Dr Dorothy Echodu
CEO, Pilgrim Africa
Uganda has achieved a remarkable reduction in malaria transmission by focussing on high burden areas. The challenge now is to maintain momentum amid the COVID-19 crisis.
Between 2017 and 2018, the number of malaria cases in Uganda fell by 1.5 million due, in part, to a renewed focus on tackling the disease in high burden areas.
Dr Dorothy Echodu, CEO of Pilgrim Africa, an NGO based in Uganda and the US, is the architect of one successful effort to dramatically reduce malaria transmission in Uganda. “The poorest 20% of citizens bear 10 times the disease burden of the wealthiest 20%,” she notes. “We will never eliminate this disease until we focus on the poorest, most difficult geographies.”
Perfect storm of poverty and ideal conditions for mosquitoes
This extraordinary progress can’t be taken for granted. Uganda faces a complex array of environmental and social challenges.
The wet, humid climate provides an ideal breeding ground for mosquitos, while widespread poverty hampers access to prevention, testing and treatment.
“And there is a psychological challenge,” explains Echodu. “Our communities sometimes have a 70% infection rate. It’s hard for people to imagine life without the constant realities of malaria. Changing this mindset is critical.”
Combined, layered strategies lead to success
Complex challenges require a coordinated response. Pilgrim Africa developed a novel approach that layers traditional control methods to help disrupt the entire malaria transmission cycle, generating significant reductions. As Echodu explains: “The key now is scaling this effort.”
“Distributing bed nets is great, but it’s only part of a comprehensive approach. Adding proactive case management in the same communities affords greater protection. Additional tools to control mosquitos may be needed, too.”
Our communities sometimes have a 70% infection rate. It’s hard for people to imagine life without the constant realities of malaria. Changing this mindset is critical.
Together with Uganda’s Ministry of Health, Pilgrim Africa led a 2008-09 trial of another layered initiative – combining indoor residual spraying (IRS) with mass drug administration. This combined approach led to a 80% drop in malaria cases. With partners, they recently conducted a longer study to further investigate this synergy.
And, because IRS can be too expensive for ongoing use, current research examines the effectiveness of combining pyrethroid-PBO bed nets, a cheaper alternative, with proactive community case management in areas where IRS must be withdrawn.
All the findings are relayed to the National Malaria Control Division in Uganda to help shape a scaled, sustainable national response.
Community volunteers are essential
When it comes to innovation, new technology often claims the limelight, but community health volunteers play a pivotal role in integrated health campaigns and on-the-ground malaria testing. In many Ugandan communities, they carry out critical, life-saving work.
Unfortunately, such workers are a low priority when it comes to distribution of personal protective equipment.
Pilgrim Africa has been quick to address this. “With help from our key partners, we were able to obtain masks, gloves and soap for hundreds of health workers.” says Echodu. With protocols in place, these local champions have been able to continue anti-malaria efforts while assisting the Ministry of Health with COVID-19 response.
“In rural communities, where malaria thrives, there isn’t the access to media and communication that we’re used to in urban centres. The best way to exchange health information is person-to-person,” confirms Echodu, underscoring the importance of an active volunteer presence.
Uganda’s progress shows what can be achieved when combined efforts are focused on high-burden areas. Pilgrim Africa hopes that further research and innovation that will help guide investment toward effective programmes.
“Lives depend on it,” says Echodu.