high, recommended practice and behaviour remains low in most of the country.

As Ministry of Health, there is needs to quickly bridge the knowledge-practice gap, by: - Patients seek treatment within 24 hours of onset of symptoms

- Clients demand for testing before treatment and that medical staff adherence to test results

- All people consistently use LLINs every night to prevent malaria;

- House hold heads engage in environmental management around home steads;

- Communities embrace indoor residual spraying and larval source management.

The plan for FY 2017/18 under this strategy was to: 1) Strengthen the implementation of the national communication framework through supporting quarterly coordination meetings at the regional level; 2) disseminate key messages on malaria prevention and management; strengthen the capacity of VHTs to undertake BCC activities; as well as commemorate key malaria events.


Coordination During the period under review, the Ministry of Health and her partners held four Technical Working Group meetings to strategize and coordinate the implementation of BCC activities under taken by the Ministry of Health and her partners. Through these meeting, key messages on malaria were developed and/ harmonized before dissemination throughout the country.

AdvocacyIn the FY under review, the national malaria control programme held a launch for the Parliamentary Forum on Malaria as well for the MAAM initiative. During this launch, His Excellency the president of Uganda YK Museveni was the guest of honour. The Ministry also reached-out for the purpose of their participation in the fight against malaria to religious and cultural leader. The Ministry of Health held advocacy meeting with the ministry of education.Social/community Mobilization During the just concluded LLIN mass campaign in the country, the BCC unit of the national malaria control programme with support from partners engaged in community mobilization across the country reaching about 78% of the country with messages on net registration, distribution and use.

Interpersonal communication engagementDuring the FY2017/18, the Ministry of Health in a bid to reach out to communities with limited access to TV and Radio, intensified Inter personal Communication through a number of activities.

The Ministry of Health with support from partners conducted orientation for VHTs, as well as Religious, Opinion and Cultural leaders on community dialogues for action using local existing resources within the community. Consequently, these teams have been influential in sensitizing the communities on Malaria prevention measures. Relatedly, Village Malaria prevention/health Club were formed in a number of districts with support from MAPD. Additionally, Orientation in inter personal communication was conducted for health workers, Champions and Head teachers in 46 districts.

The Ministry of Health also conducted Home-Visits to further diffuse undesired behaviour patterns .This helped to strengthen community initiatives for change.

With support from MAPD, MoH placed 38 TV screens outpatient departments at selected health Facility as a way to engage patient with correct messages while they await service at health facilities. This has helped to create awareness and trigger patient-health work dialogue as clients may ask questions for clarifications.

As part of Mass action against Malaria (MAAM) implementation, the Ministry of Health also supported the establishment of Malaria clubs in schools with an objective of using pupils as malaria champions and change agents. School activations through Music Dance Drama (MDD), school debates/quizzes, branded sports completions and orientation of Teachers were also with support from partners.

Development of IEC materialsDuring the implementation period, working with partners, the program developed and disseminated 36 Information, Education and Communication messages for all the Malaria intervention areas. The development of the malaria messages was based on results of knowledge Attides and Practice (KAP) studies conducted by the Communication for Healthy Communities.

Print Media: The Ministry of Health developed; LLIN brochures, LLIN Frequently Asked Questions, LLIN Posters, LLIN T-shirts, LLIN Banners and Talking points for the Clergy for the LLIN mass campaign.


It also developed; counselling guide for VHTs and Health providers, Talking points Malaria Champions and Posters with support from Communication for Healthy Communities. The ministry also engaged in development of MPI-posters and Talking Points for health providers with support from MAPD.

Broadcast Media: The Ministry of Health conducted seven Mass media campaigns throughout the Country with support from Partners. The campaigns largely focused on the LLIN distribution exercise and involved over 63 radio stations and five TV stations airing messages on the LLIN. The Ministry of Health launched the ‘Live your Dream’ campaign with support from MAPD with a focus on Malaria in pregnancy and Net use. With support from CHC, it undertook various Mass media ‘Obulamu’ campaign throughout the country. The ministry also engaged in mass media campaigns for the promotion of ACTs with a Green Leaf. The estimated reach of this campaign was 78% of the population. The messages aired during this campaign were in form of Radio/TV Spots, live announcements, Talk shows, Guest appearances and DJ Mentions.

Commemoration of important daysDuring the year, the programme organised the 13thworld malaria day commemoration celebrations celebrated which took place in Mpigi district with over 1,000 people in attendance. During the occasion, key advocacy concerns on malaria were raised especially on the promotion of the use of mosquito nets and the need to scale up the use of Indoor Residue Spraying. The theme of the day was “End malaria for good” and the slogan was “children against malaria”. The occasion was graced by Hon. Sarah Opendi, the state minister for health as the guest of honour. In her speech, she urged Ugandans to always test before treating for malaria and encouraged the proper use of LLINs. The minister was joined by 11 members of the Uganda Parliamentary forum for Malaria at the celebration field in Mpigi districts.

Committing to malaria control at the World Malaria day 24th April 2018 in Mpigi district


Capacity Building In FY2017/2018, the NMCP conducted orientation of VHT and community leaders on formation of malaria clubs in 46 districts. Training was also conducted for cultural leaders in 46 districts on their roles in malaria prevention and control. The programme also conducted training for key influencers to be able to conduct community dialogues and home visits to strengthen inter personal communication.

The programme also conducted a training-of-trainers of health workers on inter personal communication. In the same period the NMCP trained teachers in preparation for the School net distribution campaign on malaria prevention and control as well as on development of malaria clubs and use of children as agents of change in health. This was done with the aim of creating a critical mass of school children that can be malaria agents of change.

Policies, guidelines and SoPsDuring the reporting period, the NMCP with support from partners developed SoPs for conducting BCC related activities for the LLIN distribution among refugees, schools net distribution BCC guideline and the associated communication plan.

