The topic of study is analysis of malaria prevalence in children aged below 5 years in Uganda from 2006 to 2015 and the case study a case study of Tororo main hospital.

The general objective of the study is to analyses the prevalence of malaria in children aged below 5 years in Uganda, while the study is guided by the following Specific Objectives of the Study; to determine the distribution of malaria among the children below 5 years, to compare and contrast malaria prevalence by residence and region and to forecast malaria prevalence for children aged below 5 years in Uganda

The study shall use quantitative methods of research so as to obtain the viable data and this shall include structured secondary data in the records of the Ministry of health.

The process of data processing involved editing in order to check for errors and omissions and coding to reduce the data to a meaningful pattern of responses. Model specification and soft wares employed in the tabulation and processing of the findings was done in order to prepare data, analyze and compile a research report. The study used time series analysis and descriptive statistics was used to describe the information got from the field this will be inform of graphs and tables. Data Analysis involve applying statistical techniques on it for easy presentation. It include the interpretation of research findings in the light of the research questions, and objectives to determine if the results are consistent with those research questions.

The study concludes that there is variation in malaria prevalence across the region some regions had higher malaria cases than others, malaria cases are on the rise. The study also states that the variations in the total malaria cases are explained by the changes in the malaria cases of both rural and urban areas, lastly the study also concludes that malaria is high in the rural areas than urban areas.

The study also recommends that the government should increase the number of health workers in the government hospital and Regions with high malaria levels should increase findings for the rural health facilities especially in northern Uganda.

The study recommends the following areas for further study; The influence of mosquito nets on malaria prevention, the influence of foreign aid on the influence of education of malaria prevalence in Africa and the influence of malaria medicine on malaria prevention

CHAPTER ONE

1.0 Introduction

This chapter shall deal with the background of the study, statement of the problem, the objectives of the study, research questions, study scope of the study and significance of the study.

1.1Background

According to the latest WHO estimates, released in December 2016, there were 212 million cases of malaria in 2015 and 429 000 deaths, Between 2010 and 2015, malaria incidence among populations at risk fell by 21% globally; during the same period, malaria mortality rates among populations at risk decreased by 29%. An estimated 6.8 million malaria deaths have been averted globally since 2001, Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Some 13 countries mainly in sub-Saharan Africa account for 76% of malaria cases and 75% deaths globally, (WHO, 2016).

In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group. Between 2010 and 2015, the under-5 malaria death rate fell by 29% globally, However malaria remains a major killer of children under five years old, taking the life of a child every two minutes, (UNICEF, 2016).

Malaria remains one of the major killers of humans worldwide, threatening the lives of more than one-third of the world’s population. It thrives in the tropical areas of Asia, and African continents, Malaria has far-reaching medical, social and economic consequences for the countries in which it is endemic due to its high and alarming morbidity and mortality rates. Each year approximately 2.5 million people die of malaria, many of whom are children. According to WHO estimates, 40% of the population of the world lives in areas where malaria is endemic with the direct and indirect costs of management being very high (WHO 2010).

Malaria is an important health problem and pregnant women recognize its serious consequences (Mbonye et al., 2010). Effective malaria prevention and treatment interventions exist that have beneficial effects on the disease in pregnancy (Schultz et al, 2014). However, use of these interventions largely depends on local beliefs on malaria, access, costs, attitudes towards health care providers and the level of acceptability of the health system (Magnussen, 2007). These affect care seeking with regard to malaria prevention at health units and also reveal issues related to affordability and acceptance of these services in most parts of sub-Saharan Africa.

Between 2000 and 2008, the use of ITNs saved the lives of an estimated 250,000 infants in Sub-Saharan Africa from malaria; about 13% of households in Sub-Saharan countries owned ITNs in 2007 and 31% of African households were estimated to own at least one ITN in 2008. In 2000, 1.7 million (1.8%) African children living in areas of the world where malaria is common were protected by an ITN. That number increased to 20.3 million (18.5%) African children using ITNs in 2007, leaving 89.6 million children unprotected and to 68% African children using mosquito nets in 2015, most nets are impregnated with pyrethroids, a class of insecticides with low toxicity (WHO, 2013).

Malaria is the cause of outpatient, inpatient and admissions of children less than five years of age at health facilities in Tanzania (WHO, 2002).The high burden of malaria in Tanzania this is due to the fact that, every year 14-18 million new malaria cases are reported. The annual incidence rate is 400-500/1,000 people and this number doubles for children less than five years of age. There are 100,000-125,000 annual deaths due to malaria, (70-80,000 in under-fives) (Mercia et al, 2004).

