2018-19 Uganda Malaria Indicator Survey (UMIS) Atlas of Key Indicators The Republic of Uganda Ministry of Health
This atlas summarizes results from the 2018-19 Uganda Malaria Indicator Survey (2018-19 UMIS). The survey was implemented by the National Malaria Control Division (NMCD) and the Uganda Bureau of Statistics (UBOS). Financial support for the survey was provided by the United States Agency for International Development (USAID) through the President’s Malaria Initiative (PMI), the United Kingdom Department for International Development (DFID), the Government of Uganda with Global Fund support, and the the World Health Organization (WHO). ICF provided technical assistance through The DHS Program, a USAID-funded project offering support and technical assistance in the implementation of population and health surveys in countries worldwide.
Additional information about the 2018-19 UMIS may be obtained from the National Malaria Control Division, Plot 6, Lourdes Rd., Wandegeya, P.O. Box 7272, Kampala, Uganda.
Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1-301-407-6500; fax: +1-301-407-6501; email: [email protected]; internet: www. DHSprogram.com.
Recommended citation:
Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS), and ICF. 2019. 2018 ‑19 Uganda Malaria Indicator Survey Atlas of Key Indicators. Kampala, Uganda, and Rockville, Maryland, USA: NMCD, UBOS, and ICF.
Cover map is an elevation map of Uganda. About the 2018-19 UMIS
The 2018-19 Uganda Malaria Indicator Survey (UMIS) is designed to provide up-to-date estimates of basic demographic and health indicators related to malaria. Specifically, the 2018-19 UMIS collected information on vector control interventions such as mosquito nets and indoor residual spraying of insecticides, on intermittent preventive treatment of malaria in pregnant women, on care seeking and treatment of fever in children, and malaria knowledge. Young children were tested for anaemia and for malaria infection.
The 2018-19 UMIS is the third Malaria Indicator Survey conducted in Uganda; the first was conducted in 2009 and the second in 2014-15. Malaria data have also been collected in the 2006, 2011, and 2016 Uganda Demographic and Health Surveys. Repeated surveys allow for an analysis of trends over time. The information collected through the 2018-19 UMIS is intended to assist policy makers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population. Who participated in the survey? The 2018-19 UMIS data collection was conducted between December 2018 and February 2019 at the peak of malaria season. A nationally representative sample of 8,231 women age 15–49 were interviewed in 8,351 households. This represents a response rate of 98% for women. More than 7,000 children under 5 were tested for malaria and anaemia as part of the 2018-19 UMIS. This sample provides indicators for the country as a whole, for urban and rural areas separately, for each of the country’s 15 regions and for 14 current and 11 past indoor residual spraying (IRS) intervention districts. Refugee settlements in 9 northern and western districts were included as a separate sampling domain. 2018-19 UMIS Atlas Maps allow for a visual interpretation of population and health indicators across regions. Malaria prevention, treatment, and prevalence are not consistent across all regions. Maps help to show where patterns exist, which regions are making good progress towards better health, and which regions require additional interventions.
© 2012 Kim Burns Case/JHUCCP, Courtesy of Photoshare
2018-19 Uganda Malaria Indicator Survey Page 1 ITN Ownership
SOUTH SU AN EN A EMOC ATIC West Nile EPU LIC 92 Acholi OF THE 83 aramo a 58 CON O
Uganda Lango 83 unyoro 83 Teso 88 90 Refugee settlements 79% a e l ert ugisu North uganda 86 77 usoga 84 Tooro u edi 88 83 South uganda 83 ampala a e d ard An ole 74 58 - 67 86 68 - 75 ige i 76 - 84 89 85 - 92 TAN ANIA a e WAN A ictoria
Household Ownership of Insecticide-treated Nets (ITNs) More than 8 in 10 (83%) households in Uganda own at least one insecticide-treated net (ITN). ITN ownership is lowest in Karamoja, where 58% of households own at least one ITN and highest in West Nile, where 92% of households own at least one ITN. Among households in refugee settlements, 79% own at least one ITN.