2.1.2.4 Programme Management The UMRSP aims to ensure that the programme is able to manage and coordinate a multi-sectoral malaria reduction response at all levels.

In the FY 2017/18, the NMCP intended to undertake advocacy and resource as well as ensure optimal delivery of malaria control interventions through ensuring human resource capacity, compliance as well as monitoring and supervision of activity implementation. The programme also planned to ensure coordinated response of malaria control activities by all stakeholders including the private sector through national and RBM mechanisms. It also planned implement activities aimed at strengthening programm capacity for procurement and supply chain management of malaria control commodities.

Coordination and Multi sector EngagementDuring the FY 2017/18, the programme conducted thematic working group meetings for SME-OR, Case management, and IVM. The programme conduct four RBM meetings as a coordination platform for stakeholders involved in malaria control activities.

Permanent secretary Ministry of Health opening the second quarter RBM meeting at Hotel Africa April 2018


The Uganda Parliamentary Forum on Malaria (UPFM) was launched on 5th April by H.E the president of Uganda, Gen. Yoweri Museveni. He pledged to support the Malaria fund and malaria elimination efforts.

The Ministry of Health gave award of recognition to several persons involved in the fight against malaria in Uganda. Recipients included: Dr Talisuna Ambrose, Dr Myers Lugemwa, Dr. Sezi Charles, Dr Lois Mukwaya. Prof. Kirya George, Prof. Moses Kamya, Ms Zahara- Journalist, General Eli Tumwine, Dr Ivan Kamya for DHO leadership, Dr Nassanga Ruth for Mpigi District, Prof Kirumira on behalf of Global Fund Uganda Country Coordination Mechanism, Mr David Masiko for Against Malaria Foundation, Ms Joy Phumaphi the Executive Secretary, African Leaders Malaria Alliance (ALMA) Dr. Kasete Admasu the CEO, Roll Back Malaria Partnership, Ms Robinah Lukwago for DFID, UNICEF and Dr. Yonas Tegegn Woldemariam for WHO Uganda.

The program also engaged other stakeholders such as the Ministry of Education and set up a school health task force for malaria reduction; it participated in the CHOGM malaria summit and paid a visit to the speaker of parliament of the republic of Uganda.

During the reporting period, the programme initiated a partner mapping exercise aimed at developing a partner map of malaria. Partners were visited to collect information and finalization of the partner map is on-going.

Resource MobilizationDuring this period the Ministry of Health was awarded a Global Fund Grant of $185m to combat malaria. The Ministry also received support from DFID worth $60M for Strengthening Uganda’s Response in Malaria (SURMA) project that will cover 25 districts in Northern and Eastern Uganda. PMI/USAID has also agreed to support Malaria reduction efforts with a grant of $30m.

During the launch of the MAAM initiative and the PFM, the president of Uganda announced the establishment of the Presidential malaria fund and the framework for its operationalization will be finalised by the NMCP in the next financial year. The programme also initiated the process of developing a resource mobilization strategy for malaria in this financial year.

Procurement Supply management- PSMDuring the financial year under review, 24 million doses of ACTs, 3.7 million vials of Artesunate, and 27.8 million Rapid diagnostic tests were distributed to the public and private not for profit facilities. An End User Verification Survey done in July 2017 showing that 97% of the health facilities had adequate stock of anti-malaria medicines. The End User Verification Survey 6 done in 2016 had report that only 89% of the health facilities had adequate stocks of anti malarials.

The Ministry of Health engaged National Medical Stores and districts during the financial year to strength evidence based PSM during the financial year under review.


Percentage of health facilities with at least one ACT on the day of the EUV

PlanningDuring the Financial Year, the NMCP together with partners developed and implemented a joint work plan. The process of development of the workplan too longer than anticipated and mechanisms have been but in place that this is done in a shorter time in the following period.

Policies, guidelines and SoPsDuring FY17/18, the NMCP initiated the development of the LLIN repurposing guideline and the Routine LLIN distribution guideline. The programme also initiated. The NMCP also initiated the process of updating the malaria policy no align it with the new global malaria technical strategy and other malaria related developments in the country and the region.

Capacity to implementDuring the FY, the programme conducted M&E training for NMCP staff. All NMCP staff and selected partner staff were involved in the meeting.

2.1.2.5 Surveillance Monitoring and Evaluation This objective aims to have all health facilities and district Health Officers reporting routinely and timely on malaria programme performance.

Under this strategy in FY 2017/18, the programme planned to: 1) strengthen epidemiological, parasitological and entomological surveillance; production of quarterly surveillance bulletins; strengthen malaria surveillance through HMIS (public and community); and conduct program implementation reviews. 2) conduct regular malaria surveys/evaluations; strengthen data collection from the private sector; strengthen data demand and use at all levels; and 3) implement the operation research agenda for malaria.

Reporting, Reviews and evaluationsDuring the FY under review, the Ministry of Health with support of partners conducted a mid-term review of the Uganda Malaria Reduction Strategy (2014-2020). The review recommended a Mass-Action-Against-Malaria as a framework for accelerating the implementation of the UMRSP.

In this same year, MoH produced two Quarterly Bulletin Malaria, 51 Weekly Malaria Status reports and one malaria Executive Briefs as tools to track progress in malaria control and it shared these with relevant stakeholders.


The Ministry of Health also initiated a malaria-death audit process to as part of its efforts to achieving zero deaths due to malaria.

The programme in collaboration will ALMA developed a malaria scorecard to facilitate performance monitoring and management decision making in the same period. It also as part of her international commitment, submitted Uganda data for the production of the world malaria report in the same FY.

Submission of Routine data by health facilitiesThe Ministry of Health requires all health facilities to provide weekly and monthly report of cases seen across all disease managed. While all public health facilities have been registered to report in the DHIS2, only about 25% of the privately-owned health facilities are registered in the DHIS2 for reporting.

