Malaria in Uganda: Challenges to control on the long road to elimination. II. The path forward

In the recent past there have been several reports of successes in malaria control, leading some public health experts to conclude that Africa is witnessing an epidemiological transition, from an era of failed malaria control to progression from successful control to elimination. Successes in control have been attributed to increased international donor support leading to increased intervention coverage. However, these changes are not uniform across Africa. In Uganda, where baseline transmission is very high and intervention coverage not yet to scale, the malaria burden is not declining and has even likely increased in the last decade. In this article we present perspectives for the future for Uganda and other malaria endemic countries with high baseline transmission intensity and significant health system challenges. For these high burden areas, malaria elimination is currently not feasible, and early elimination programs are inappropriate, as they would further fragment already fragmented and inefficient malaria control systems. Rather, health impacts will be maximized by aiming to achieve universal coverage of proven interventions in the context of a strengthened health system.

Uganda bears a large malaria burden. It has made progress in implementing key control measures, but there is not yet convincing evidence that the burden has decreased. We summarize malaria epidemiology, control efforts, and challenges to control.Figure optionsDownload as PowerPoint slideHighlights
► Uganda bears a particularly large burden from malaria.
► Our understanding of malaria in Uganda is limited by a lack of reliable data.
► Uganda has made progress in implementing key malaria control measures.
► There is no convincing evidence that the malaria burden has decreased recently.
► There remain major challenges to malaria control in Uganda.