The malaria burden in Uganda

Malaria is one of the oldest diseases, and the mosquito is the deadliest insect on the planet. The highest malaria transmission rate is found in Africa, specifically four African countries, which accounted for just over half of all malaria deaths worldwide in 2021.
These countries are Nigeria (31.3 percent), the Democratic Republic of the Congo (12.6 percent), the United Republic of Tanzania (4.1 percent) and Niger (3.9 percent). According to the latest World Malaria Report, there were 247 million malaria cases in 2021 compared to 245 million cases in 2020. The estimated number of malaria deaths was 619,000 in 2021 compared to 625,000 in 2020.
Uganda carries the 5 percent of the malaria burden in Africa, with a 1.7 million increase in cases between 2019 and 2021. The average economic loss in Uganda annually is over $500 million. In 2021, WHO reported an estimated 13 million malaria cases and over 19,600 estimated deaths in the country.
Between 2000 and 2020, there was a significant decrease in malaria cases in Uganda, from 487 (per 1,000 people) in 2000 to 283 (per 1,000 people) in 2020. (World Bank.)  For a long time, Chloroquine was the main antimalaria drug, but since the appearance of chloroquine-resistant strains in the 1950s, the resistance has spread quickly, leading to declines in efficiency and use.
Artemisinin, derived from the plant artemisia annua, is now the first line of treatment. Used in combination with other drugs, it rapidly clears inside the body and kills the parasites at a fast pace before another long-lasting drug ends the process. These combinations are known as Artemisinin-based Combination Therapies (ACT).
Other preventative tools include insecticide-treated bed nets, indoor residual sprays, and preventative chemotherapy used for vulnerable populations. Preventative chemotherapies, include perennial malaria chemoprevention, seasonal malaria chemoprevention and intermittent preventive treatment of malaria in pregnancy. These are safe and cost-effective strategies intended to complement other malaria control strategies.
In 2021, WHO began recommending the use of RTS,S/AS01 malaria vaccine among children living in regions with Plasmodium falciparum malaria transmission. The vaccine has been shown to reduce malaria and deadly severe malaria among young children. Insecticide-treated bed nets have helped reduce the number of deaths, but the numbers are rising again. Many mosquitos have developed resistance to insecticides, making the nets less effective.
Recent studies by the WHO confirm the emergence of partial artemisinin resistance in Eritrea, Rwanda and Uganda. Although resistance to the currently used Artemisinin-based Combination Therapies (ACT) partner drugs has not been confirmed, the artemisinin is clearing the parasite at a slower pace than it should be, paving the way to resistance development soon.
A new Anopheles mosquito, Anopheles stephensi, commonly found in Asia, has been spotted in Africa. In comparison to An. gambiae which thrives in rural environments and rainy seasons, the An. stephensi prefers human-made water storage containers, allowing it to survive all year and stay active during dry seasons. Research also shows that An. Stephensi prefers to rest in barns or sheds rather than homes. Therefore, mosquito control measures, such as bed nets and indoor insecticide spraying, may not provide effective control. With many countries worldwide investing in various research and projects to combat malaria, progress is continuously being made. Malaria can be eliminated through continued efforts to innovate and find new tools for fighting malaria-transmitting mosquitoes.
Jonathan Kayondo is the principal investigator for Target Malaria in Uganda.