Page 2 2018-19 Uganda Malaria Indicator Survey Universal Coverage of ITNs
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 56 Acholi OF THE 46 aramo a 25 CON O
Uganda Lango 50 54 unyoro Teso 55 52 Refugee settlements a e l ert ugisu 38% North uganda 58 50 usoga 51 Tooro 58 u edi 47 South uganda 59 ampala a e d ard An ole 59 62 25 - 37 ige i 38 - 52 62 53 - 62 TAN ANIA a e WAN A ictoria
Universal Coverage of Insecticide-treated Nets Universal coverage is defined as the proportion of households with at least one ITN for every two people in the household. More than half (54%) of Ugandan households have at least one ITN for every two people in the household. Universal coverage of ITNs is lowest in Karamoja (25%) and highest in Ankole and Kigezi (62% each). Nearly 4 in 10 (38%) households in refugee settlements have at least one ITN for every two people in the household.
2018-19 Uganda Malaria Indicator Survey Page 3 ITN Access
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 76 Acholi OF THE 62 aramo a CON O 41
Uganda Lango 66 72 unyoro Teso 75 75 Refugee settlements a e l ert 61% ugisu North uganda 74 69 usoga 67 Tooro u edi 78 66 South uganda 75 ampala a e d ard An ole 72 79 41 - 54 ige i 55 - 67 78 68 - 79 TAN ANIA a e WAN A ictoria
Access to Insecticide-treated Nets by Household Members Access to an ITN is measured by the proportion of the population that could sleep under an ITN if each ITN in the household were used by up to two people. Overall, nearly three-quarters (72%) of Ugandans have access to an ITN. Access to ITNs by household members is lowest in Karamoja (41%) and highest in three regions – Ankole (79%), Kigezi (78%), and Tooro (78%). Sixty-one percent of the refugee settlement household population has access to an ITN.
Page 4 2018-19 Uganda Malaria Indicator Survey ITN Use by Household Members
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 62 Acholi OF THE 55 aramo a CON O 28
Uganda Lango 59 unyoro 55 Teso 67 66 Refugee settlements 60% a e l ert ugisu North uganda 70 52 usoga 52 Tooro u edi 68 56 South uganda 62 ampala a e d ard An ole 59 66 28 - 42 ige i 58 43 - 56 57 - 70 TAN ANIA a e WAN A ictoria
Use of Insecticide-treated Nets by Household Members Overall, more than half (59%) of household members slept under an ITN the night before the survey. Use of ITNs by household members is lowest in Karamoja (28%) and highest in Bugisu (70%). Six in ten household members in refugee settlements slept under an ITN the night before the survey.
2018-19 Uganda Malaria Indicator Survey Page 5 Intermittent Preventive Treatment during Pregnancy (IPTp)
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 78 Acholi OF THE 66 aramo a 71 CON O
Uganda Lango 66 72 unyoro Teso 71 86 Refugee settlements a e l ert ugisu 74% North uganda 71 74 usoga 72 Tooro 73 u edi 77 South uganda 66 ampala a e d ard An ole 63 71 63 - 68 ige i 69 - 77 81 78 - 86 TAN ANIA a e WAN A ictoria
IPTp2+ Pregnant women should receive two or more doses of SP/Fansidar to prevent malaria during pregnancy (IPTp2+). Nearly 3 in 4 (72%) Ugandan women age 15-49 with a birth in the two years before the survey received at least two doses of SP/Fansidar during their most recent pregnancy. Coverage of two or more doses of IPTp is lowest in Kampala (63%) and highest in Teso (86%). In refugee settlements, 74% of pregnant women received IPTp2+.
Page 6 2018-19 Uganda Malaria Indicator Survey SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 46 Acholi OF THE 39 aramo a CON O 43
Uganda Lango 41 unyoro 39 Teso 42 48 Refugee settlements a e l ert 48% ugisu North uganda 44 42 usoga 36 Tooro 40 u edi 40 South uganda 36 ampala a e d ard An ole 39 38 36 - 41 ige i 42 - 47 52 48 - 52 TAN ANIA a e WAN A ictoria
IPTp3+ Updated IPTp guidelines recommend that pregnant women receive at least three doses of SP/Fansidar during pregnancy (IPTp3+). Nationally, 2 in 5 (41%) women with a birth in the two years before the survey received three or more doses of SP/Fansidar during their most recent pregnancy. Coverage of three or more doses of IPTp is lowest in Busoga and South Buganda (both 36%) and highest in Teso (48%) and Kigezi (52%). Nearly half (48%) of women in refugee settlements received IPTp3+.
