Uganda Malaria Quarterly Bulletin Issue 10: April — June 2015 Uganda Ministry of Health | National Malaria Control Program | P.O. Box 7272 | Kampala | Uganda Editorial Contents 1. Editorial and report highlights……………...….page 1 This is the 10th issue of the Uganda Malaria 2. Malaria Interventions……………………………....page 2 Quarterly Bulletin that focuses on the second quarter 3. Malaria Burden…………………………...……...…..page 3 of 2015. The aim of this bulletin is to inform district, 4. Laboratory diagnosis…………………………….….page 4 national, and global stakeholders on progress achieved 5. Treatment practices……………………….……...…page 5 and challenges encountered in malaria control in 6. Uganda Malaria Surveillance Project ………..page 6 Uganda. Most importantly, it is to encourage use of this 7. Special Topic: EPR ……………………………………..page 7 information at all levels in order to foster improvement 8. District malaria burden……………………………..page 8 of our efforts and to highlight achievements and create 9. Malaria burden maps… …………………….....page 10 awareness for increased resource mobilization& alloca- tion in order to maintain the gains we have achieved. 10. Indicator definitions……………………………....page 11 2015 Q2 Report highlights In this issue, we present HMIS and Malaria Reference data under the UMSP, representing • Overall, malaria burden, both the out-patient and in-patient, has risen rapidly to more than coverage of malaria interventions, malaria burden, double the malaria burden in this quarter when laboratory and treatment practices. We also present compared to the first quarter. the guidelines of Malaria Epidemic Preparedness and • A malaria epidemic was confirmed, from April, in Response as the special edition topic for this quarter. 10 northern districts. This follows the most significant malaria related event • Close to 50% of reported malaria cases, from 38%, are laboratory confirmed malaria. in this quarter, which was the confirmation of an • The number of doses of ACTs consumed still Epidemic in the ten former Indoor residual spraying remains at twice as much as the reported districts of Northern Uganda. The knowledge and use of malaria cases. these guidelines is of most relevant now as we strive to maintain the achieved low malaria burden. Editorial Team National Malaria Control Program In a bid to strengthen malaria surveillance focused Okui A Peter, Program Manager Katamba Henry on the district level, we have introduced district level Denis Rubahika Agaba Bosco malaria maps with colour codes to supplement and Mathias Mulyazawo ease data interpretation and improve usage. Vincent Katamba Wanzira Humphrey Additionally, we shall be highlighting the districts that Resource Centre Mukoyo Eddie need urgent action in the district level malaria burden Kyozira Carol Kissa John table. World Health Organisation Katureebe Charles We are happy to hear from you regarding this US President’s Malaria Initiative Kassa Belay publication, and we welcome your contributions to sub- BK Kapella sequent issues. Thank you again and we hope this will Uganda Malaria Surveillance Project Ruth Kigozi be an informative reading for you. African Leaders Malaria Alliance Gasasira Anne 1 HMIS reporting rates • HMIS data comes from all government, private-not- for-profit and some private -for-profit health facilities. • Over 90% of such expected health facilities send their monthly reports to the HMIS. • Of these, just over 80% send their reports within the first two weeks of the following month. Malaria Intervention updates • Routine ante natal (ANC)LLIN distribution and intermittent preventive treatment in pregnancy (IPTp) with Fansidar continues to be the major malaria interventions among for pregnant mothers. • The proportion of pregnant women attending their first ANC visit and receiving the first dose of IPTp was just above 80% in this quarter just like in the first quarter ,of this year. • Those receiving the second dose of IPTp was 20% lower than IPTp 1. However, in this quarter, IPTp 2 coverage rose from 50 to 60% when compared to the first quarter. • The proportion of pregnant mothers attending their first ANC and receiving an LLIN drastically dropped from 56% to 20% by end of the second quarter • 15 districts received IRS in this quarter, one under the Ministry of Health (Kumi) and 14 ABT associates/ PMI/DFID supported districts (Budaka, Bugiri, Butaleja, Kibuku, Namutumba, Pallisa ,Serere, Alebtong, Amolator, Dokolo, Kabaremaido, Lira, Otuke and Tororo district). Preparations are underway for Ngora district to be sprayed under the Ministry of Health. 