% of health facilities submitting reports

Figure 22: Summary of Health Facilities submitting monthly and weekly surveillance reports

Figure 22 above gives a summary of the report completion rates for OPD month reporting, IPD monthly reporting and weekly surveillance reporting. In FY 2017/18, all health facilities currently registered in the HMIS submitted their monthly OPD reports. This was up from 98% in the FY 2016/17.

In the same period IPD monthly reporting rate was 97% up from 94% in the previous financial year, A slight drop in the level of weekly surveillance reporting was observed in the same period with weekly surveillance reporting rate dropping from 77% in FY 2016/17 to 75% in FY 2017/18.

Since the introduction IPTp3 and its subsequently inclusion within the HMIS tools in July 2017, reporting of this data element has steadily improved. The proportion of health facilities submitting reports with data on IPTp3 increased from about 16% in July 2017 to 54% in Jun 2018. This improvement is quite remarkable and should be encouraged and strengthened.


Reporting IPT3

Figure 23: Trends of IPT3 for the year 2017-2018

Data Quality Audits and ReviewsDuring the FY 2017/18, the Ministry of Health conducted xx data quality reviews in which data elements relevant for malaria where included. In these reviews highlighted a number of challenges with the data. These included;

• Use of wrong registers and aggregate form is some health facilities

• Minimum review and analysis of routine data at district and facility levels

Malaria Death Investigation and AuditDuring the FY2017/18, the Ministry of Health introduced a weekly malaria death investigation process, through this process. Through this process, the Ministry of Health has been able to confirm all malaria deaths as well as identify reasons for deaths due to malaria. Below is a summary of the attributable causes for malaria deaths during the financial year: 1) Late coming in health care facilities for medical attention coupled with delayed referral were the most predominant 2) Anemia and the shortage of blood in most facilities was commonly linked to deaths among children under five year. 3) Children under five years contributed 75% of the total malaria deaths.

Sentinel surveillanceIn FY2017-2018, the Uganda Malaria Surveillance Program (UMSP) expanded the malaria-sentinel site surveillance program from 21 to 35 outpatient health facilities located in 32 districts in the country with support from PMI/USAID/MAPD and in collaboration with IDRC. . The goal of the expansion was to enable the MoH to get high quality malaria data from a wider geographical area across the country with better epidemiological representation as it seeks to make surveillance a core intervention.


Location of sentinel surveillance sites in Uganda

Figure 24: Map showing the coverage / Location of sentinel surveillance sites in Uganda

Therapeutic efficacy Testing of Antimalarial medicines in Uganda:The emergence of artemisinin resistance and high treatment failure with Artemisinin- based Combination Therapy (ACT) in South East Asia call for vigilance in monitoring therapeutic efficacy of antimalarial medicines. During the FY 2017/18, The Ministry of Health conducted four preparatory meeting as part of activities intended to lead to a successful TES study in Uganda. The TES will be conducted in the FY 2018/19.

Epidemic detection and ResponseThe Ministry of Health responded to malaria epidemics in Kisoro, Nwoya and Black water fever upsurge in Manafwa. The Malaria cases in Kisoro were reduced to pre-epidemic levels. The program is currently responding to Nwoya and Manafwa epidemics.


NMCP staff collecting larva at Sereri swamp in Kisoro district as part of malaria outbreak investigation

Operational ResearchA study on the efficacy of Piperonyl Butoxide (PBO) in malaria control was initiated during the reporting period and is currently in advance stage. The country continues to conduct entomological studies including: Insecticide susceptibility status, Insecticide resistance mechanisms, insecticide resistance intensities in 4 districts of Arua, Apac, Tororo and Kanungu. IRS Susceptibility studies and Insecticide Resistance monitoring conducted. A study supported by Pilgrim with the objective of conducting health facility surveillance and entomological monitoring as part of evaluation of effectiveness of different combinations of malaria control strategies (MDA+ with IRS, MDA+IRS+LLINs, vs IRS+LLINs vs LLINs vs LLINs)

A Scientific Colloquium was conducted as part of the world malaria day celebration during the financial year where researchers from presented new evidence in the area of malaria control. Together with IDRC a malaria stakeholder’s dissemination meetings was held in which several studies were discussed and shared with malaria implementing partners.

Capacity Building In order to strengthen district level capacity in Surveillance, Monitoring and Evaluation- district-level capacity assessment and mentorship concept developed and rolled out in fourteen select districts. A multi-faceted approach was used to implement the activities. Strategic policies, guidelines, training circular and tools were developed to support capacity and health systems strengthening activities.

A national training of trainers (ToT) for malaria surveillance was done with over 30 participants. A regional ToT was done in which 14 districts participated. In collaboration with USAID supported MAPD project, over 45 district health teams were trained in malaria data use and analysis.

National ToT refresher for EPR for Malaria with CPD/WHO/DFID was done and 25 National level trainers trained. With support from CPD/WHO 529 Health Workers trained from 82 districts 10 regions venues ( Jinja, Soroti, Mbale Tororo, Lira, Arua, Gulu, Hoima, Mbarara and Kabale. Training on conducting Therapeutic Efficacy studies on going.

The following abstracts were submitted for scientific conferences:1. Early detection of malaria upsurges at sub-National levels in Uganda

2. Transforming surveillance into a core intervention: The path to building a strong malaria surveillance system in Uganda


3. Malaria Death Surveillance in Uganda: Novel approach to introduce mortality Audit in high patient volume facilities

4. Early Focal Malaria Upsurge Detection and Response in Kisoro, a low transmission, unstable malaria setting of Uganda

Policies, guidelines and SoPs- Epidemic Preparedness and Response guidelines update: preliminary work on going.

2.2 Challenges and lesson learnt

• Selection of indicators: The current selected indicators for SMEOR are inappropriate to track implementation of malaria activities.

