THE REPUBLIC OF UGANDA NATIONAL MINISTRY OF HEALTH CONTROL DIVISION World Malaria Day Scientific Conference 2019

Percent of children sleeping under ITN 80 Contributions for malaria reported by Uganda 2013-2015 70 80% 60 70% 50 60% 50% 40 40% 30 30% 20 A control in Uganda Funding (USD millions) 20% 10 10% 0 Country Global World PMI/ Other WHO UNICEF Other % of children sleeping under ITN % of children 0% 2001 UDHS 2006 UDHS 2009 UMIS 2011 UDHS 2014-15 UMIS Fund Bank USAID bilaterals contributions 2014 2015 2016 (WHO World Malaria Report 2017)

1900 1920 1930 1940 1950 1960 1970 1980 1990 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013 2014 2015 2016 2017 1997: East Africa Network for 1929: Colonel SP Uganda Malaria Upsurge detected Behaviour Change and 1994: Severe Monitoring Anti-Malaria Surveillance Programme Infectious Disease in 10 phased-out IRS Communication (BCC) James visits to 1933: Government 1950: World Health 1976: Civil war epidemics in Treatment (EANMAT), a 23451 Research Collaboration provide advice 1996: National 1998: MCU zonal coordinators (UMSP) founded districts and Arua district strategy launched appoints first Organization (WHO) 1964: Malaria with Tanzania Kabale district, 1995: Malaria sub-regional network of MoH develops (IDRC) created from in April; epidemic surges on malaria control, 1993: Decentralised Intensified Malaria system initiated jointly National Malaria Uganda Malaria National Malaria National Malaria USAID-supported Malaria entomologist to convenes first Pre-eradication and political increasing across Control Unit ministries of health and Four MCU technical National Malaria Strategy the Resource Centre the UMSP continue until 2016, leading to healthcare system Action Plan with existing Integrated Strategy 2000-5 Research Centre Strategy 2011-5 Strategy 2015-20 Action Plan for Districts project work under malaria conference Programme (MPeP) turmoil continues the highlands in (MCU) research agencies, established working groups 2005-9 launched to manage public affecting over 1 million ORG establishment adopted 1996-2000 Management of Childhood launched established launched launched launched to support 48 districts Agriculture in Equatorial Africa established until 1986, health frequency and established Large outbreak in established to report to sector health data MCU develops its first people; NMCP sends 370 of Malaria Survey launched Illnesses programme MoH Inter-agency ever Monitoring and health workers to region Mid-term review of National Unit and a Department in Kampala system collapses severity in three south-western Uganda year intervals associated with El Niño Coordinating Committee Evaluation plan and improves supply of Malaria Reduction Strategic plan malaria engineer (February to March) effective medicines (2014-20) conducted ITN policy and strategy finalised, taxes 1998: Parliament passes and tariffs on nets and insecticides -based IRS policy and National diagnostic IPTp3 policy launched anti-malaria policy waived, and quality standards established Combination Therapy implementation (microscopy and MoH implements WHO long-lasting (ACT) policy First Malaria IPTp policy with three guidelines finalised mRDT) policy launched Integrated Vector ITNs included as key insecticidal nets (LLIN) policy to target implemented Programme Review doses of SP approved as part of Integrated Guidelines and distribution to pregnant women and following 2004 conducted IPTp policy changed but not implemented P preventative strategy for Vector Management Management Strategy children in high risk areas announcement and to include three doses the first time as part of the (IVM) approach of SP approved national anti-malaria policy Fees for using government health preparation period facilities abolished 1920: Major Nakivubo 1950: Ministry of Sanitation’s Vector Control Unit 1959: Malaria eradication Total of nets sold/distributed through Mass screening IRS conducted in Apac IRS switched to use of bendiocarb, IRS scaled-down in IRS implemented in 14 high Médecins Sans covering 10 northern districts, 1917: “Anti- Swamp reclamation continues control activities throughout 1950s to experiments successfully 1990: Small insecticide- all channels increases from 100,000 a and treatment and Oyam using northern districts, burden eastern districts; 1945: Field trials 1948: Gammexane 1963: Large-scale Frontières conducts protecting circa 3 million people by 2013 IRS using Malarial Gangs” 1928: Increasing 1931: Malaria ordinance carried out with IRS and treated nets (ITN) trials year in 2000 to 815,000 in the first half Urban malaria Free nets made IRS with “ITN mixed model” using artemisinin- alpha-cypermethrin following Study shows widespread phased out or ended IRS re-introduced in 11 project in Kampala of DDT undertaken powder sprayed on 1983 in urban areas which included improving field trial of malathion mass distribution of proven resistance to DDT, pirimiphos–methyl used in major use of oil and passed, malaria mass drug administration and projects and district- of 2005 alone vector control available in lambda-cyhalothrin approach between napthaquone, then With GFATM funding, National Malaria DDT, permethrin, deltamethrin in 10 other districts northern districts as part of through to 1950s backwaters and drainage and larviciding in Kampala and carried out in Masaka 25,552 ITNs to 16,687 MoH conducts IRS in Kumi extended to seven towns for Indoor residual spraying Paris green as engineer employed with chloroquine (CQ) and based net sales through projects started economically begins in Kabale and private and dihydroartemisinin– Control Programme (NMCP) carries out lambda-cyhalothrin, and switched to an epidemic response municipalities district with support of From 2000 to 2005, mass ITN households in and Ngora until 2012 its first targeted community mass additional districts (IRS) conducted with by Colonial spraying oil along pyrimethamine (P) in in Jinja and disadvantaged piperaquine conducted, pirimiphos–methyl sensitive VC drainage and larvicides in and Paris green widely NGOs and bilaterals distribution delayed due to change internally displaced is expanded to public sector distribution campaign seven eastern districts MoH launches mass dichloro-diphenyl- Insecticides the lake edges Experimental eradication pilot projects with northern Kigezi, and WHO, protecting 26,000 Kampala areas in the north alongside larval control DDT and pyrethroid at all sentinel sites protecting circa filling in of urban centres used in towns distribute several in implementation plan and Global people (IDP) camps Kanungu in 2007 delivery adopted resistance described following using bendiocarb distribution of trichloroethane (DDT) in Research Unit around Jinja vector- and parasite-based control conducted expanded to region people and IRS implemented Mass free ITN campaign distributes 2,061,057 people breeding sites thousand nets per year Fund to Fight AIDS, Tuberculosis and in Bundibugyo vector susceptibility tests in circa 7.2 million nets to children protecting circa 25 million LLINs Lake Mutanda, Kigezi in Kigezi, Masaka, Lugazi and Kakira by 1964 Malaria (GFATM) procurement process in Katakwi six districts under 5 and pregnant women 2,551,123 people Policy change of first-line Affordable Medicines 1964: CQ-medicated 1988: Study of nearly 1998: EANMAT begins CQ clinical failure reaches 33%; SP Village Health Teams Test, Treat and Track treatment to artemether- Facility - malaria (AMFm) standardised testing of CQ, failure rates are 5-12% across country introduce home-based Initiative adopted salt project at sugar 4,000 children across lumefantrine, with Study of 364 children conducts pilot study Integrated community case provides ACT in private sector iCCM scaled up in sulphadoxine-pyrimethamine management of under 5 in Kyenjojo, Home-based estates in Lugazi and 1969: Study of 489 Arua, Kampala, CQ+SP replace CQ as first-line Results of ongoing artesunate-amodiaquine in five districts to management (iCCM) rolled 33 additional districts (SP) and amodiaquine at eight treatment [malaria] fever (HBMF) Mubende and Kanugu management pilot Integrated community Kakira conducted children shows CQ Masaka, Missindi, efficacy studies showed for children under 5 defined as an alternative inform roll out mRDTs rolled out out nationally Policy changed to support epidemiologically representative sites indicates 34% to 67% projects conducted case management Malaria in Pregnancy Control Strategic widespread resistance in 10 districts to of malaria rapid the use of injectable artesunate iCCM, including malaria, until 1965 under fully sensitive at Kasese and Jinja Updated training in severe risk of clinical failure to 21 districts (iCCM) with malaria CM WHO management of severe malaria Plan launched, emphasising to CQ/SP complement availability diagnostic tests in Kamuli, Kaliro, as the preferred first-line expanded to an malaria eradication Kuluva in West Nile shows CQ malaria management for CQ+SP HBMF with ACTs rolled out to treatment expanded training materials adapted for Uganda intermittent preventative treatment in of free malaria (mRDTs) in all lower Pallisa and Budaka treatment in management of additional 18 districts experimental pilot parasitological failure provided for 2,150 health more than 39 districts in 34 hard-to-reach and a first round of training workshops pregnancy (IPTp), clinical case treatment at facilities severe malaria from project rates exceed 25% for physicians carried out in districts workers in 80 hospitals districts management and prevention with ITNs facilities (30 districts) injectable quinine 1998: Ministry of Health HMIS revised to capture First Malaria Indicator 1957: Human- and (MoH) establishes sentinel Survey (MIS) conducted 1990: Isolated 1992: Health indicators to support mTrac (weekly vector-based studies sites with support of DHIS 2 is nationally surveillance) rolled out 1965: MPeP conducts 1985: First health 1988: First studies of malaria management national monitoring UMSP and MoH undertaken to malaria 1997: HMIS EANMAT and WHO and planning Evidence of rising rates adopted into the nationally, using a survey of 120,000 information system Demographic epidemiology carried information system 1995: Second establish a sentinel epidemiology of system rolled Fourth DHS conducted of malaria hospitalisation HMIS system SMS-based system Sixth DHS conducted people to produce first designed, focused Health Survey out in Kabarole (HMIS) developed DHS conducted EANMAT sentinel sites Third DHS conducted malaria surveillance SM approximately 50,000 out nationally show evidence of CQ since 1999, despite malaria risk map on specific diseases (DHS) conducted and Bundibugyo to include system people in resistance exceeding Integrated Disease distribution of over Fifth DHS conducted Second MIS conducted until 1996 management data Surveillance and northern Kigezi WHO-recommended 15 million ITNs threshold Response (IDSR) adopted since 2005

