In Uganda, the battle against malaria is taking a concerning turn. In particular, Pallisa Hospital, along with 13 health center IIIs and four health center IIs, is experiencing a surge in severe malaria cases. These cases, primarily affecting children between the ages of five and fifteen, present a distressing challenge to the local healthcare system. What makes the situation even more complex is the shortage of blood, required for transfusions, and the recurrent stock-outs of anti-malaria drugs that the hospital had been grappling with since October 2022.
Malaria’s Grip on Uganda
Uganda is grappling with a severe malaria crisis, and its struggle against the disease is intensifying. The nation holds the unenviable title of having the highest malaria incidence rate worldwide, with 478 cases per 1,000 people annually, according to the World Health Organization (WHO). Malaria, characterized by intermittent and remittent fever, stands as the primary cause of illness and death in Uganda. It accounts for a substantial percentage of outpatient visits, hospital admissions, and fatalities.
The malaria situation in Uganda is further complicated by the estimated death toll, ranging from 70,000 to 100,000 people each year, exceeding the mortality rate of HIV/AIDS. This grim reality challenges the country’s goal of eliminating malaria entirely by 2030.
Understanding Partial Resistance
Recent data from Uganda, published in a study titled “Evolution of Partial Resistance to Artemisinins in Malaria Parasites in Uganda,” reveals the emergence of partial resistance to artemisinins in various geographical locations. This partial resistance results in a delay in malaria parasite clearance after treatment with Artemisinin-based combination therapy (ACT).
Artemisinin-based combination therapies are the standard treatments for malaria in Uganda and across much of Africa. When microorganisms like malaria parasites develop resistance to these therapies, it becomes exceedingly challenging to treat infections, leading to severe illness and death. The WHO has emphasized that the emergence of resistance to ACTs in Africa could have devastating consequences and warrants continuous surveillance.
The Study
To gain insights into the alarming rise of drug-resistant malaria, researchers conducted annual surveillance among patients with uncomplicated malaria across Uganda from 2016 through 2022. The study included clinics in multiple districts, with variations in the use of indoor residual spraying (IRS) of insecticides. By 2021 to 2022, the prevalence of parasites with validated or candidate resistance markers had exceeded 20 percent in many districts, indicating a worrying trend.
The study reveals the emergence of resistance mutations, including PfK13 469Y, 675V, 469F, 561H, and 441L, in different regions of Uganda. Significantly, the emergence of resistance was most pronounced in areas where effective malaria control measures had been discontinued or where transmission was unstable.
Previous Research
This recent study is not the first to shed light on the challenge of drug-resistant malaria in Uganda. A 2020 study titled “Changing Prevalence of Potential Mediators of Aminoquinoline, Antifolate, and Artemisinin Resistance Across Uganda” highlighted the diminishing effectiveness of Artemisinin-based combination therapy. Despite replacing chloroquine with ACTs for malaria treatment in Africa, the study found the persistence of mutant parasites, even a decade after the change.
Government’s Response
In response to the growing threat of drug resistance in Uganda, the government has taken action. Dr. Jane Aceng, the Health Minister, acknowledged the rise in cases of malaria drug resistance. This resistance is affecting widely-used drugs such as Primaquine and Coartem. Moreover, mosquitoes have developed resistance to chemicals used in bed nets and indoor spraying, leading to increased malaria-related deaths in various regions of the country. In response, Uganda has established a scientific advisory committee to address the issue of drug resistance, which is expected to inform policy changes in malaria treatment.
Malaria continues to be a formidable foe in Uganda, and the emergence of drug resistance presents a significant challenge to the nation’s healthcare system and its goal of malaria elimination.