• A SMEOR thematic working group is in place but needs to be regular to support the functioning of this team.

• There is limited retrieval and analysis of readily available data from both DHIS2 and other programs to inform implementation and decision-making


3. Status of malaria epidemics in Uganda

Figure 25: Example of a ‘Normal Channel graph’ at Health Facility in Kisoro district

3.1 BackgroundThe Country had malaria outbreaks in Nwoya and Kisoro. There were also increased malaria above the normal channel levels in West Nile districts of Moyo, Yumbe, Arua, Packwach, Adjumani and Maracha largely attributed to the immigration of sudanese and Congolese citizens from insecurity in these countries.

Kisoro and Nwoya district health teams timely identified the epidemics and notified the national control Divisionand stakeholders. The district lead approach led to quick control of the epidemic in Kisoro. The National Malaria Control Division is focussed on empowering all districts and facilities to have capacity to detect and respond just as Kisoro did.

Figure 26: Kisoro District Malaria Normal Channel


3.2 Risk factors and drivers of the malaria epidemicsFollowing outbreak investigation in the affected districts, a number of risk factors for the detected epidemics were identified;

• Human Activities- The encroachment of the swamps by human activities such as brick making, farming and mining have created several breeding areas for mosquitoes such as the case of the outbreak in Kisoro

• Scale down of interventions as was the case in Northern Uganda leaves a population with low immunity and at risk of not only malaria but also severe forms of the diseases

• Weak Health systems leaving many populations without access to vital interventions such as malaria case management leading to delayed health care seeking habits

• Weak surveillance systems make it hard to detect epidemics and respond to them on a timely basis

• Climate and environmental factors such as global warming have made areas initially with low mosquito density such as Kigezi to have increased populations. The Increased rainfall pattern in some seasons predisposes ill prepared districts to upsurges.

3.3 Best practices in epidemic detection and response• Community outreaches in malaria hotspots with screening and treatment to supplement facilities

drastically reduces cases like in Kisoro

• Involvement of the district and local leadership in malaria epidemic control immensely improves on uptake of interventions such as net use

• Nwoya and Kisoro district were able to construct normal channels and identify the malaria epidemics within 3 weeks of onset

• Kisoro district leadership investigated, confirmed and responded to the epidemic using available district resources such as redistribution of staff from low malaria burden to high burden areas as they waited for MOH support.

3.4 Main Challenges• A resurgence of malaria after cessation of interventions. This is critical in resource limited settings

like Uganda. As part of the epidemic response in Northern Uganda, all 11 districts received one round of IRS with Actellic. However, at the end of this financial year we saw a rebound of malaria in all the districts.

• Limited resource envelope to comprehensively respond to epidemics. The response is still piece meal because mobilizing funds for interventions such as Indoor Residual Spraying, Larviciding and Mass Drug administration is a very arduous task at district and National level

• The reduction of malaria prevalence predisposes the population to severe forms of malaria due to low immunity. This was the case of the outbreak of Black Water fever in Manafwa. Severe malaria is big challenge to our weak health system.

• A number of communities do not have good coverage of the health system such as Karamoja and highland areas.

• The surveillance system for the private sector and community is still weak. This means outbreaks are sometimes detected late

• The unstable political environment of neighbouring countries leading to mass influx of refugees and populations along borders that are not having access to malaria interventions.


3.5 Recommendations to strengthen epidemic preparedness and response• Strengthen malaria data use for action at facility and district level by all stakeholders

• Advocacy and mobilisation of resources for f contingency funds at district and National level for epidemic response.

• Scale up and Fast track implementation of interventions of malaria reduction for eventual elimination

• Strengthening iCCM and increased investment in facilities and health system building blocks to cover vulnerable populations.

• Development of a holistic private sector and community strategy to strengthen surveillance and response.


4. Conclusions and Recommendations

4.1 ConclusionsThere has been a significant decline in the malaria mortality and mobility in the FY 2017-2018 compare to the previous year. The decline in morbidity however was not observed in West Nile and Karamoja regions and the plausible factor being influx of migrant population and limited use of interventions. A universal net coverage campaign was conducted in Uganda and one round of IRS conducted in the 11 Northern Uganda (Acholi) regions, to manage the malaria resurgence that followed withdrawal of the intervention.

There was increased availability of malaria case management commodities especially in the public sector, improved coordination between Ministry of Health, National medical stores, districts and health facilities. However, with improving stock management, there is need for more granular planning and tracking of stock at district level for efficient internal redistribution of the medicine at that level.

There were capacity building activities including trainings in Surveillance, epidemic preparedness and response and case management in over 80% of the districts. Community interventions including ICCM roll out and provision of tools were continued at various sites. There is limited mechanism for enforcing adherence to prevention and treatment guidelines by health workers especially at the lower facilities. Continued capacity building including clinical audits and case management will be needed to improve outcomes. Partner Coordination and collaborations was strengthened through technical working groups and meetings.

A mid-term review of the UMSRP 2014-20120 was conducted and provided key recommendations that directed the ministry to accelerate the interventions if they are to achieve the 2021 targets.

4.2 Recommendations• Sustain the gains in the reduction in mortality and morbidity achieved over the past year, the

following are recommended

o The malaria stakeholders take up the UMRSP mid-term review recommendations including review of policies and guidelines

o Provide at least two rounds of IRS in Northern Uganda as we plan the exit strategy

o Fast track the malaria fund announced by H.E the President

o Utilise the lessons learnt from the LLINs to plan the next Universal Coverage campaign for LLINs in Uganda

o Strengthen the PSM to adequately manage the over stock and prevent expiry of commodities in all districts

o Close support to district during planning and implementation to increase ownership and governance oversight

• To sustain the gains in reducing malaria mortality, MOH and partners should promote integrated program approach and strengthen health care delivery system to ensure at all levels: prompt diagnosis, appropriate treatment, tracking and timely referral as and when required. Based on the observed impact of IRS in Northern Uganda, MoH and partners should prioritize IRS in hot spot districts while rolling out across a wider geographic coverage.