Organisational: Evolution of national malaria programme, strategic plans and major contextual factors Case management: First-line drug treatments, drug resistance, drug trials, chemoprevention Acknowledgement: Dr. Jimmy Opigo (NMCP), Damian Rutazaana (NCMP), Allen Eva Okullo (NMCP), Agaba Bosco (NMCP), Denis Okethwangu (NMCP), Myers Lugemwa (NMCP), KEY ORG CM Daniel Kyabayinze (NMCP), Jimmy Ogwal (DHI, MoH), Bayo Segun Fatunmbi (WHO AFRO), Paul Mbaka (WHO AFRO), Charles Katureebe (WHO AFRO), Dr Michael E Okia (USAID/Uganda IRS Project Phase II), Dr Adoke Yeka (IDRC, MUSPH), Freddy Kitutu (MakSPH), Arthur Mpimbaza (IDRC), Ruth Kigozi (USAID MAPD), P Policy: Policy and legislation SM Surveillance and monitoring: Surveys, evaluation and operational research Seraphine Adibaku, Andrew Magumba (Malaria Consortium), Espilidon Tumukurate (Jhipiego), Betty Mpeka (Abt Associates), Peter Thomas (US Center for Disease Control & Prevention), Julius Kuule (UMRC/MoH), Simon Kasasa (MUSPH), Peter Mbabazi (NMCP), Rukia Nakamatte (NMCP), Mariam Nabukenya (NMCP), Lucia Baguma (NMCP), Medard Rukaari (NMCP), VC Vector control: LLINs, IRS, environmental and larval control Jane Nabakooza (NMCP), Ambrose Talisuna (WHO AFRO) and Prof Bob Snow (KEMRI-Wellcome Trust Research Programme)

THEME: “It’s a Household War-Chase Malaria to Zero, The Scientific Touch”

VENUE: HOTEL AFRICANA

Wednesday, 17th April, 2019 8.00 AM - 6.00 PM WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

WHO. Target Malaria. PMI MAPD, Arysta Life Sciences, msh, PMI VectorLink, BRAC, Sumitomo, IDRC, Quality Chemicals/ Cipla, CHAI, Guliun Pharma-FOSUM Pharma, IPCA, Vestergaard Frandesen. Pilgrim, KPI. HEPS. Syngenta. Kansai Plascom. Sino Africa. Healthcare Perspective. Norvatis. Troikaa.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 PROGRAM Date 17th April 2019 Hotel Africana, Kampala Uganda

TIME DETAILS RESPONSIBLE ENTITY SESSION I. GOVERNANCE Chair Dr. Henry G. Mwebesa 8.00-8.30am Registration of participants NMCD 8.30-8.35am Welcome Remarks from Organizing Dr. Myer Lugemwa Committee Chair 8.35-8.45am Remarks from Malaria Control Division ACHS Dr. Opigo Jimmy 8.45-8.55am Word from WHO Dr. Bayo Fatunmbi 8.55-9.05am Conference Opening Dr. Atwine Diana Permanent Secretary MoH 9.05-9.20am Guest Lecture Prof. Fred Sengooba, Makerere University, 9.20-9.40am Private sector presentation (5 min each) Bayer, Norvartis, & Sumitomo Chemical Group photograph 09.40- 10.00am Tea/Coffee Break All participants - Hotel Africana SESSION II. INTEGRATED VECTOR MANAGMENT Chair Dr. Shililu Josephate 10.00-10.15am LLIN Evaluation in Uganda Project (LLINEUP) Dr. Samuel Gonahasa – Impact of long-lasting insecticidal nets with, and without, piperonyl butoxide on malaria indicators in Uganda: a cluster- randomised trial 10.15-10.30am Relevance of electronic data management Mr. Muhumuza to the 2017/18 mass LLINs distribution Solomon campaign in Uganda

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10.30-10.45am Insecticide Susceptibility Status of Mr. Michael Okia gambiae s.l. and An.funestus s.l. to Public Health Insecticides from Sentinel Site Surveys in Uganda 10.45-11.00am Recent advances in Gene Drive Research; Dr. Jonathan Kayondo Uses, Risks, Benefits; The case of 11.00-11.30am Q&A SESSION III: MALARIA CASE MANAGEMENT Chair Dr. Magumba Godfrey 11.30-11.45am End User Verification Survey Mr. Joel Miti 11:45-12:00 Aligning National Quantitation to Reduce Ms Juliet Nakiganda Central and Facility Level Stock out of Malaria Commodities 12.00-12.15pm Why do health workers give antimalarials to Dr. Anthony Nuwa RDT-negative patients 12.15-12.30pm Suspected Black Water Fever among children Ms. Esther Kisakye in Manafwa District, Eastern Uganda, 2015 12.30-13.00 Q&A All panelists 13:00-14:00 Lunch SESSION 111: SURVEILLANCE Chair: Dr. Charles Katureebe 14.00-14.15 The Burden of asymptomatic Malaria among Mr. Francis Abwaimo children under five In Acholi, Lango and Karamoja Sub-Region 14:15-14:30pm Piloting expansion of a Public Sector Ms. Dorcas Kemigisha Reporting Tool into Community-Level Private Sector Facilities in Uganda 14:30- 14:45pm Malaria morbidity and mortality trends in Dr. Daniella Busharizi Central Uganda

