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You are here:  HomeUrban Malaria Control

Control of urban malaria in Kampala and Jinja by environmental management

Urban malaria continues to be an important public health burden against a background of unabated urban growth and rural migration to cities. Malaria control in Uganda is predominantly by treatment of patients using antimalarials, and long-lasting insecticide-treated bednets and indoor residual spraying with insecticides. The gains made by these conventional control measures are undermined by the emergence of drug and insecticide-resistance by malaria parasites and mosquito vectors. There is no information about the effectiveness of biophysical environmental modifications in malaria control. Kampala and Jinja are cities situated close to the equator with rain falling throughout the year. Water collects in low-lying valleys characterized by market gardening, swamps, and brick pits. These valleys are ideal breeding sites for Anopheline mosquitoes in both cities.
We undertook a two-year study designed to assess the effectiveness of a community-based environmental management (EM) program for malaria control in Kampala and Jinja. Two sites in Kampala (Kitebi and Kikulu) and two in Jinja (police barracks and Loco Estate) were selected. Both sites in Kampala were in small valleys with extensive areas of flooded brick pits, while in Jinja they were estates close to farmland or swamps. During the first year we carried out routine entomological and clinical surveys to establish the sources of vectors and the baseline level of malaria transmission at each study site. Anopheline mosquitoes were less abundant compared to culicine mosquitoes. Anopheline mosquitoes occurred in a wide variety of different water bodies at each study site. In Kampala, brick pits, tyre ruts, and puddles were the predominant sites favored by the major malaria vector Anopheles gambiae. In Jinja, few anopheline larvae were found near the police Barracks, while in Loco most were on the edge of a large swamp bordering the settlement. The level of infection with malaria parasites was similar in children living in all study sites (14-29%) except for Loco where the prevalence was markedly higher (36-46%). During the second year, we undertook site-specific interventions: filling puddles, introducing larvivorous fish and improving drainage in Kitebi; building and repairing drainage channels and soak pits in police Barracks. The other two communities served as non-intervention controls.
EM reduced the number of breeding sites for anopheline mosquitoes, the numbers of anopheline larvae and pupae, and malaria prevalence in children. This project provided insights for future scaling of EM in malaria control.From an outreach point of view, the project made it possible for the study team to engage with District and Municipal Health Authorities, Ministry of Health Malaria Control Program, and community members themselves. The awareness of community members about the role of mosquitoes in malaria transmission was enhanced by practical demonstration of Anopheles larvae in stagnant water collected from their homesteads and gardens.