• NMCP should urgently develop and implement a plan for mass action against malaria using and engage multi-sectoral approach at individual, household, community, district, institutional, national and international level; to create a mass movement against malaria in line with the framework for “malaria smart” families and communities, for zero malaria death by 2020 and a malaria free Uganda by 2030. Among others, the following initiatives should be prioritized: a) Mass Action Against Malaria; and b) Uganda Parliamentary Forum for Malaria (UPFM)- a community that serves as advocates for political, legislative and community action for a malaria free Uganda.

• NMCP should operationalization of the intended decentralized service delivery at district level. Touchdown model to decentralize National Malaria Control Program to the District levels towards reaching every household should be operationalized. Staff of NMCD will be assigned to empower and coordinate malaria action in clusters of districts in the 14 Uganda regions, in line with Regional Referral Hospital catchment areas.

• NMCD needs to improve and strengthen coordination with the private sector quality of care provided, training in IMM and provision of tools to enhance data collection and reporting into DHIS2.

4.3 Way forwardAll malaria stakeholders must play their part not only to sustain the gains but to accelerate the path towards achieving malaria free Uganda. This process has been embedded in the new strategy of Mass Action against Malaria (MAAM). This requires commitment and dedication not only from Ministry of Health but from global partners, in country organisations, politicians, opinion leaders, district and community members.

There is need to increased coordination and information sharing between all malaria implementing partners to promote the ‘three ones’ : One Coordination, One plan, and M&E


ANNEX 1: Special Projects

MAPD

USAID’s Malaria Action Program for Districts (here in referred to as MAPD) through President’s Malaria Initiative (PMI) funding aims to improve the health status of the Ugandan population by reducing childhood and maternal morbidity and mortality due to malaria. This project is implemented by Malaria Consortium in partnership with Jhpiego, Banyan Global, Communication for Development Foundation Uganda (CDFU), Deloitte Uganda, Infectious Diseases Institute (IDI) and International Development Research Collaboration (IDRC). The 5-year project supports the Government of Uganda in reducing deaths from malaria among the general population, especially children under five years of age and pregnant women, with a geographical focus of 47 districts.

RHITES SOUTH WEST

Covers 16 districts of the South-West region: Kisoro, Kanungu, Rukungiri, Kabale, Ntungamo, Iban-da, Isingiro, Kiruhura, Bushenyi, Sheema, Buhweju, Mitooma, Rukiga, Rubanda, Rubirizi & Mbarara Malaria. Covering. Covering training, motorship, provision of job aids, data reviews, regional stake-holders’ meetings.

CDP

Support to the NMCP Capacity Building for effective delivery of the Uganda Malaria Reduction Strategy (UMRSP). The project intends to do this by: Strengthen human resources capacity of NMCP; Strengthen the planning, programming, supervision, monitoring and evaluation in respect of malaria service delivery; and To improve the coordination and implementation of malaria control activities at national and sub-national levels

Uganda IRS project

Conducts IRS and entomological monitoring in 14 districts in Eastern and north eastern Uganda. The project also conducts capacity building activities across the country.

PILGRIM

Involved in trial of Enhanced suppression of malaria transmission with joint medical and entomological control measures: operational research in Uganda. Working in collaboration with Rotary International, IDRC, Uganda IRS, Peace Corps Uganda, Makerere University School of Public Health, Rotarian Malaria Partners, Rotary Districts 5020, 5030, and 9211, Bill & Melinda Gates Foundation.

IDRC

Supported sentinel surveillance in 35 malaria reference districts located in districts. IDRC also supports studies in malaria including drug efficacy studies of first and second line antimalarial. IDRC is also involved in the evaluation of the process, outcome, and impact of Global fund activities.


TASO

The activities TASO is implementing Global funded activities that include: community interventions that include; Integrated Community Case Management (ICCM) targeting children under 5yeras; trainings of cadres at different levels to ensure quality ICCM service delivery, training of private for profit (PFP) sector in the Integrated Management of Malaria and routine HMIS reporting, support supervision activities together with technical teams from the district to PFP Health facilities and facilities implementing ICCM in 29 districts,

Provision of routine Long Lasting Insecticidal Treated Nets (LLINs) in ANCs (Antenatal Clinics) and EPI (Expanded Programme for Immunization) clinics for PNFP (Private not for Profit) and Public health facilities and various SBCC (Social and Behavioral Change Communication) interventions including school engagement activities with the Ministry of Education and Sports. ICCM implementation is now in 29 districts in the Eastern (5), West Nile (6), Western (6), Central and Southern (12) regions of the country.

RHITES E

The USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity is USAID-funded activity supporting the Government of Uganda (GOU) and key stakeholders to increase availability and utilization of high quality health services in 23 districts in Eastern Uganda and 2 in Karamoja region. RHITES-E worked with districts to improve and strengthen knowledge and skills of health workers in various health service areas through classroom based training and facility based mentorship. 318 health workers were trained on integrated management of malaria, 230 on quality assurance for mRDTS, and 678 were mentored on new guidelines for management of malaria in pregnancy including IPTp. Mentors observed improvements in implementation of the IPTp3+ strategy across all districts with data being captured in the ANC registers. On site mentorship for 1906 HWs on the test and treat policy and quality assurance on mRDT use at facilities contributed to an increase in the proportion of patients treated after a positive laboratory test


ANNEX 2: Uganda district profiles

Acholi

Burden

OPD case Confirmed IPD cases Under 5 Pregnant Women

668,787 475,657 30,067 153,768 17,898

CoverageTesting rate: 69%,

% Negative treated: 34%,

% Positive treated 97%

IPT2 Coverage: 79%

IRS: Yes

iCCM: Yes

ImpactTrends in Death Trends in Incidence


Ankole

Burden


554,899 454,686 22,989 78,901 7,738




IPT2 Coverage: 77%

IRS: No

iCCM: Yes (5 districts)