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SESSION IV: BEHAVIOR CHANGE COMMUNICATION Chair: ACHS Richard Kabanda 14.45-15:00 Novel Strategy To Create Demand For Uptake Mr. Musa Odongo of IPTp and MiP Service through Family Connect Platform In Northern Uganda 15:00-15:15 Mass Action Against Malaria; ‎The benefits of Mr. Peter Mbabazi multisectoral actors engagement in the fight against malaria. A case study of Schools in Mid Northern Districts of Uganda 15.15-15.30 Influence of Behavioral Change Ms. Mariam Communication Approaches on the uptake Nabukenya of Malaria Mass Drug Administration among persons in Kapujan sub-County, Katakwi District 15.30-16:00 Q&A All panellists 16.00-16.15 Summary and way forward Dr. Myers Lugemwa 16.15-16.30pm Closing remarks Director Clinical Services Dr Olaro Charles 16.30-16.00pm Closing Malaria Scientific Conference and Minister of Health launch of the World Malaria Day week Hon. Dr. Jane Ruth Aceng Open time Exhibit and Cocktail

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” iii WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 Prologue In the era where both the and the female Anopheles mosquito have learnt escape routes from antimalarials and insecticides, the need to have science guided interventions for Malaria Control Programs becomes imperative.

The theme for this year’s World Malaria Day globally is” Zero Malaria starts with me” This theme comes in at a time when Uganda has made some good progress in controlling malaria, i.e. from being the 4th global malaria burden contributor after Nigeria, the DRC and India at the turn of the century to No. 10.This theme comes in more handy when the country is planning a 3rd Universal Coverage Campaign next year over and above other control interventions. This success cannot be sustained or improved on without a scientific touch. This onus is therefore not a tall order for all persons of reason in this country since we have the arsenal and scientists in this conference. I am therefore, more than confident that Uganda will meet this challenge through our scientists, who, today are putting on table, some of their research works that will contribute, one way or the other, in defeating malaria the from this country.

The menu for this conference is rich and can be summarized in three categories: studies on case management including malaria in pregnancy aimed at hitting the malaria causative agent-the Plasmodium, studies on integrated malaria vector control, and those on behavioral change and communication. Therefore, as the technical head in the Ministry of Health, it is incumbent upon me and the entire fraternity at the ministry to evaluate contents of this small but important booklet, for possible adoption as strategies to nip malaria in the bud if we have to meet this year’s theme. I therefore wish to thank the organizers and also acknowledge the support from all partners and friends, without whose input, this colloquium would not be consummated.

Dr. Henry G Mwebesa Ag Director General Health Services MINISTRY OF HEALTH

iv “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 Acknowledgement The Uganda Annual World Malaria Day scientific conference hosted by ministry of health draws malaria stakeholders in medicine, professionals representing academia, non-profits NGOs, industry, military Development and Implementation partners and private practice services. The meeting is designed for malaria stakeholders to share information and study findings. It is therefore our duty to understand the evidence presented in this one day scientific conference to direct our planning and policy directions.

I would like to extend a word of thanks to all the staff of the national malaria control programme, the organizing committee led by Dr. Myers Lugemwa, and the team that included Dr Damian Rutazaana, Dr Daniel Kyabayinze, Dr Catherine Maiteki-Sebuguzi, Agaba Bosco, Peter Mbabazi, Rukia Nakamate Maria Nabukenya and Samuel Aine.

In a special way we thank our development and Implementing partners who have continued to support and compliment government efforts to end malaria in Uganda.

I thank all the persons that have supported both financially and in-kind the preparation of the conference. We thank DFID/UKAID, USAID/PMI, WHO, UNICEF, Global Fund, and all their implementing partners including TASO, RHITES, MAPD, Vector Link, PACE, Pilgirm Malaria Consortium, IDRC, HEPS, the academic institutions and our affiliated government agencies.

It is my conviction that this meeting will provide us an avenue to debate and further understand options for malaria control on the path towards malaria elimination under the theme ‘Zero malaria starts with me’

I thank you

Dr Opigo Jimmy ACHS/ Malaria Control Division

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” v WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Word from the Conference Chair Through prayer, magic and witchcraft, mankind has endeavored to deal a blow to malaria with little success if at all and it was not until scientists in the names Dr. Ross and Loverlan identified the causative agent of the malady which has annihilated half the population since Stone Age that better engagement with the culprits was made and continues in the name of science.

Today, we are congregating here to be privy to some of the works by scientists from within and outside the boarders of Uganda, whose main objective in presenting their work is in the name of malaria chasing malaria to zero.

Making this day feit accompli has not been an easy task; a team comprising of Drs. Jimmy Opigo, Dan Kyabayinze, Catherine Maiteki, Damian Rutazaana, Maurine Amutuhaire, Peter Mbabazi, Bosco Agaba Sam Aine, Joel Miti, other members of the National Malaria Control Division and fellows from the Field Epidemiology Fellowship Program had to burn the midnight candle to consummate this activity.

I wish to most sincerely thank all those organizations and persons without whose contribution directly or otherwise this Conference would have been a fiasco. Asante sana WHO, Target Malaria, PMI MAPD, Arysta Life Sciences, msh, PMI VectorLink, BRAC, Sumitomo, IDRC, Quality Chemicals/Cipla, CHAI, Malaria Consortium, Guilin Pharma,FOSUM Pharma, IPCA, Vestergaard Frandesen EA Ltd. HEPS, Syngenta, Kansai Plascon, Sino Africa, Healthcare Perspective, Troikaa Pharmaceuticals Ltd., CRS, Bayer and BHL to mention but a few. It would be naïve of me not to say thank you to you all for coming not only to attend but also to join the intellectual gymnastics taking place in the colloquium. I also wish to apologize for any short-comings that may have occurred in the process of making this exercise.

Dr. Myers Lugemwa Chair- World Malaria Day Scientific Colloquium 2019.

vi “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 Table of Contents Program for World Malaria Day Scientific Colloquium...... i PROLOGUE...... iv Acknowledgement...... v Word from the Colloquium Chair...... vi

ABSTRACTS...... 1

LLIN Evaluation in Uganda Project (LLINEUP) –Impact of long-lasting insecticidal nets with, and without, piperonyl butoxide on malaria indicators in Uganda: a cluster-randomised trial...... 1

Relevance of electronic data management to the 2017/18 mass LLINs distribution campaign in Uganda...... 3

Insecticide Susceptibility Status of Anopheles gambiae s.l. and An.funestus s.l. to Public Health Insecticides from Sentinel Site Surveys in Uganda...... 4

Recent advances in Gene Drive Research; Uses, Risks, Benefits; The case of mosquito control...... 5

Why do health workers give antimalarials to RDT-negative patients? A qualitative study of factors affecting provider decision making at rural health facilities in Uganda...... 7

Suspected Black Water Fever among children in Manafwa District, Eastern Uganda, January 2015 – June 2018...... 8

Prevalence and clinical outcomes of and intestinal parasitic infections among children in Kiryandongo refugee camp, mid-Western Uganda: a cross sectional study...... 10

