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Arguably no public health problem is as urgent in Uganda as malaria, the nation’s leading cause of morbidity and mortality. Malaria accounts for approximately 10 million cases per year and roughly one in 10 hospital deaths, many of them children. And the problem appears to be worsening. According to the 2009 Uganda Malaria Indicator Survey, for example, 30-50 percent of children ages six months to 5 years have malarial parasitemia observable by microscope.
To complete the practical component of my MPH degree, I sought international experience and found it at the Stop Malaria Project (SMP). Supported by funding from the Drabkin Foundation, I was based for three months at the SMP Central Office in Kampala, Uganda. SMP is a five-year project of the Ugandan Ministry of Health, financed by the U.S. President’s Malaria Initiative (PMI). Operating in 34 districts of Uganda, it is focused primarily on implementing and improving prevention programs, strengthening laboratories to improve malaria diagnosis and treatment, and increasing the capacity of the national malaria control program.
During my internship I explored the availability and efficacy of rapid diagnostic testing (RDT). Confirmation by RDT is the gold standard for uncomplicated malaria diagnosis in facilities without laboratories in Uganda. But use of RDT and adherence to the result remains low. In an effort to improve malaria diagnosis and management, SMP is in the process of providing RDT education and training to health workers. To determine where the training falls short and identify additional barriers to RDT use, I attended Integrated Malaria Management Training and Data Quality Assessment training sessions and interviewed health workers to learn about their beliefs, attitudes and practices with RDTs. Additionally, I helped to develop a tool to determine health worker practice in reality.
Malaria need not be a fatal disease. It is possible to effectively treat even when the symptoms are minimal and non-specific, but the ability to treat starts with proper identification of disease. With an RDT, a diagnosis is possible in even the most primitive of facilities – running water and electricity are not necessary. And the diagnosis is rapid: Disease can be confirmed and drugs prescribed and delivered in less than a half hour. While the current policy supports RDT use, it is my belief – based, anecdotally, on visits to dozens of health facilities – that the supply of RDTs in facilities remains the limiting factor.