2018-19 Uganda Malaria Indicator Survey Page 7 ITN Use by Children
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 64 Acholi OF THE 59 aramo a 35 CON O
Uganda Lango 61 60 unyoro Teso 67 72 Refugee settlements a e l ert 63% North uganda ugisu 74 52 usoga 57 Tooro u edi 68 61 South uganda 59 ampala a e d ard An ole 62 35 - 45 62 46 - 55 ige i 56 - 64 55 65 - 74 TAN ANIA a e WAN A ictoria
ITN Use among Children under 5 Overall, 60% of children under 5 in Uganda slept under an ITN the night before the survey. ITN use by children under 5 ranges from 35% in Karamoja to 74% in Bugisu. In refugee settlements, 63% of children under 5 slept under an ITN the night before the survey.
Page 8 2018-19 Uganda Malaria Indicator Survey Care Seeking for Fever in Children
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 86 Acholi OF THE 87 aramo a 85 CON O
Uganda Lango 95 87 unyoro Teso 85 81 Refugee settlements a e l ert 85% ugisu North uganda 85 89 usoga 88 Tooro 79 u edi 81 South uganda 97 ampala a e d ard An ole 79 - 84 (91 ) 85 - 88 ige i 89 - 93 (88 ) a e 94 - 97 TAN ANIA ictoria WAN A
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Advice or Treatment Sought for Children with Fever Advice or treatment was sought for nearly 9 in 10 (87%) children under 5 with fever in the 2 weeks before the survey. Care seeking for children under 5 with recent fever ranges from a low of 79% in Tooro to a high of 97% in South Buganda. Among children under 5 with recent fever in refugee settlements, 85% had advice or treatment sought.
2018-19 Uganda Malaria Indicator Survey Page 9 Low Haemoglobin in Children
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 5 Acholi OF THE 4 aramo a 13 CON O
Uganda Lango 3 4 unyoro Teso 3 3 Refugee settlements a e l ert 3% North uganda ugisu 4 3 usoga 8 Tooro 1 u edi 3 South uganda 1 ampala a e d ard An ole 5 1 - 4 2 5 - 7 ige i 8 - 10 2 11 - 13 TAN ANIA a e WAN A ictoria
Prevalence of Low Haemoglobin in Children Nationally, only 4% of children under 5 have low haemoglobin (less than 8 g/dl). The prevalence of low haemoglobin in children is highest in Karamoja (13%) followed by Busoga (8%), and lowest in South Buganda and Tooro (1% each). Among children in refugee settlements, 3% have low haemoglobin.
Page 10 2018-19 Uganda Malaria Indicator Survey Malaria Prevalence
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 22 Acholi OF THE 12 aramo a 34 CON O
Uganda Lango 13 9 unyoro Teso 9 8 Refugee settlements a e l ert ugisu 13% North uganda 5 9 usoga 21 Tooro u edi 5 3 South uganda 1 ampala a e d ard An ole 1 0 - 8 3 9 - 17 ige i 18 - 26 1 27 - 34 TAN ANIA a e WAN A ictoria
Malaria Prevalence Overall, 9% of children under 5 tested positive for malaria by microscopy in the 2018-19 UMIS. Malaria in children is most common in Karamoja, where 1 in 3 (34%) children tested positive for malaria, while less than 1% of children tested positive for malaria in Kampala and Kigezi. Among children under 5 in refugee settlements, 13% tested positive for malaria.
2018-19 Uganda Malaria Indicator Survey Page 11 Malaria Prevention Messages
SOUTH SU AN EN A
EMOC ATIC West Nile EPU LIC 41 Acholi OF THE 53 aramo a CON O 43
Uganda Lango 38 39 unyoro Teso 39 53 Refugee settlements a e l ert 16% North uganda ugisu 50 41 usoga 41 Tooro u edi 30 40 South uganda 34 ampala a e d ard An ole 44 27 - 34 27 35 - 40 ige i 35 41 - 47 48 - 53 TAN ANIA a e WAN A ictoria
Exposure to Malaria Prevention Methods Overall, 39% of women age 15-49 have seen or heard a message about malaria in the six months before the survey. Half of women in Acholi (53%), Teso (53%), and Bugisu (50%) report having heard or seen a malaria prevention message, while women in Ankole (27%) are least likely to have heard or seen a malaria prevention message. Only 16% of women in refugee settlements have seen or heard a message about malaria in the six months before the survey.
Page 12 2018-19 Uganda Malaria Indicator Survey