Aligning National Quantitation to Reduce Central and Facility Level Stock out of Malaria Commodities...... 11

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The Burden of Asymptomatic Malaria among Children under Five in Acholi, Lango and Karamoja Sub-region...... 13

Malaria morbidity and mortality trends in Central Uganda...... 14

Piloting expansion of a Public Sector Reporting Tool into Community-Level Private Sector Facilities in Uganda...... 15

Novel Strategy to create Demand for uptake of IPTP and MIP Service through Familyconnect Platform in Northern Uganda...... 16

Introducing Malaria Testing using MRDTS in the Ante-natal Clinics to improve Parasite Based Diagnosis among Pregnant Women: The case of Public Health Facilities in Mid-Northern Uganda...... 17

Introducing Mass Action against Malaria the Benefits of involving multisectoral actors in the fight against malaria. Case in point for Schools and Mid-Northern Districts of Uganda...... 19

Influence of Behavioral Change Communication Approaches on the Uptake of Malaria Mass Drug Administration among Persons in Kapujan Sub-County, Katakwi District...... 21

Insecticide Resistant Management – New tools...... 23

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LLIN Evaluation in Uganda Project (LLINEUP) – Impact of long-lasting insecticidal nets with, and without, piperonyl butoxide on malaria indicators in Uganda: a cluster-randomised trial

Samuel Gonahasa*, Moses R Kamya, Grant Dorsey, Catherine Maiteki-Sebuguzi, Adoke Yeka, Amy Lynd, Jimmy Opigo, Janet Hemingway, Martin J Donnelly, Sarah G Staedke

ABSTRACT Background. Long-lasting insecticidal nets (LLINs) are a key malaria control intervention, but their effectiveness is threatened by resistance to pyrethroid insecticides. Some new LLINs combine pyrethroids with piperonyl butoxide (PBO), a synergist that can overcome P450-based metabolic resistance to pyrethroids in mosquitoes. In 2017- 18, the Ugandan Ministry of Health distributed LLINs with, and without, PBO through a national mass-distribution campaign, providing a unique opportunity to rigorously evaluate PBO LLINs across different epidemiological settings.

Methods/Design. Together with the Ministry of Health, we embedded a cluster- randomised trial to evaluate the impact of LLINs delivered in the 2017-18 national campaign. A total of 104 clusters (health sub-districts) in Eastern and Western Uganda were involved, covering 48 of 121 (40%) districts. Using adaptive randomisation driven by the number of LLINs available, clusters were assigned to receive one of 4 types of LLINs, including 2 brands with PBO: (1) PermaNet 3.0 [n=32] and (2) Olyset Plus [n=20]; and 2 without PBO: (3) PermaNet 2.0 [n=37] and (4) Olyset Net [n=15]. We are conducting cross-sectional community surveys in 50 randomly selected households per cluster (5200 households per survey) and entomological surveillance for insecticide resistance in up to 10 randomly selected households enrolled in the community surveys per cluster (1040 households per survey), at baseline, and 6, 12, and 18 months after LLIN distribution. Net durability and bio-efficacy will be assessed in 400 nets withdrawn from households with replacement at 12 months. The primary trial outcome is parasite prevalence as measured by microscopy in children aged 2-10 years in the follow-up surveys.

Discussion. PBO LLINs are a promising new tool to reduce the impact of pyrethroid resistance on malaria control. The World Health Organization has issued a preliminary endorsement of PBO LLINs, but additional epidemiological evidence of the effect of PBO LLINs is urgently needed. The results of this innovative, large-scale trial embedded

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 1 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 within a routine national distribution campaign, will make an important contribution to malaria control policy in Uganda, and throughout Africa, where pyrethroid resistance in malaria vectors has increased dramatically. This model of evaluation could bea paradigm for future assessment of malaria control interventions.

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Relevance of Electronic Data Management to the 2017/18 mass LLINs Distribution Campaign in Uganda

*Muhumuza Solomon, Kyagulanyi Tonny, Opigo Jimmy, Katamba Henry, Nuwa Anthony

ISSUE In order to reduce malaria morbidity and mortality, the government of Uganda implemented the 2017/18 LLIN Universal Coverage Campaign, where 26.6million LLINs were distributed to a population of 50.7 million persons reaching a total of 9.5million households in 116 districts and achieving a universal coverage of 97% country wide of the initial target of 85%.

Description: To deliver LLINs to the intended recipients in the most effective and efficient manner, an electronic data management system was put in place to support the monitoring and evaluation (M&E) function of the campaign. The system comprised of key cutting edge technologies, processes and human resource that redefined the face of data management for the entire 2017/18 LLINs campaign as compared to the 2014 LLINs campaign. The system was a high performance role based system that captured 9.5 million records aided by 735 data center staff who also carried out vigorous data quality checks. The system in addition enabled tracking of 884,528 individual house hold registration forms using a unique six-digit barcode number. Using the system, all physical HHR forms were scanned, subjected to Optical Character Recognition (OCR) to enable easy retrieval and securely stored.

Lessons learned: The electronic data management system facilitates easy data entry, backup, allocation, analysis, compilation, retrieval, tracking and reporting onthe various activities of the campaign which helps to inform stakeholders and improve on the overall accountability of the campaign.

Next steps/recommendations: The electronic data management system is currently aiding randomization for the on-going Post LLIN Distribution Monitoring project in 67 districts in Eastern and Western regions of Uganda. The system should be extended to other campaign related data including training and logistics in future to aid easy monitoring, reconciliation and reporting of campaign information. Piloting of mobile electronic devices for registration should be explored.

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Insecticide Susceptibility Status of Anopheles gambiae s.l. and An.funestus s.l. to Public Health Insecticides from Sentinel Site Surveys in Uganda

Michael Okia1, Joseph W. Diclaro II2, James Kirunda1, Josephat Shililu 1, Muhanguzi, Asaph1, Opigo, Jimmy3, Katamba, Vincent3, Richard Echodu4, Jenny Carlson6, Kristen George6, Joel Kisubi7, Kassahun Belay7, Dereje Dengela5, Ananya Price5 , and Hoel, David F8

1.PMI VectorLink Project Uganda, Abt Associates Inc, 2.Uniformed Services University of the Health 3.National Malaria Control Program, 4.Ministry of Health, Uganda; 5.Faculty of Science, Gulu University, Gulu, Uganda; 6.President’s Malaria Initiative VectorLink Project

Insecticide resistance is an increasing threat to the two core vector control interventions in Uganda, indoor residual spraying (IRS) and long lasting insecticide treated nets (LLINs). Using the World Health Organization (WHO) susceptibility test method, we investigated the susceptibility level of Anopheles gambiae s.l. to three pyrethroids (alpha-cypermethrin, deltamethrin and permethrin), one organophosphate (pirimiphos-methyl), and one carbamate (bendiocarb) insecticide in 10 sentinel surveillance sites across Uganda in 2018. The susceptibility of the local vectors to clothianidin and chlorfenapyr was also assessed in 14 and 10 sentinel sites (districts), respectively. Oxidase resistance mechanisms were investigated with synergist assays using the World Health Organization (WHO) test protocol with to piperonyl butoxide (PBO). Intensity of resistance was assessed using both the Centers for Disease Control and Prevention (CDC) bottle and WHO tube assay methods. Three to five day-old female Anopheles mosquitoes reared from field- collected larvae or indoor-resting adults were morphologically identified and tested. Anopheles gambiae s.l. was found generally susceptible (99-100% mortality) to organophosphates, clothianidin and chlorfenapyr. Possible resistance to carbamates was detected in one site, Hoima (97% mortality). Resistance to pyrethroids was widespread with varying exposure mortality ranging from 0% to 85%. An. funestus s.l. was found susceptible (99-100% mortality) to pirimiphos-methyl, bendiocarb, chlorfenapyr, and clothianidin in Katakwi and Soroti districts but was found resistant to pyrethroids in Katakwi and Soroti (2-52% mortality). Resistance intensity studies of An. gambiae s.l. using the CDC bottle and WHO tube assays provided differing resistance intensities. Pre-exposure of An. gambiae s.l. to PBO fully or partially restored susceptibility to pyrethroid insecticides in all test sites. The susceptibility of the two vectors to next-generation insecticides provide alternative insecticide choices for IRS, which can be rotated to help mitigate resistance.