2 Malaria Burden Out-patients • The number of monthly malaria cases diagnosed (lab confirmed and clinical) and malaria incidence rapidly doubled in this quarter from the lowest (829,548) recorded in over two years to the highest (1,629,237)since July 2013. • A similar trend of increasing malaria cases among children under 5 years doubled from 238,961 cases by end of March 2015 to over 500,000 cases by June 2015. • This surge in malaria burden is probably attributable to seasonal- ity, drop in intervention coverage (especially IRS and LLINs) and inadequate malaria related behavior change communication In-patients • A similar trend was also observed among those admitted to hospital due to malaria with the numbers/malaria incidence tripling from the lowest in the last 2 years (36,863) to the sec- ond highest in the same period (94,490) • The number of pregnant women admitted to hospital doubled in the second quarter when compared to the first quarter of this year. • However, the case fatality rate was still at less than 1% of all malaria admitted patients. 3 Malaria diagnosis Comparison of reported Malaria cases with laboratory test done • RDTs contribute over 70% of all the malaria laboratory tests performed in this quarter. • The comparison of reported malaria cases with laboratory test done followed the same trend, with increasing tests done similar to the increasing reported malaria cases. However, the number of tests done was still higher than the reported malaria cases. Test positivity rate • The test positivity rate in this quarter also rose from 38% in the first quarter of 2015 to close to 50% of all malaria tests done. 4 Malaria diagnosis Proportion of laboratory confirmed cases among all malaria diagnosed cases • Among those diagnosed/ reported to have malaria, the average proportion of laboratory confirmed cases in this quarter was 58% as compared to the 41% of the first quarter. Treatment practices ACTs consumed • The number of ACT doses prescribed also rose in this quarter following the same trend like the reported malaria cases. However, the number of ACTs rise was steeper and is still more than twice as much as number of malaria cases diagnosed. 5 Malaria Reference Centers There are 32 Malaria Reference Centres (MRC) under the Uganda Malaria Surveillance Project (UMSP), and for this bulletin issue, we shall focus our data on the Test positivity rates of the Northern Uganda Reference centers. Overall, there is an upward trend of TPR in most of the MRC sites, evidence that complements and supports the presented HMIS data. Awach, Lalogi, Patongo and Pajule had IRS in Nov-14 while Amolatar, Do- kol, Alebtong and Orum had IRS in Jan 2015 Amolatar Dokolo Alebtong Orum IRS 1 0.8 0.6 0.4 0.2 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aduku Aboke Anyeke 0.8 0.6 0.4 0.2 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Awach Lalogi Patongo Pajule IRS 1 0.8 0.6 0.4 0.2 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Amolatar Dokolo Alebtong Orum IRS 1 0.8 0.6 0.4 0.2 0 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 6 Special Topic: Malaria Epidemic Preparedness • Towards the end of May 2015, three of the former 10 IRS districts in Northern Uganda (Gulu, Lamwo and Kitgum) reported an increase in malaria cases to the NMCP, Ministry of Health. • A review of the weekly surveillance data received from the 10 former IRS intervention districts (Apac, Kole, Gulu, Amuru, Nwoya, Pader, Agago, Kitgum, Oyam and Lamwo) indicated that there were upsurges in weekly Malaria cases reported beyond the average threshold starting from weeks 16 to 26. The data was indicative of a “Malaria Outbreak” in these districts as shown in the graph below (of note– HMIS could only provide two complete years of weekly data for 2013 and 2014) • The NMCP with the support of the Epidemic and Surveillance division has been working with the affected districts to ensure that this epidemic is brought under control by: 1. Working with the district per- sonnel to strengthen surveil- lance systems 2. Coordinate with the National Medical Stores to ensure delivery of emergency antimalarials. 3. Designing and implementa- tion of BCC messages on ma- laria prevention, especially use of LLINs and treatment. 4. Coordination with the blood bank to ensure blood availability for those with severe anaemia HMIS could only provide two complete years of weekly data for 2013 and 2014 Guidelines for malaria epidemic preparedness and response • The National Malaria Control Program has taken the following steps in an effort to prevent and /reduce the impact malaria epidemics through the following: 1.