Impact Evaluation

Evaluation of the Impact of Malaria Control Interventions in Uganda, 2000 - 2011

Principal Investigator: Professor Moses Kamya, Makerere University 

Co-Investigators:

Makerere University: Adoke Yeka

UCSF: Grant Dorsey, Phil Rosenthal

LSHTM: Sarah Staedke

Uganda National Malaria Control Program (UNMCP): Okui Albert Peter, Lugemwa Myers, Henry Katamba, Mathias Mulyazawo

WHO-Uganda: Katureebe Charles

ICF International: Yazoume Ye

Centre for Disease Control (CDC): Achuyt Bhattarai

United States Agency for International Development (USAID): Christine Hershey, Joel Kisubi

President's Malaria Initiative (PMI), Uganda: BK Kapella, Kassahun Belay

The goal of the Roll Back Malaria Partnership (RBM) is to reduce the number of malaria cases and deaths by 50% by the year 2010 and to reduce the global incidence of malaria by 75% by 2015 through the scale up of proven interventions. Efforts to reduce the burden of malaria in Africa have intensified recently through the use of effective tools for malaria control, notably long-lasting insecticide treated nets (ITNs), indoor residual spraying (IRS) of insecticides, treatment with artemisinin-based combination therapies (ACTs), and intermittent preventive therapy (IPT) for high-risk groups. These efforts have been made possible by recent focused policy recommendations and increased support from governments and international organizations such as the President’s Malaria Initiative (PMI) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Like many other countries in SSA, Uganda has made substantial progress towards implementing malaria control interventions particularly distribution of ITNs, IRS and IPTp for prevention and ACT for case management. Uganda has seen improvement in malaria intervention coverage from 2006-2010 approximately 11.5 million long-lasting insecticidal nets (LLINs) were distributed nationwide. By 2011, 59% of households reported owning at least one LLIN. In 2011, 812,522 structures were sprayed as part of IRS programs protecting more than 4 million residents. Coverage of IPTp has however remained low at 26.7% in 2011.

To date, no comprehensive analyses have been done to assess the impact of malaria control interventions at national and sub-national levels in Uganda. Following the surge in control activities over recent years, there is a strong international and national demand for evidence on the impact of malaria control, particularly for the last 10-year period.

The main objective of the evaluation is to assess the impact of malaria control interventions, such as use of ITNs, IRS, intermittent preventive therapy in pregnant women (IPTp) and malaria case management, on malaria morbidity and all-cause mortality in children under five years of age, during 2000-2011. The evaluation also considers other factors that might have contributed to the mortality decline over the period. The impact evaluation shall measure the progress toward achieving national and international goals and targets that result from the combined efforts of the government of Uganda and other partners involved in malaria control efforts in the country. In addition to providing data on the impact of malaria control interventions, the report gives information on malaria epidemiology and control in an area of high malaria transmission intensity.

The evaluation will focus on the 2000-2010 period during which most malaria control interventions were introduced. Prior to 2000, new antimalarial drugs had not yet been introduced, and ITN and IPTp had not yet been scaled-up on a national scale. Mortality data and background information on relevant malaria control policies from the 1990s will be included where this helps to put recent changes into perspective.

The impact evaluations will assess whether or not changes have occurred in all cause under-five mortality. All cause under-five mortality is used as a primary measure of impact because of the difficulty in directly measuring levels and trends in malaria-specific mortality in sub-Saharan Africa (SSA). The evaluations are guided by the RBM Monitoring and Evaluation Reference Group (MERG) recommendations on using indirect methods and models to measure the change in malaria-specific mortality.