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Recent advances in Gene Drive Research; Uses, Risks, Benefits;The case of mosquito control

Jonathan, K., Kayondo*1 on behalf of Target Malaria Uganda

1, Dept. of Entomology, Uganda Virus Research Institute (UVRI),/ Target Malaria Uganda. (E-mail: [email protected]; [email protected])

ABSTRACT Gene drives, systems that increase transmission of genetic traits into a disproportionate fraction of the organism’s progeny, thereby increasing the odds that they will spread quickly through populations are a natural phenomenon which could be harnessed for control applications against mosquito disease vectors. This is now almost becoming a reality thanks to several technological breakthroughs over the years. Among mosquito research, the most advanced developments are those focused on vector- targeted malaria control applications where various candidate target effector genes, involved in reproduction, and parasite resistance, have been identified; and synthetic genome editing/and drive systems e.g. homing endonucleases, TALENs, CRISPR/Cas9 nucleases e.t.c. have been engineered. Even though no gene-drive products ready for field application are available at the moment, laboratory progress has been promising warranting strategic thinking about preparations for the next steps- i.e. open field trials. While potentially very beneficial, there are risks associated with gene drive research and applications that need to be considered, especially unintended effects on human health or environment. A paramount issue is public acceptance of this novel approach. Experts recommend step-wise research/product development pathways, broad public engagement, robust regulatory and policy frameworks to direct and govern safe and responsible development of this novel application. However, each application is going to have to be considered on its own merit.

Keywords: Gene drive, Synthetic gene drives, Engineered gene drives, mosquito control, Malaria

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 5 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

UGANDA PARLIAMENTARY FORUM ON MALARIA

6 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Why do Health Workers give Antimalarials to RDT-negative Patients? A qualitative study of factors affecting Provider Decision-making at Rural Health facilities in Uganda Anthony Nuwa1, Robin Altaras1 Agaba Bosco2, Elizabeth Streat1, James K. Tibenderana1, Clare Strachan1

1 Malaria Consortium, Kampala, Uganda, 2 National Malaria Control Programme, Ministry of Health, Kampala, Uganda Introduction: Large-scale use of malaria rapid diagnostic tests (RDTs) promises to improve fever case management and ensure the more rational use of antimalarials. However, evidence shows impact has been mixed. This study explored determinants of provider decision making to prescribe antimalarials following a negative RDT result. Methods: A qualitative study was conducted in a rural district in western Uganda, ten months after RDT introduction. To select health facilities for study, prescriptions for all patients with negative RDT results were audited from outpatient registers for a two-month period at all facilities using RDTs (n=30). Facilities were ranked by overall prescribing performance, defined as the proportion of patients with a negative result prescribed any antimalarial. “Positive and negative deviant” facilities were selected; positive deviants (n=5) were defined as < 0.5% and negative deviants (n=7) as > 5%. 55 fever cases were observed at the 12 facilities; all patients were interviewed. 22 providers were interviewed. Analysis followed the framework approach. Results: 8368 RDT-negative patients were identified at the 30 facilities (prescription audit); 330 (3.9%) were prescribed an antimalarial. Of the 55 observed patients, 38 tested negative; 1 of these was prescribed an anti-malarial. Treatment decision making was influenced by providers’ clinical knowledge and beliefs, capacity constraints, and interaction with the patient. Although providers believed in the accuracy ofRDTs, a limited understanding of how the RDT works appeared to affect management of patients who already took artemisinin-based combination therapy. Patient assessment and other diagnostic practices were limited; providers lacked means for identifying alternative causes of fever. Provider perceptions of patient acceptance sometimes influenced treatment decisions. Conclusions: We found overall high provider adherence to test results, but that providers believed in clinical exceptions and sometimes felt they lacked alternatives. Clear communication on test functioning and better methods for assisting diagnostic decision making are needed. “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 7 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Suspected Black Water Fever among Children in Manafwa District, Eastern Uganda, January 2015 – June 2018

Esther. Kisaakye1*, Basuta Bennadette1 , Eurien Daniel1 Lilian Bulage1, Dr. Ario Riolexus Alex1

1Uganda Public Health Fellowship Program, Kampala, Uganda Correspondence: [email protected], [email protected]

Background: On 23 May 2018, a Member of Parliament reported a strange disease affecting children in Manafwa District, Eastern Uganda in the floor of Parliament. Additionally, Uganda Radio Network reported that 14 children had been affected, 8/14 had died, and 6/14 were still hospitalized. The children presented with dark urine following onset of high grade fever. We determined; the existence, nature and magnitude of the disease and recommend evidence-based control measures.

Methods: We defined a suspected case as onset of dark /red urine and any of the following: High grade fever, loss of appetite, fatigue, abdominal pain, abdominal distention, anemia, jaundice, headaches, vomiting, palpitations, sweating and painful urination in a resident of Manafwa District. We reviewed medical records and conducted active community case-finding. We described case persons by time, place and person characteristics. We collected and analyzed blood and urine samples for 11 suspected cases.

Results: We line listed 500 cases with case fatality rate of 6.4% (32/500). Cases increased gradually over years from 2013 to 2018 (2015: AR=5.42 (83/153015), 2016: AR= 8.23 (113/160591), 2017, AR=9.8 (164/166693), and 2018, AR = 6.7 (114/169861). Starting from 2015, when the cases started increasing markedly, to June 2018, the most affected: (1) age-group was 0 to 4 years (AR_2015=7.5/10,000, AR_2016=11/10,000, AR_2017=13/10,000, and AR_2018 (January to June)=7/10,000), and (2) sex were males (AR_2015=5.7/10,000, AR_2016=11/10,000, AR_2017=14/10,000 and AR_2018 (January to June)=9/10,000). The number of sub-counties affected increased over years from one in 2013 to sixteen in 2018. There was no schistosma haematobuim ova, protein, and bilirubin in all the 11 urine samples analyzed. Sickle cell was detected in 1/11 samples, 3/11 tested positive for plasmodium falciparum by microscopy, 9/11 tested positive for malaria by RDT. Haemoglobin levels were low in 9/11 samples, neutropenia and leukopenia was detected in most samples (8/11).

8 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Conclusion, public health actions, and recommendations: The strange disease was likely to be black water fever (BWF), a severe form of Plasmodium Falciparum malaria in which blood cells are rapidly destroyed, resulting in dark urine. We recommended, further investigations to establish the true exposures, emergency management of case-persons and stocking of health facilities with supplies and drugs required in treatment of cases.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 9 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Prevalence and Clinical Outcomes of Plasmodium Falciparum and Intestinal Parasitic Infections among Children in Kiryandongo Refugee Camp, mid-Western Uganda: A Cross Sectional Study

Authors: Paul Oboth1, Yahaya Gavamukulya2* and Banson John Barugahare3

1 Department of Community and Public Health, Faculty of Health Sciences, Busitema University 2 Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University 3 Department of Biology, Faculty of Science and Education, Busitema University

Background: The prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia isa condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body.

