LIST OF ACRONYMS

WHO: world health organization

WMR: world malaria report

MOH: ministry of health.

EIR: entomological inoculation rates

PMI: President’s Malaria Initiative

HMIS: Health Management Information System

UMIS: Uganda Malaria Indicator Survey

UBOS: Uganda Bureau of Statistics

ARIMA: Autoregressive Integrated Moving Average

GDP: gross domestic product.

LBW: Low Birth Weight.

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

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. Total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Contributions from governments of endemic countries amounted to US$ 800 million, representing 31% of funding (WHO, 2017).

According to the latest World Malaria Report, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015. The estimated number of malaria deaths stood at 445 000 in 2016, a similar number to the previous year (446 000). The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths. Some 15 countries all in sub-Saharan Africa, except India accounted for 80% of the global malaria burden (World Malaria Report, 2017). Total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Contributions from governments of endemic countries amounted to US$ 800 million, representing 31% of funding (WHO, 2017).

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. The number of under-5 malaria deaths has declined from 440 000 in 2010 to 285 000 in 2016. However, malaria remains a major killer of children under five years old, taking the life of a child every two minutes (Leder et al., 2017).

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season (Okello et al., 2016).

Globally 3.2 billion people remain at risk of malaria and nearly one million malaria deaths occur each year, mostly in children under five years of age in sub-Saharan Africa (WMR,2008). The greatest burden of malaria, by far, remains in the heartland of Africa, characterized by large contiguous areas of high transmission, low coverage of control interventions, and limited infrastructure to monitor disease trends. Besides neonatal-related causes, malaria is the second leading cause of morbidity and mortality in Africa, and accounts for 21-26% of all under-five mortality in Uganda. 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.

Although funding for malaria has remained relatively stable since 2010, the level of investment in 2016 is far from what is required to reach the first milestone of the GTS, which is a reduction of at least 40% in malaria case incidence and mortality rates globally when compared to 2015 levels. To reach this milestone, the GTS estimated that annual funding would need to increase to US$ 6.5 billion per year by 2020. The US$ 2.7 billion invested in malaria in 2016 represents less than half (41%) of that amount. Stepping up investments in malaria research and development is key to achieving the GTS targets. In 2015, US$ 572 million was spent in this area, representing 83% of the estimated annual need for research and development.

Malaria not only causes ill health and death but also hampers development due to the fact that lots of resources are spent combating the disease. For instance, expenditure on treatment and prevention is very high and there is loss of household incomes through absenteeism from work. According to a United Nations (UN) study, Malaria costs Uganda $347 million annually (The New Vision newspaper, 2004).

1.2 Statement of the problem.

In 2016, 15 million children in 12 countries in Africa’s Sahel sub region were protected through seasonal malaria chemoprevention (SMC) programs. However, about 13 million children who could have benefited from this intervention were not covered, mainly due to a lack of funding. Since 2012, SMC has been recommended by WHO for children aged 3-59 months living in areas of highly seasonal malaria transmission in this sub region.

According to Francis et al., (2006), there has an increased fight against malaria especially on the children below 5 years across Africa and Uganda in particularly, 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. There were an estimated 438000 deaths, 90% from Africa, 7% from Southeastern 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 malarias areas.(Leder et al., 2010).

Basing on this Background this study intends to investigate into malaria prevalence of children aged below 5 years in Uganda.

1.3 Objectives of the Study

1.3.1General Objective:

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

1.3.2 Specific Objectives of the Study

To compare malaria prevalence by residence and region in Uganda.
To determine malaria distribution in Uganda.

To forecast malaria prevalence for children aged below 5 years in Uganda up 2022.

1.4 Research hypotheses.

Ho₁: There is no difference in malaria prevalence by residence and region.
Ho₂: All regions have the same malaria prevalence.

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

IV Ho₄: Malaria prevalence in Uganda will reduce by 2022.

1.5 Scope of the Study:

1.5.1 Subject scope

This research intended to analyses malaria prevalence of children aged below 5 years in Uganda.

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 welfare. The research study is hoped to bring the public to the knowledge of how dangerous malaria is to society especially in children aged below 5 years.
The study is hoped to avail valuable information for consideration in making of important policies for example through sensitization of the public and government partnering with responsible organizations to reduce the malaria burden it may also beneficial to the researcher as it will equip him with skills into further research.