3 JULY 2023 The Independent (Kampala)
Kampala, Uganda — Even though the government has over the past couple of decades masterminded a wide-range of interventions in its fight against malaria, one of the deadliest diseases on earth, Uganda remains the third most affected country in the world according to data from the UN’s World Health Organization (WHO).
Recent victims of the disease and some experts are blaming climate change for the explosion of populations of the malaria- causing mosquitoes in most parts of the country including colder areas like Kigezi in the Southwest, reports Ronald Musoke.
Mary Tibenkana, 28, a mother of three who lives in Mugona, a small village on the outskirts of Bugiri – a small town which is just about 150km to the east of Uganda’s capital city, Kampala, says it is difficult for anyone here to have a good night’s rest without sleeping under a mosquito net. She says the increase in mosquito populations in Bugiri District is disturbing.
“Even during day, mosquitoes bite,” she recently told The Independent. “I don’t know why this is the case; we just got mosquito treated nets and they just sprayed our houses (Indoor Residual Spray).”
She says residents have done everything the government has told them to do to prevent malaria but mosquito numbers and disease cases keep growing.
“We have been told to sleep under mosquito nets; we have been asked to clear bushes around our houses and to get rid of broken basins and used mineral water bottles that keep stagnant water. We have also been advised to report quickly to a government hospital when we fall sick so that we can get full treatment,” she told The Independent.
Since this is like an epidemic, unless you come with an open wound, we normally test most of them who present with symptoms of malaria. Even if you come with cough, we will send you to the laboratory.” She says almost three quarters of those who are tested in the laboratory, their results are usually positive.
Bugiri District is probably the country’s epicentre of malaria at the moment. Even this year’s commemoration of World Malaria Day on April 25 was marked in Bugiri Municipality. The area offers probably the best example of what is at stake as Uganda tackles the increased malaria burden.
Nabwire says most patients at Bugiri Hospital’s Out Patient Department (OPD) present with malaria. She says they are in the thousands every month and include patients from surrounding districts of Busia, Mayuge, Bugweri, Namayingo and Namutumba.
“We don’t know whether it is because of the rainy season. May be the wet and warm conditions have made it a little more conducive for the mosquitoes to thrive here,” she says, “But it is also possible that the ever-rising human population has played a role; may be the more human blood the mosquitoes suck, the better their chances of growing and laying more eggs.”
Stubborn mosquitoes
What disturbs Nabwire and Tibenkana is that the malaria problem persists even when the government has provided a range of interventions to stop it. This includes recent distribution of free insecticide treated nets and indoor residual spraying (IRS). “After spraying, the mosquito population went down but they have since made a comeback,” Nabwire says.
Nabwire also told The Independent that although the government supplies the hospital with antimalarial drugs, they now suffer drug stock-outs. “What they (National Medical Stores) deliver gets finished very quickly, especially injectable anti-malarial medicine,” she says. She adds that the hospital also runs out of blood supplies needed to help patients with severe malaria who are anaemic.
However, Dr. Opigo says, according to what they have observed over the last five years (relying on data from the Uganda National Meteorological Authority (UNMA), the minimum and maximum temperatures have remained within the range mosquitoes require to thrive.
But Dr. Opigo adds that since flooding episodes tend to destabilise communities by sweeping away their houses, the victims end up crowding into makeshift camps without proper housing, which is one of the most important malaria control measures.
“So, in this context, the effects of climate change (flooding) could have to do with population displacement and destabilization of their normal lifestyles,” he says.
Dr. Opigo adds that the other climate variability is drought. “Usually when there is prolonged drought, people become complacent and when mosquitoes breed in those areas following heavy rains, malaria cases shoot up,” he says.
Dr. Opigo further explains that climate change also tends to affect the way mosquitoes behave. “Mosquitoes live for only one month; so in one year there can be at least six generations. So, their genetic make-up and behaviour can be altered quite fast. They may, for instance, decide not to bite you inside your house, they may decide not to rest indoors,” he says.
“This is what we have observed in eastern Uganda. We deployed IRS but realized that nothing was happening. We later observed that mosquitoes are no longer dwelling inside the houses. We found the population of mosquitoes which can bite you from outside your house had increased relative to those which bite you while indoors.”
“For those which bite from inside people’s houses, we found that they had stopped resting on the walls (after biting you). They now bite and fly out of the houses. We are yet to find out the factors behind this change in behaviour but it can either be climate-change related or a reaction to the pressure the mosquitoes are feeling due to malaria control measures.”
Dr Jonathan Kayondo, a research biologist based at the Uganda Virus Research Institute (UVRI)’s Department of Entomology in Entebbe says this is not surprising. He told The Independent that mosquitoes are living things and also respond to the environmental pressure thrown at them.
Malaria and Poverty
Meanwhile, Dr. Opigo told The Independent that there is one other factor that should not be downplayed when it comes to malaria prevalence. He says there appears to be a correlation between high malaria incidence and level of poverty in the country. “If you get the Uganda Bureau of Statistics (UBOS) poverty map, it exactly overlays the regions with the highest malaria burden,” he said.
“And if you dig deeper, even within those malaria-prone regions, you will find that the urbanized areas have less malaria because housing is relatively better, drainage is fixed, people’s compounds are groomed and the residents have relatively better access to healthcare services.”
Opigo told The Independent that the people in urban areas also tend to be more educated than rural people, meaning they are more likely to adhere to malaria preventive measures than rural folk.
Interestingly this is what Mary Tibenkana says she and residents of Bugiri have been doing and yet they still have a malaria problem.
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