Methods: This was a cross sectional study conducted among 476-refugee camp schoolchildren. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration.

Results: The overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual coinfection with Plasmodium falciparum + Taenia spp. compared to single parasitic infection (Odds = 14.13, P = 0.019). Co-infection with Plasmodium falciparum + Taenia spp, was a strong predictor of Malaria and anaemia.

Conclusion: This study shows that Plasmodium falciparum and Taenia spp. co- infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the coinfections in the study area and similar settlements.

10 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Aligning National Quantitation to Reduce Central and Facility Level Stock out of Malaria Commodities

Authors: Juliet Nakiganda, Alex Ogwal, Dr. Jimmy Opigo, Dr. Morries Seru, Bernard Nsubuga

Author affiliations: Clinton Health Access Initiative, NMCP Uganda, Pharmacy Division, National Medical Stores

Abstract: Uganda is one of the top ten countries with the highest malaria disease burden in the world with 95% endemicity, leading to 30-50% of outpatient visits and 15-20% hospital admissions. Despite the marked improvement in its management, commodity access remains a problem with 10% of health facilities continuously stocking out (ACTs) despite increasing efforts to ensure antimalarial commodity funding is 100%.

To address this problem, in 2017, an analysis was carried out by the National Malaria Control Program (NMCP) with support from partners to investigate the cause and design appropriate remedial interventions to fill this gap. It was then discovered that the two quantification exercises, one informing funding and procurement and the other informing distribution to health facilities, were having different outputs with 59% standard deviation. This resulted into continuous central level stock outs, 40% of Health facilities continuously over stocked while 10% were always stocked out. Further Analysis indicated that health facility quantification exercise were not data driven while MoH quantification was based on epidemiological data.

In the FY 2018/19, the NMCP, Pharmacy Division with support from Clinton Health Access Initiative and National Medical Stores, supported health facilities to carry out a data driven quantification exercise and align their output with the Ministry of Health quantification output to ensure commodity availability at all levels of care. The exercise involved using morbidity data (from DHIS2) to estimate health facility commodity need, as well as splitting up the national quantification output basing on the disease burden.

The results from the quantification indicated that the standard deviation from MoH quantification reduced from 59% in 2017 to 3% in 2018 (ACT). The NMS has been adequately stocked throughout the period (FY 2018/19) and health facilities stock availability has improved to over 97%.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 11 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

12 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

The Burden of Asymptomatic Malaria among Children under five in Acholi, Lango and Karamoja Sub-region

Authors: 1Anthony Nuwa1 Francis Abwaimo, 1Musa Odongo, 1Edmound Kertho, 1Shirah Karungi, 1G. Beinomugisha, 2Agaba Bosco, 1Alex Ojaku,2 Opigo Jimmy

Affiliations: 1 Malaria Consortium, Kampala, Uganda 2 National Malaria Control Programme, Ministry of Health, Kampala, Uganda

Track C: Epidemiology, Prevention, Control and Elimination Type of presentation: oral

Introduction: Asymptomatic malaria is commonly defined as “malarial parasitaemia of any density, in the absence of fever or other acute symptoms, in individuals who have not received recent antimalarial treatment” Asymptomatic malaria remains a challenge for malaria control programmes as it significantly influences transmission dynamics. Uganda’s malaria control strategy focuses exclusively on the management of symptomatic malaria.

Methods: A Cross-sectional study design comprised of Household and Malariometric survey was conducted in 8,000 households between July and August, 2018. Each child from the households sampled were invited to participate in the malariometric measurements. In total 6,350 children were tested for malaria using Rapid Diagnostic Testing (RDT) and thick films were picked and sent to Makerere University for microscopy.

Results: The percentage of children under five who had fever in the last two weeks preceding the survey was 22.4% (20.1, 24.9). Results from the malariometric tests revealed that the percent of children under five with malaria parasites (microscopy) was at 17.1% (13.9, 20.9); highest in Karamoja at 36% (29.5, 43), followed by Acholi at 9.8% (7.9, 12.1) and lowest in Lango at 7.9% (5.2, 11.8). Of those who tested for positive with mRDTs 31.1% did not have fever. Karamoja sub region had the highest proportion at 55.3%, while Lango had the lowest at 16.6%. Districts with the highest asymptomatic cases in the respective regions were Kole in Lango at 50%, Kotido in Karamoja at 85.7% and Nwoya in Acholi at 55.8%.

Conclusions: Significant proportion of children without history of fever or having taken anti-malarial medicines in recent past tested positive for malaria.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 13 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Malaria Morbidity and Mortality trends in Central Uganda

1Daniella Busharizi, 1Ruth Kigozi, 1Emily Godwin, 1Patricia Mukose, 2Gloria Sebikaari, 3Peter Thomas, 1Paul Oboth, 1Patrick Bukoma, 4Damian Rutaazana 1Thomson Ngabirano, 6Godfrey Magumba, 6James Tibenderana, 1Sam Siduda Gudoi

1 US President’s Malaria Initiative, MAPD project, Uganda, 2 US President’s Malaria Initiative, US Agency for International Development, Kampala, Uganda , 3US President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA, 4 Uganda National Malaria Control Divisions, Kampala, Uganda, 5 Health Information Division, Ministry of Health, Kampala, Uganda 6Malaria Consortium, London, UK Malaria remains a global heath challenge with 3.2 billion people at risk. In 2016, there were 216 million cases of malaria and 445,000 deaths globally. In Uganda, malaria is among the leading causes of morbidity and mortality, contributing to 30-50% of outpatient department attendance and over 20% of inpatient hospital admissions. In the last quarter of 2016, the US President’s Malaria Initiative (PMI)-supported Malaria Action Program for Districts (MAPD), instituted several interventions to prevent and control malaria in nine high burden districts in Uganda: Kyotera, Sembabule, Lwengo, Rakai, Lyantonde, Bukomansimbi, Kalangala, Kalungu and Masaka. These included: distributing long lasting insecticidal nets through schools and health facilities, improving data reporting and use, and training and mentoring health workers in malaria diagnostics and case management. This study sought to assess the effect of these interventions by comparing trends in malaria morbidity and mortality at the start (October – December 2016: pre-I) and during the intervention period (October – December 2017: post-1yr and October –December 2018: post-2yr). Analysis of District Health Information System 2 data from all 400 district health facilities showed that while the proportion of malaria that was confirmed did not change from 76% in pre-intervention (pre-I), to 75%post- 1yr intervention (post-1yr), it improved to 89% in post-2yr. The proportion of OPD attendance due to malaria fell from 41% in Pre-1 to 27% in post-1yr and 15% in post- 2yr (p-value = 0.003). Similarly, the proportion of inpatient admissions due to malaria reduced from 31% to 21% and then to 15% (p-value = 0.001) in pre-1, post-1yr and post-2yr periods respectively. The number of reported malaria deaths per 100,000 population in the region has fallen from 4 (pre-I) to 3 (post-1yr) to 2 (post-2yr). Malaria morbidity and mortality in this region has fallen significantly over the last 2 years and lessons of implementing multi-channel vector control and reinforcing health worker capacity should be well noted to guide national control efforts.