Health indicators for children show very slow progress over the last 10 years. While Uganda has made some progress in reducing under-five mortality from 137 per 1,000 live births in 2005/06 to 90 per 1,000 live births in 2011/12, child and maternal health conditions continue to impose the highest total disease burden with perinatal and maternal conditions accounting for 20.4% (Ministry of Health [MoH], 2010). In 2011, Uganda ranked 26th amongst countries with highest under-five deaths globally (UNICEF, 2012). Progress in reducing maternal mortality, an underlying factor in child mortality, has been very slow coming from 438 per 100,000 live births to 320 in 2011 (MOFPED, 2013). Based on the rates of progress at the time of writing this report, Uganda was unlikely to achieve Millennium Development Goals (MDG) 4 and 5, which focused on reducing under-five mortality and improving maternal health respectively. It was also unlikely to achieve the goals set in the National Development Plan (NDP) II of reducing the Infant Mortality Rate per 1,000 live births from 54 to 44 and reducing the under-five mortality rate per 1,000 live births from 90 to 51 (MoH, 2013; GoU, 2015). The allocation to health as a percentage of the total government budget reduced from 9.6 percent in 2003 to 8.6% in 2014/15 contrary to the Abuja Declaration target of 15% (GoU, 2015)

Malaria remains the second killer disease among children under five, claiming 42 children daily and 1,095 annually, the Government of Uganda and partners called for more investments towards the reduction of malaria deaths especially among children under five years and women who are more vulnerable (Uganda Demographic Health Survey 2011).

During the week of 5-11 September 2016, a cumulative total of 195,424 cases of malaria with 43 deaths (CFR 0.02 percent) were reported. Over 40,062 children under the age of 5 years affected by the epidemic are under five years of age. Over the past month, there has been a reduction in the number of cases reported in the 10 Indoor Residual Spray (IRS) districts as well as in Arua, which could be due to the onset of the dry spell. Most malaria epidemic districts in Northern Uganda are still above the respective malaria threshold. The most at risk populations are in the districts of Gulu, Nwoya, Amuru, Kitgum, Lamwo, Agago, Pader, Oyam, Apac, Arua and Kole (MoH, 2016).

Malaria remains the second killer disease among children under five, claiming 42 children daily and 1,095 annually according to the Uganda Demographic Health Survey 2011, Many of these deaths occur at home due to poor access to health care, inappropriate or delayed care seeking and inadequate quality of health services hence need to take analysis the levels of malaria prevalence in the home with children below 5 years.

1.2 Statement of the problem.

The government of Uganda in conjunction with other non-government organizations have put a lot of effort to curb the malaria infection in children, adults and pregnant women in Uganda, but malaria still claims a lot of morbidity with 40 percent comparison to other diseases. The prevalence of these polymorphisms has consistently measured well above 50% across Uganda (Francis et al., 2006). There were an estimated 438000 deaths, 90% from Africa, 7% from South Eastern Asia region and 2% from Eastern Mediterranean region. Of these, 306000 deaths have occurred in children aged under 5 years.(WMR 2015) In comparison, 198 million infections and 584 000 deaths were estimated in 2013.(WMR 2014) More than 30000 cases of malaria are reported annually among travelers from developed world visiting malarious areas.(Leder et al., 2010). With that there is need to take analysis of the extent of this malaria prevalence to date since the perennially prevalent malaria, therefore, remains an ever existing danger for humanity, in every part of the globe.

1.3 Objectives of the Study

1.3.1General Objective:

The general objective of the study was to analyses the prevalence of malaria in children aged below 5 years in Uganda.

1.3.2 Specific Objectives of the Study

To determine the distribution of malaria among the children below 5 years.
To compare and contrast malaria prevalence by residence and region.

To forecast malaria prevalence for children aged below 5 years in Uganda

1.4 Research hypotheses.

Ho₁: There is no trend for malaria prevalence among the children.

ii Ho₃: Rural has the same malaria prevalence as urban.

iii Ho₄: There is no difference in malaria prevalence by region.

1.5 Scope of the study

The study scope covered the following aspects;

1.5.1 Study scope

This included; determining the distribution of malaria among the children below 5 years, to compare malaria prevalence by residence and region and to forecast malaria prevalence for children aged below 5 years in Uganda.

1.5.2 Geographical scope

The study was carried out in Ministry of health Kampala Uganda.

1.5.3 Time scope

The research was carried out from February to August 2017.

1.6 Significance of the Study

The study will help the government and the health officers to come up with reasonable policies to overcome the high rates of malaria prevalence in Uganda among children below 5 years.
In the field of academics, the study will be helpful to the future researchers with enough data and a literature review for them to review their weak areas in their research.

The study will act as a source for further research regarding the analysis of malaria prevalence in children aged below 5 years.

In regard to Uganda, the research is hoped to be generally of great benefit to people’s