A History of Malaria Control in Uganda: The Limiting Effects of Political and Socio-Economic Inequality in Implementing Global Health Programs

Abstract

Objective: To analyse the extent to which political and social-economic inequality have affected malaria control programs for prevention and treatment from 1950 to 2011 in Uganda.

Methods: My analysis is based on both ethnographic study findings over a one-year period with children who experienced war in northern Uganda in 2004-2005. The main objective of the research was to investigate children's illnesses and quests for therapy during a time of war. Additionally, I conducted a review of all policy documents and strategic plans by Uganda's Ministry of Health capturing experiences in implementing global and national health policies in malaria control.

Findings: Wartime children rarely engage in preventive measures, use cheap and affordable antimalarials, most of which have been scientifically proven to be ineffective. In addition the earlier ‘war’ on the malaria mosquito and the more recent recommendation of Artemisinin-based Combination Therapy (e.g. Coartem) as the first-line drug for uncomplicated malaria have been largely unsuccessful ventures, because malaria control requires programmes focusing on the social determinants of disease, such as poverty, since these factors hinder people's ability to practice recommended measures. Programmes aimed at the zoonoses, parasites, or vectors and pharmaceutical/technological aspects of control and management of malaria, like indoor residual spraying, using insecticide treated nets, spraying with DDT and use of Artemisinin-based Combination Therapies for uncomplicated malaria are short-term approaches which do not contribute to eradication, as frequently announced and promoted.

Conclusion: Socio-economic and political inequality are obstacles to effective malaria treatment and prevention programmes in Uganda and other resource-poor settings in sub-Saharan Africa.