ANEMIA AND PARISTOLOGY SURVEYS

Malaria Intervention Coverage and Associated Morbidity Indicator Survey in Children under five years in Uganda

USAID/PMI
Dr. Patrick Okello

CDC/PMI
Dr. Sussann Nasr
Dr. Scott Filler
Dr. Laura Steinhardt
Dr. Manoj Menon

In collaboration Uganda Malaria Surveillance Project (UMSP) including:

Makerere University
Prof. Moses Kamya
Dr. Adoke Yeka
Mr. Sam Nsobya
Ms. Moses Kiggundu

UCSF
Dr. Grant Dorsey

LSHTM
Dr. Sarah Steadke

Ministry of Health, Uganda Adibaku Serraphine
Dr. Denis Rubahika
Mr. Agaba Bosco

Malaria is one of the leading causes of morbidity and mortality in Uganda. Data from public and private health facilities indicate that malaria is responsible for 30-50 % of out-patient clinic attendances, 15-20 % of admissions and 9-14 % of in-patients deaths. Surveillance of these conditions is based on passive case reports from health facilities and sentinel surveillance from selected sites. This survey is designed to obtain population-based estimates of malaria programme indicators to complement routine data in informing strategic planning and evaluation of relevant control programmes.

Objective:

1. To measure the impact of IRS on malaria transmission intensity (as measured by parasitemia and anemia) in northern Uganda.

2. To determine the coverage of LLINs in the central region after the targeted distribution campaign to pregnant women and children under 5 years.

Impact of IRS in Northern Uganda. Cross-sectional household surveys with biomarkers will evaluate the effect of IRS in 2 districts (Pader, Apac) that have received spraying funded by PMI and in one control district (Lira) that has not been sprayed. The survey took place in November 2010 and then repeated in November 2011 at the peak of the malaria transmission season. The survey was based on a two-stage sampling procedure within each district. The primary sampling units was the census enumeration areas (EAs) of the 2002 National Housing and Population Census. In each district, 30 enumeration areas (EAs) with 20 households (HHs) per EA were selected. All children under five years (about one per household or 600 per district) were tested for biomarkers. Household interviews were administered to heads of households. Women’s interviews were conducted with consenting females aged 15-49 years in the households. Survey teams comprised of supervisors, interviewers, and laboratory technicians conducted interviews and collect the biological samples. Data were collected on socio-economic and demographic characteristics and knowledge of malaria. The survey was also collect data on indoor residual spraying, long-lasting insecticidal mosquito nets, mosquito net re-treatment status and use among all household members, home-based management of malaria, and intermittent preventive treatment for pregnant women. Capillary blood from children 0-59 months was collected and tested for malaria and anaemia. Thick and thin blood smears was also be prepared from these children and used for surveillance. Home-based testing with a rapid test algorithm was conducted for malaria and anaemia, to identify participants that would benefit from treatment, and results returned to respondents in their households. Respondents with malaria were treated at home according to national treatment guidelines. Blood smears were prepared in the field and shipped to the UMSP Molecular Diagnostic Laboratory in Mulago. Malaria microscopy was conducted on the blood smears. These microscopy results were not be returned to participants.

Coverage of LLIN in the central region. A cross-sectional household survey without biomarkers testing were conducted across 7 districts in the central region (Kayunga, Luwero, Nakaseke, Mubende, Mityana, Mukono and Nakasongola districts) with the primary goal of documenting the change in coverage levels compared to data from the 2009 MIS following a recent targeted campaign to distribute nets to pregnant women and children under 5. The survey was based on a two-stage sampling procedure with a sample size of 600 total households from 30 enumeration areas (EAs) targeting heads of households. Household interviews were administered to heads of households. Women’s interviews were conducted with consenting females aged 15-49 years in the households. The survey was collect data on long-lasting insecticidal mosquito nets, mosquito net re-treatment status and use among all household members, home-based management of malaria, and intermittent preventive treatment for pregnant women.