14 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Piloting Expansion of a Public Sector Reporting Tool into Community-Level Private Sector Facilities in Uganda

Authors: Dorcas Kemishiga, Emily Briskin, Luke Baertlein, Alex Ogwal, Deepa Pindolia, Caroline Kyozira, Dr. Jimmy Opigo

Author affiliations: Clinton Health Access Initiative, NMCP Uganda

Abstract: The private sector is an important source of care for sick children in Uganda. With the aims of improving the quality of care and enhancing government awareness and follow-up of fever cases, in August 2018, a pilot group of 108 community-level private facilities in three districts of Uganda were trained to use a government-designed patient register book and to report a set of case count, diagnosis, treatment and stock indicators weekly via the public-sector SMS-based disease surveillance system, mTrac. Data from mTrac flows into the national DHIS-2, increasing oversight and accountability. District and national health authorities met quarterly to review HMIS data submitted by private facilities via mTrac, selecting those with poor reporting or case management practices to be supervised using a standardized checklist. An observational study was conducted over the six-month pilot, descriptively analyzing routine weekly mTrac data completeness and quality. Further, Mann-Whitney test was used to compare private sector reporting rates to those in the private sector, and linear regression was used to assess trends in private sector reporting rates over time. Results from this pilot period showed that frequency, timeliness, and quality of data reported by private facilities were similar to that of public facilities. With an average weekly reporting rate of 90% in private facilities and 95% in public facilities, the rates were similar, but statistically different (p<0.01), suggesting the need for continued refinement of reporting training and support practices for the private sector. Linear regression analysis showed no effect of time on private sector reporting rate (slope = 0.0, p=0.62), suggesting the reporting rate did not decline over the six-month pilot period. The results indicate that private facilities can be expected to report into HMIS via the mTrac SMS-based platform reliably, and that these results can be sustained. To ensure the scalability and sustainability of reporting by private sector facilities, the relevant policies, guidelines, budgets, and national training and support curricula must be updated to integrate the community-level private sector.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 15 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Novel Strategy to create demand for Uptake of IPTP and Mip Service through Familyconnect Platform in Northern Uganda

1Musa Odongo, 2Joseph Kalanzi, 2Ernest Mayengo, 2Olivia Ichimpaye, Maureen 3Amutuhaire, 3Jimmy Opigo, 1Anthony Nuwa

1Malaria, Malaria Consortium Uganda. 2UNICEF, FamilyConnect, 3National Malaria Control Program, Ministry

Background: FamilyConnect is a short message service based system that sends messages to pregnant women and new mothers on what they can do to keep in good health and stimulate optimal development during the critical first 1000 days of life. This was used in 5 districts to improve health seeking behavior, antenatal clinic (ANC) attendance and the uptake of intermittent presumptive therapy (IPT).

Methods: A cascaded orientation and training of 1483 district leaders, 25 District trainers, 215 Village Health teams (VHT) supervisors and 4969 VHTs on FamilyConnect was conducted. During implementation, VHTs registered pregnant women who then received weekly messages relating to ANC. We reviewed DHIS2 data base for ANC attendance, intermittent presumptive therapy (IPT) 2 and IPT3 uptake in the 5 districts for the period January – December 2018; and January – February 2019. Summary statistics were computed. Three year averages (2015 – 2017) was used to compare trends for 2018 and 2019.

Results: The ANC attendance as measured by st1 and 4th visits remained stable. Lower number of mothers received IPT2 compared to the expected who had received IPT1. Number of districts reporting IPT3 plus uptake increased from 1 in December 2018 to 4 in February 2019. This could be attributable to messages pregnant women received. Limited availability of fansidar in health centre II, myths about registration on FamilyConnect and poor network connectivity limits observable effects.

Conclusion: FamilyConnect is positively influencing health seeking behaviors of pregnant women. There is need to fast track registration of all VHTs on FamilyConnect.

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Introducing Malaria Testing using MRDTS in the Ante-natal Clinics to improve Parasite based Diagnosis among Pregnant Women: The case of Public Health Facilities in Mid-Northern Uganda

Authors: 1Harriet Acio, 2Jane Nabakooba, 2Maureen Amutuhaire, 2Jimmy Opigo, 2Anthony Nuwa

1Malaria, Malaria Consortium Uganda, 2National Malaria Control Program, Ministry of Health

Background: Adherence to the new Malaria in pregnancy policy in Uganda is still low. Malaria testing during first antenatal clinic (ANC) visit is usually performed in laboratories and mainly when the woman complains of fever. Studies show that there is a significant number of people who a symptomatic for malaria but are positive on testing. We trained midwives and introduced malaria testing corners in ANC to improve parasite based diagnosis among pregnant women in mid-northern Uganda.

Methods: Cascade training of 933 Health workers especially those handling ANC from 176 health facilities in 9 districts was conducted. Under the supervision of national trainers from Ministry of Health we used a standardized and updated Malaria in pregnancy training curriculum.

Results: All 176 health facilities established malaria testing points in ANC. Documentation of testing varies by site with majority documenting testing in counter books. There was a significant increase in number of pregnant women attending ANC who were tested for malaria. Positivity rates ranges from 20-50%. The number of mothers receiving IPT2 as compared to IPT1 is still lower. However, the DHIS2 does not capture Malaria testing in ANC.

Conclusion: Malaria testing in ANC is a promising strategy to reduce malaria caseload in pregnancy. Standardizing the documentation of Malaria testing in the ANC register would help in monitoring progress.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 17 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

18 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Introducing Mass Action against Malaria the Benefits of involving multisectoral actors in the fight against malaria. Case in point for Schools and Mid-Northern Districts of Uganda

Authors: Peter Mbabazi1, Geoffrey Ssenvuma2, Silver Kasozi1, Francis Abwaimo2, Anthony Nuwa.2 Isaac Kimera2

Affiliations: 1 National Malaria Control Programme, Ministry of Health, Kampala, Uganda 2 Malaria Consortium, Kampala, Uganda

INTRODUCTION: Over the years, the fight against malaria in Uganda has been a sole responsibility of the health workers. As such; they have solely been responsible for issues regarding protection, diagnosis and treatment, ensuring the masses are knowledgeable and act right on malaria related issues (SBCC), conduct surveillance, handle programmatic issues as well as Monitoring and Evaluation (M&E). Never the less a lot has been achieved i.e. reducing malaria prevalence to an average of 9% across the country, increasing knowledge levels on malaria to over 90%1 among others. With the above in mind , the call for everyone to join hands in the fight against malaria and need to achieve the Uganda Malaria Reduction Strategic Plan (UMRSP) 2014- 2020 objectives was re-intensified, Malaria Consortium through her SURMa project, introduced and launched MAAM in 17 districts in mid northern Uganda in April 2018.

METHODS: Using the Strengthening Uganda’s Response to Malaria (SURMa) project proposal the project team working with National Malaria Control Program team and implementing districts brain stormed the composition of MAAM task force committees (MTFC) for districts. While proposing the composition of MTFC, different departments were listed including religious and political heads both elected and those appointed to represent the central government interests at district level. List of suggested MTFC members was shared with districts through District Health Teams represented by District Health Educators (DHE) to propose inclusion and/exclusion of other members bearing in mind an upper limit of 15 members and roles played by different departments and how they influence and execute their respective mandate.