Bugisu

Burden


444,610 249,125 23,437 88,667 8,075




IPT2 Coverage:70%

IRS: No

iCCM: No



Bukedi

Burden


492,090 297,365 18,288 135,964 6,959




IPT2 Coverage: 83%

IRS: Yes

iCCM: No

Impact

Trends in Death Trends in Incidence


Bunyoro

Burden


542,717 400,337 29,950 128,898 14,585




IPT2 Coverage: 60%

IRS: No

iCCM: Yes (2 districts public)

Impact



Busoga

Burden


1,490,569 940,218 40,510 423,689 36,877




IPT2 Coverage: 64%

IRS: No

iCCM: No



Kampala

BurdenOPD case Confirmed IPD cases Under 5 Pregnant Women

377,679 122,567 5,218 115,918 5,158




IPT2 Coverage: 33%

IRS: No

iCCM: No

Impact



Karamoja

Burden


498,710 279,377 41,506 178,239 11,012




IPT2 Coverage: 77%

IRS: No

iCCM: Yes (All districts)

Impact

Trends in Death Trends in incidence


Kigezi

Burden


172,251 125,996 11,833 27,618 1,162




IPT2 Coverage: 91%

IRS: No

iCCM: No

ImpactTrends in Death Trends in incidence


Lango

Burden


380,670 250,067 18,191 85,580 16,832




IPT2 Coverage: 75%

IRS: Yes




North Buganda

Burden


1,009,419 750,243 27,944 219,700 20,483




IPT2 Coverage: 63%

IRS: No




South Buganda

Burden

OPD case (define) Confirmed IPD cases Under 5 Pregnant Women

989,799 655,532 45,601 199,784 15,003

CoverageTesting rate: 60% (ABER), (trend); TPR



IPT2 Coverage: 62% (trend)

IRS: No


ImpactTrends in Death (number/100,000 pop) Trends in incidence (number/1000 pop)


Teso

Burden


682,819 385,588 35,667 141,562 21,742




IPT2 Coverage: 75%

IRS: Yes (Pallisa, Serere, Kaberamaido)




Tooro

Burden


725,073 505,515 61,058 157,963 11,852




IPT2 Coverage: 77%

IRS: No


Impact

Trends in Death Trends in incidence


West Nile

Burden


1,951,758 1,534,176 85,087 575,148 31,117




IPT2 Coverage: 75%

IRS: No

iCCM: Yes



ANNEX 3: District Malaria Profiles

District

Con

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Abim 359 59% 14.8 326 0.45% 60% 50% 82% 0% 80% 28% 41% 71%

Adjumani 1148 76% 31.2 654 0.48% 78% 52% 95% 8% 36% 40% 42% 92%

Agago 234 67% 9.1 117 0.78% 48% 37% 96% 0% 42% 21% 15% 78%

Alebtong 51 50% 3.6 36 0.99% 91% 23% 69% 0% 8% 11% 12% 78%

Amolatar 66 74% 3.6 54 0.67% 100% 23% 74% 0% 12% 12% 13% 99%

Amudat 118 73% 8.1 73 1.11% 68% 52% 63% 0% 47% 28% 30% 100%

Amuria 209 77% 4.9 205 0.24% 83% 44% 86% 0% 26% 33% 33% 73%

Amuru 287 76% 12.7 155 0.82% 79% 42% 61% 0% 28% 25% 28% 53%

Apac 77 58% 14.0 48 2.91% 95% 35% 71% 0% 29% 17% 19% 81%

Arua 444 78% 35.9 291 1.24% 84% 56% 100% 55% 51% 32% 27% 74%

Budaka 42 22% 0.4 20 0.21% 37% 12% 83% 0% 56% 7% 6% 91%

Bududa 96 69% 1.6 70 0.23% 85% 26% 70% 0% 11% 11% 12% 82%

Bugiri 129 68% 8.4 81 1.04% 29% 33% 67% 0% 43% 21% 23% 66%

Bugweri 62% 0.35% 87% 50% 57% 0% 60% 30% 16% 52%

Buhweju 48 89% 0.7 12 0.64% 93% 28% 100% 18% 7% 7% 5% 93%

Buikwe 234 71% 9.0 122 0.74% 81% 42% 64% 12% 31% 25% 21% 72%

Bukedea 102 64% 0.4 82 0.05% 80% 26% 78% 0% 18% 22% 39% 62%

Bukomansimbi 127 87% 13.6 127 1.08% 98% 38% 62% 26% 13% 19% 30% 74%

Bukwo 49 34% 38.1 99 3.84% 76% 16% 75% 3% 49% 4% 20% 91%

Bulambuli 121 53% 1.0 68 0.14% 26% 38% 71% 0% 100% 21% 20% 85%

Buliisa 218 64% 5.2 146 0.35% 73% 41% 71% 34% 10% 27% 23% 91%

Bundibugyo 335 41% 12.5 495 0.25% 93% 31% 70% 13% 76% 30% 42% 92%

Bunyangabu 85 59% - 51 0.00% 38% 34% 69% 18% 50% 13% 12% 89%

Bushenyi 143 92% 7.8 181 0.43% 43% 25% 79% 25% 11% 12% 13% 75%

Busia 397 68% 11.9 238 0.50% 98% 55% 69% 0% 56% 36% 33% 70%

Butaleja 56 37% 5.4 93 0.58% 94% 18% 88% 0% 49% 6% 12% 71%

Butambala 365 84% 1.9 244 0.08% 99% 48% 63% 33% 26% 27% 18% 76%

Butebo 68 58% 2.4 80 0.30% 87% 21% 78% 0% 33% 15% 25% 94%

Buvuma 157 87% - 59 0.00% 95% 44% 51% 12% 22% 29% 35% 88%

Buyende 83 67% 1.8 65 0.28% 100% 40% 52% 0% 32% 22% 25% 92%

Dokolo 66 70% 1.5 32 0.47% 74% 18% 81% 0% 9% 11% 10% 97%


DistrictC

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Gomba 163 87% 1.2 14 0.83% 100% 46% 55% 17% 11% 25% 6% 80%

