The past, present and future use of epidemiological intelligence to plan malaria vector control and parasite prevention in Uganda

Abstract

BackgroundAn important prelude to developing strategies to control infectious diseases is a detailed epidemiological evidence platform to target cost-effective interventions and define resource needs.MethodsA review of published and un-published reports of malaria vector control and parasite prevention in Uganda was conducted for the period 1900–2013. The objective was to provide a perspective as to how epidemiological intelligence was used to design malaria control before and during the global malaria eradication programme (GMEP) and to contrast this with the evidence generated in support of the Roll Back Malaria (RBM) initiative from 1998 to date.ResultsDuring the GMEP era, comprehensive investigations were undertaken on the effectiveness of vector and parasite control such as indoor residual house-spraying (IRS) and mass drug administration (MDA) at different sites in Uganda. Nationwide malariometric surveys were undertaken between 1964 and 1967 to provide a profile of risk, epidemiology and seasonality leading to an evidence-based national cartography of risk to characterize the diversity of malaria transmission in Uganda. At the launch of the RBM initiative in the late 1990s, an equivalent level of evidence was lacking. There was no contemporary national evidence-base for the likely impact of insecticide-treated nets (ITN), no new malariometric data, no new national cartography of malaria risk or any evidence of tailored intervention delivery based on variations in the ecology of malaria risk in Uganda.DiscussionDespite millions of dollars of overseas development assistance over the last ten years in ITN, and more recently the resurrection of the use of IRS, the epidemiological impact of vector control remains uncertain due to an absence of nationwide basic parasite and vector-based field studies.ConclusionReadily available epidemiological data should become the future business model to maximize malaria funding from 2015. Over the next five to ten years, accountability, impact analysis, financial business cases supported by a culture of data use should become the new paradigm by which malaria programmes, governments and their development partners operate.

The skeletal manifestation of malaria: An epidemiological approach using documented skeletal collections

“…The Galloway Osteological Collection, housed at the Makerere University Medical School in Kampala, Uganda, is a large medical collection of unclaimed and donated Mulago Hospital patients who died between 1947 and 1980. In the mid-20th century, chloroquine and pyrimethamine were the main antimalarial drugs used in Africa to ameliorate the symptoms of malarial infections, including severe anemia (Musoke, 1961;Webb, 2014;Talisuna et al, 2015). Since East Africa is known to be holoendemic for falciparum malaria, all of the individuals present in the collection likely experienced multiple infections of malaria during their lifetimes.…”

“…Additionally, medical records associated with the collection provide demographic information (i.e., age, sex, tribe) and cause of death for each individual. Although the WHO sponsored Global Malaria Eradication Program was active in Southwestern Uganda between 1955 and 1969, the few attempts at mass antimalarial chemoprophylaxis failed due to noncompliance (Webb, 2014;Talisuna et al, 2015). It is likely that medical intervention with administration of antimalarial drugs would have taken place if the patients presented with symptoms of malaria when they were admitted to the hospital, no matter the determined cause of death.…”

Low prevalence of laboratory-confirmed malaria in clinically diagnosed adult women from the Wakiso district of Uganda

“…According to the results of this survey, malaria prevalence based on LM ranged from 3.0 to 5.1% among adults aged ≥18, while prevalence based on both LM and molecular techniques ranged from 18.8 to 53.5% in the same age group [8]. This is one of the first detailed studies on the prevalence of malaria in adults, but additional data from other regions and broad age groups is needed to adequately monitor malaria trends in Uganda [10]. …”

Migration statistics relevant for malaria transmission in Senegal derived from mobile phone data and used in an agent-based migration model

“…In locations where endemicity is spatially heterogeneous, population mobility can also act to transport malaria parasites, and may lead to outbreaks in epidemic zones (Martens and Hall, 2000;Wesolowski et al, 2012b). For example, the success of early efforts to control malaria in northern Uganda was hindered by the reintroduction of the parasite through population movements (De Zulueta et al, 1961;Talisuna et al, 2015). A number of studies have attempted to determine the role of migration in malaria transmission (TorresSorando and Rodrıguez, 1997;Tatem and Smith, 2010;Lynch and Roper, 2011;Pindolia et al, 2013).…”