RESULTS: Following deliberations in all 17 SURMa implementing districts and sharing of their suggestions, it was resolved that MTFC be increased to 20 members 1

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 19 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019 drawn from different departments. MTFC set meetings were held in all 17 districts implementing SURMa project. During these meetings, a team from MoH/NMCP introduced the MAAM initiative to the members and proposed Terms of Reference (ToR) were reviewed and action areas identified and different members ofMTFC responsible assigned responsibilities of ensuring action areas area addressed and members informed in the next MTFC review meetings. Different districts agreed to regularly meet and also use every forum in line with their work to deliberate on malaria issues.

CONCLUSIONS: With MAAM it is evident that the fight against malaria is everyone’s responsibility. MAAM brings everyone on board and calls for self-evaluation as far as malaria activities cascading to the closest person in your everyday life up to household level. MAAM brings about the needed synergy for the country to achieve and/or get closer to the UMRSP 2014-2020 objectives.

20 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Influence of Behavioral Change Communication Approaches on the Uptake of Malaria Mass Drug Administration among Persons in Kapujan Sub-county, Katakwi District

Mariam Nabukenya, (Pilgrim Africa / NMCD)

BACKGROUND: Social Behavioral Change and Communication (SBCC) has been implemented prior to MDA roll out however, the uptake of MDA is still not sub optimal, which thus calls for evaluation of the effect that various BCC approaches have had on MDA uptake. OBJECTIVE: The purpose of this study was to evaluate the effect of behavioral change communication approaches on the uptake of malaria mass drug administration among persons in Kapujan sub-county, Katakwi district METHODS: This study used a sequential mixed methods approach, with the quantitative part being an analytical cross sectional survey design was used and the qualitative part being a case study exploratory design. This study targeted household heads in Kapujan Sub County. Kapujan Sub County was sampled judgmentally. In Kapujan Sub County, stratification was first done at parish level. RESULTS: Almost all household heads sampled had up taken Malaria MDA (n = 323, 97%), that is they had participated, and then taken three doses of antimalarial. Household heads who had ever had a one on one session with MDA staff, at their households (AOR = 5.781, CI = 2.241 - 8.454), Household heads who strongly agreed to have ever been educated about the need for adherence to MDA medication (AOR = 4.707, CI = 1.798 - 7.213) and household heads who agreed that MDA staff had engaged their community in door to door visits educate about malaria control (AOR = 4.543, CI = 1.959 - 8.114), were 4.7 times more likely to have up taken malaria MDA. Household heads who reported that they were in communities where leaders had been engaged by MDA staff for purposes of training them, were 3.5 times more likely to have up taken MDA (AOR = 3.500, CI = 1.724 - 8.129). No mass media (Radio) behavior change communication approach had a statistically significant relationship with the uptake of Malaria MDA. CONCLUSION: Malaria MDA uptake is high in Kapujan sub county but not universal. Behavior change communication has indeed had an influence of the uptake of Malaria MDA in Kapujan Sub County, however, that is mainly from the perspective of interpersonal communication and to some extent by community.

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 21 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

SINOAFRICA MEDICAL DEVICES COMPANY (U) LIMITED

A local manufacturer and supplier of Yorkool Long Lasting Insecticidal Mosquito Nets (LLINs) approved by World Health Organisation (WHO)

SINOAFRICA MEDICAL DEVICES COMPANY LIMITED P.O BOX 7321 KAMPALA (U) PLOT 104-106 5TH STREET INDUSTRIAL AREA Tel: +256 414340075 Email: [email protected] | Web: www.smd.co.ug

US 307:2014

17

22 “It’s a Household War-Chase Malaria to Zero, The Scientific Touch” WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Insecticide Resistant Management – New tools

There has been increased effort globally to reduce malaria related morbidity and SINOAFRICA MEDICAL DEVICES mortality. WHO recommends the use of long-lasting insecticidal nets (LLINs) and COMPANY (U) LIMITED indoor residual spraying (IRS) as the main methods for the control of malaria vectors. Control of malaria vectors is heavily reliant on chemical insecticides. The significant increase in insecticide-based malaria vector control in the past decade has A local manufacturer and supplier of Yorkool resulted in increasing insecticide resistance among the major malaria vectors because Long Lasting Insecticidal Mosquito Nets (LLINs) approved by of the selection pressure placed on resistance genes. This necessitates the use of a World Health Organisation (WHO) number of strategies to manage insecticide resistance. These measures are aimed at reducing or delaying the emergence of resistance. One of the methods used to counteract resistance is the use of combinations/rotation of insecticides with different modes of action for IRS. There has been a need for a new mode of action (MOA) product for many years and nothing has been introduced for more than 30 years until now.

Sumitomo Chemical has introduced clothianidin a neonicotinoid, as SumiShield®50WG, an Indoor Residual Spray (IRS) product containing a new mode of action chemistry for IRS. This will be valuable when used in insecticide resistance management strategies.

SINOAFRICA MEDICAL DEVICES COMPANY LIMITED P.O BOX 7321 KAMPALA (U) PLOT 104-106 5TH STREET INDUSTRIAL AREA Tel: +256 414340075 Email: [email protected] | Web: www.smd.co.ug

US 307:2014

17

“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 23 WORLD MALARIA DAY SCIENTIFIC CONFERENCE 2019

Pyramax®, a fixed-dose combination of pyronaridine and artesunate co-developed by Medicines for Malaria Ventures (Geneva) and Shin Poong Pharmaceutical Co. Ltd., South Korea, is the newest Artemisinin Combination Therapy (ACT) combination to be approved by a Stringent Regulatory Authority. It is the only ACT to be granted a positive scientific opinion under the European Medicines Agency’s (EMA) Article 58 procedure, and is the only ACT to be specifically indicated for the treatment of uncomplicated malaria due to blood-stage treatment of both of the two main strains of malaria: P. falciparum and P. vivax. Pyramax is also the first Korean product included in WHO’s list of prequalified medicines for malaria and was added to the WHO’s Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc) in 2017.

This once-daily, 3-day therapy is available in Pyramax tablets for the treatment of uncomplicated malaria in adults and children over 20kg and Pyramax granules in children and infants between 5 and 20 kg.

Pyramax® Granules, the child-friendly fixed-dose artemisinin combination therapy (ACT) of pyronaridine and artesunate, is the first paediatric antimalarial to be granted a positive scientific opinion from the European Medicines Agency (EMA) under Article 58. Article 58 was established to enable the EMA to undertake a scientific assessment and provide guidance, in cooperation with the World Health Organization (WHO), on products that are not intended for use in Europe, thereby providing a valuable service for the wider global health community.

Adapted to the needs of children, Pyramax Granules is taste-masked, suspends in approximately two teaspoons of liquid, and is taken once-daily for 3 days with or without food. This formulation is well suited to sick children, who need to take the full dose in order to achieve complete cure. Pyramax Granules is also the first paediatric medicine to be indicated for the treatment of acute, uncomplicated blood-stage malaria caused by either of the two main species of parasite, P. falciparum and P. vivax.

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“It’s a Household War-Chase Malaria to Zero, The Scientific Touch” 25 Distributed by: Manufactured by: Phillips Pharmaceuticals (Uganda) Limited Guilin Pharmaceutical Co., Ltd. P. O. Box 21428, Kampala, Uganda. No. 43 Qilidian Road, Guilin 541004, Guangxi, Chaina Tel: +256 414 288 663 / 288 665

E-mail: [email protected]

E-mail: [email protected]

Tel: +256 414 288 663 / 288 665

P. O. Box 21428, Kampala, Uganda. No. 43 Qilidian Road, Guilin 541004, Guangxi, Chaina

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