Gulu 281 72% 17.0 266 0.64% 79% 30% 74% 0% 32% 16% 14% 70%

Hoima 86 78% 15.5 56 2.79% 98% 39% 70% 26% 25% 17% 11% 83%

Ibanda 358 93% 13.2 87 1.52% 66% 45% 78% 0% 35% 28% 13% 77%

Iganga 212 75% 8.6 110 0.78% 94% 45% 59% 0% 63% 30% 20% 50%

Isingiro 154 68% 4.7 97 0.49% 34% 35% 100% 1% 50% 17% 25% 89%

Jinja 353 51% 14.5 137 1.06% 87% 39% 100% 0% 100% 20% 15% 55%

Kaabong 349 49% 32.7 571 0.57% 62% 52% 70% 0% 93% 11% 52% 79%

Kabale 29 93% 2.5 19 1.34% 90% 13% 100% 8% 3% 2% 2% 91%

Kabarole 74 79% 41.3 174 2.37% 80% 22% 79% 12% 44% 7% 12% 61%

Kaberamaido 71 35% 0.8 44 0.18% 84% 17% 67% 0% 24% 9% 10% 50%

Kagadi 158 87% 6.0 172 0.35% 93% 49% 60% 36% 45% 35% 33% 70%

Kakumiro 63 81% 2.3 62 0.36% 88% 38% 56% 37% 10% 20% 20% 91%

Kalangala 148 57% 1.6 87 0.18% 84% 33% 80% 52% 18% 9% 20% 62%

Kaliro 161 69% 3.0 195 0.15% 100% 40% 63% 0% 48% 35% 44% 58%

Kalungu 178 86% 7.9 149 0.53% 96% 38% 70% 46% 12% 21% 23% 79%

Kampala 76 33% 4.8 35 1.38% 71% 15% 100% 21% 58% 5% 2% 78%

Kamuli 272 72% 3.6 116 0.31% 77% 47% 94% 0% 58% 33% 21% 61%

Kamwenge 265 89% 7.0 226 0.31% 95% 49% 79% 18% 37% 33% 28% 71%

Kanungu 187 63% 2.6 155 0.17% 67% 34% 80% 14% 23% 14% 17% 81%

Kapchorwa 74 45% 41.2 80 5.12% 82% 28% 79% 2% 51% 7% 12% 77%

Kapelebyong 76% 0.00% 100% 38% 74% 0% 23% 26% 27% 76%

Kasese 188 63% 17.6 305 0.58% 87% 38% 100% 28% 48% 20% 27% 86%

Kassanda 64% 0.29% 100% 50% 54% 11% 15% 26% 16% 62%

Katakwi 357 58% 2.2 369 0.06% 56% 42% 77% 0% 52% 29% 45% 80%

Kayunga 273 91% 2.0 50 0.41% 60% 51% 57% 30% 30% 35% 15% 70%

Kibaale 150 80% 2.8 124 0.23% 94% 54% 59% 41% 21% 34% 29% 99%

Kiboga 208 93% 9.9 129 0.77% 97% 34% 76% 41% 5% 17% 13% 69%

Kibuku 30 56% 0.4 50 0.09% 64% 8% 73% 5% 7% 6% 9% 93%

Kikuube 66% 0.66% 93% 51% 55% 29% 19% 25% 34% 75%

Kiruhura 130 95% 0.5 25 0.22% 94% 32% 81% 0% 16% 18% 12% 79%

Kiryandongo 214 80% 9.5 200 0.48% 99% 40% 51% 27% 8% 27% 23% 75%

Kisoro 37 100% 5.3 58 0.92% 76% 20% 80% 51% 15% 3% 5% 82%


DistrictC

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Kitgum 257 58% 26.5 239 1.11% 72% 34% 79% 0% 26% 19% 19% 52%

Koboko 429 93% 6.3 169 0.37% 98% 64% 51% 6% 26% 54% 28% 96%

Kole 121 94% - 22 0.00% 67% 46% 74% 0% 32% 34% 11% 101%

Kotido 262 49% 9.3 631 0.15% 39% 56% 89% 0% 100% 25% 38% 64%

Kumi 227 61% 18.7 211 0.89% 92% 33% 87% 0% 68% 20% 23% 82%

Kwania 43% 0.19% 57% 30% 77% 0% 35% 15% 10% 81%

Kween 89 36% 1.0 19 0.52% 26% 28% 69% 4% 100% 8% 8% 92%

Kyankwanzi 103 85% 0.4 23 0.17% 85% 36% 67% 31% 18% 23% 11% 77%

Kyegegwa 147 73% 9.0 72 1.26% 83% 42% 80% 22% 47% 26% 16% 81%

Kyenjojo 117 82% 7.8 106 0.74% 78% 39% 81% 14% 30% 20% 17% 68%

Kyotera 281 68% 36.6 263 1.39% 93% 34% 64% 32% 32% 23% 33% 101%

Lamwo 607 75% 25.7 276 0.93% 83% 49% 82% 0% 27% 27% 32% 84%

Lira 70 54% 22.4 135 1.66% 95% 21% 70% 0% 13% 9% 16% 98%

Luuka 302 63% - 94 0.00% 98% 60% 66% 0% 60% 36% 35% 64%

Luwero 176 72% 4.6 70 0.66% 50% 38% 82% 18% 47% 17% 10% 69%

Lwengo 149 62% 1.8 149 0.12% 91% 40% 70% 33% 29% 20% 37% 79%

Lyantonde 264 72% 10.6 152 0.70% 100% 37% 64% 39% 18% 17% 21% 78%

Manafwa 187 51% 4.2 272 0.16% 62% 48% 61% 5% 51% 27% 38% 100%

Maracha 422 76% 31.1 57 5.50% 100% 58% 84% 5% 26% 46% 13% 89%

Masaka 166 68% 41.2 207 1.99% 64% 37% 67% 23% 20% 13% 14% 74%

Masindi 208 62% 10.3 105 0.98% 98% 37% 68% 42% 16% 18% 19% 86%

Mayuge 193 58% 2.8 20 1.45% 86% 46% 81% 0% 45% 31% 9% 56%

Mbale 180 76% 11.9 218 0.54% 55% 31% 84% 6% 31% 18% 16% 91%

Mbarara 80 79% 8.0 43 1.87% 85% 23% 73% 0% 41% 8% 4% 88%

Mitooma 173 67% 1.6 107 0.15% 88% 37% 80% 12% 21% 18% 30% 82%

Mityana 250 86% 13.5 125 1.08% 41% 46% 78% 58% 65% 24% 17% 63%

Moroto 295 78% 16.0 345 0.46% 70% 36% 68% 0% 100% 21% 31% 80%

Moyo 1283 73% 25.2 893 0.28% 54% 55% 100% 14% 48% 37% 42% 92%

Mpigi 201 102% 7.7 112 0.69% 92% 35% 69% 15% 12% 20% 10% 95%

Mubende 82 65% - 28 0.00% 84% 46% 67% 17% 20% 24% 9% 52%

Mukono 153 70% 1.7 19 0.86% 100% 42% 100% 10% 27% 22% 7% 72%

Nabilatuk 48% 0.10% 69% 49% 81% 0% 73% 26% 62% 81%


DistrictC

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Nakapiripirit 128 60% 3.8 147 0.26% 64% 40% 75% 0% 30% 29% 42% 80%

Nakaseke 133 54% 8.6 37 2.34% 62% 27% 73% 16% 22% 13% 4% 75%

Nakasongola 279 68% 6.9 160 0.43% 56% 43% 73% 29% 50% 22% 28% 77%

Namayingo 473 75% 10.1 213 0.47% 91% 64% 74% 0% 55% 47% 44% 65%

Namisindwa 78 51% 4.9 24 2.00% 66% 40% 66% 8% 70% 23% 15% 86%

Namutumba 131 49% - 37 0.00% 78% 41% 57% 0% 44% 20% 14% 86%

Napak 193 60% 13.8 218 0.63% 96% 41% 80% 0% 66% 23% 21% 75%

Nebbi 364 74% 31.6 320 0.99% 99% 53% 69% 4% 28% 34% 22% 91%

Ngora 304 62% 7.0 142 0.50% 19% 40% 79% 0% 100% 30% 34% 69%

Ntoroko 51 56% 11.0 86 1.28% 86% 19% 80% 29% 26% 7% 12% 90%

Ntungamo 144 78% 4.8 65 0.74% 74% 33% 64% 1% 26% 19% 19% 78%

Nwoya 231 88% 4.7 144 0.32% 60% 56% 78% 0% 39% 32% 29% 98%

Omoro 250 73% 4.9 102 0.48% 83% 38% 82% 0% 66% 24% 27% 52%

Otuke 177 98% 6.6 151 0.44% 76% 37% 65% 0% 7% 26% 24% 99%

Oyam 188 70% 3.1 110 0.28% 70% 51% 92% 7% 100% 27% 23% 67%

Pader 235 64% 2.6 120 0.22% 70% 36% 85% 2% 36% 19% 21% 42%

Pakwach 535 94% 14.9 190 0.78% 100% 63% 67% 25% 35% 45% 31% 87%

Pallisa 77 39% 3.3 36 0.91% 100% 18% 79% 1% 36% 11% 11% 85%

Rakai 231 64% 15.5 90 1.73% 84% 46% 78% 42% 28% 21% 16% 71%

Rubanda 19 100% 0.5 14 0.34% 94% 16% 100% 2% 13% 2% 4% 104%

Rubirizi 116 100% 3.6 22 1.64% 97% 32% 79% 2% 3% 17% 8% 92%

Rukiga 26 94% 1.0 19 0.50% 45% 13% 98% 18% 40% 2% 4% 89%

Rukungiri 157 75% 8.3 154 0.54% 66% 29% 80% 14% 28% 11% 17% 92%

Sembabule 145 58% 6.4 54 1.17% 20% 44% 58% 23% 28% 24% 25% 94%

Serere 80 32% 2.3 138 0.17% 61% 15% 77% 1% 72% 10% 20% 80%

Sheema 81 101% 5.7 76 0.76% 28% 21% 78% 11% 9% 9% 11% 91%

Sironko 98 40% 5.9 49 1.20% 84% 33% 69% 13% 49% 15% 15% 87%

Soroti 232 50% 38.4 242 1.58% 78% 26% 60% 0% 45% 17% 20% 78%

Tororo 158 83% 4.8 56 0.85% 43% 24% 100% 34% 22% 14% 11% 75%

Wakiso 63 53% 2.3 41 0.56% 40% 28% 100% 0% 44% 12% 18% 38%

Yumbe 496 81% 6.4 219 0.29% 72% 61% 86% 14% 65% 42% 34% 94%

Zombo 174 79% 8.3 83 1.00% 94% 41% 79% 0% 28% 26% 15% 88%




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MINISTRY OF HEALTH Plot 6, Lourdel Road, Nakasero

P. O. Box 7272, Kampala - UgandaTel: +256 417 712260. Email: [email protected]

Call Center Toll free 0800-100-066