Angella Kyagera 

Program Officer in the Community Empowerment Program at the Center for Health, Human Rights and Development

At the moment, almost all efforts, energies and resources are geared towards COVID-19, the global pandemic. Killer diseases like malaria are almost forgotten. Malaria is a disease transmitted by mosquitoes that kills more than one million people in Africa annually. Whereas it is a preventable and treatable disease, malaria is still the leading cause of death among children under five mostly in the sub-Saharan Africa region yet also a global public health concern that perpetuates a vicious cycle of poverty in the developing world. 

Uganda has the third highest deaths from malaria in Africa and some of the highest recorded malaria transmission rates in the continent, particularly in the areas around Lake Kyoga in central Uganda. The Ministry of Health stated on August 12th 2019 that there had been an increase in the Malaria cases by over 1 million countrywide for the period of June-August 2019. It also stated that there has been a 40% increase in the Malaria cases from 1 million cases in June 2018 to 1.4 million cases in June 2019. The increase in Malaria cases was attributed to seasonality, climate change, reduced net ownership and use due to the aging of nets distributed in the 2017 mass campaign, low malaria prevalence in areas such as Kampala, Population growth and refugee immigration in specific regions. The pearl of Africa also contributes to about 5% of global malaria deaths but strides have been taken to reduce these numbers with a total of 2.2 million nets handed out in 2008 so the proportion of long-lasting insecticidal net (LLIN) coverage has now reached an estimated 84%. Health workers at all levels (including the private sector) were also trained in integrated management of malaria (IMM) in 102 of 112 districts (10,500 HWs), including training in the management of severe malaria. Clinical audits for severe malaria were performed in 34 of 112 districts. The Ministry of Health has also supported districts with increased cases to order and receive emergency services, revised the quantification of ACTs for this financial year, redistributed malaria commodities from facilities and districts with overstocks to those that are facing a stockout of malaria commodities. They are also monitoring malaria cases, admissions and deaths and using data to guide decisions at all levels. This has helped identify and contain many outbreaks and continued the routine distribution of long lasting insecticide treated mosquito nets (LLINs) to pregnant women attending antenatal care and children in immunization clinics. It has also fast tracked the implementation of the 2020 LLIN mass campaigns and introduced new channels of LLIN distribution such as schools in selected districts.

Globally, every year on the 25th  of April, we remember the deaths caused by malaria. It is also an opportunity to   highlight the need for better political interventions in malaria control and prevention. This day marks the milestones in the fight against malaria as well as continuously contributing to the efforts in averting this disease through sensitizing citizens mostly in malaria affected countries on simple actions they can take to prevent and treat this killer disease. As a means of investing in ending malaria, some efforts such as engaging community, national and global leaders to prioritize the fight against this disease have been put in place. 

During last year’s commemoration under the theme “Zero Malaria Starts with Me,’” we called upon relevant stakeholders to highlight the importance of robust health and surveillance systems. These systems can sustain malaria prevention and control interventions for the most vulnerable as the world grapples with COVID-19.  This day also highlights the importance of upholding progress and commitments made in the global fight to end malaria. We call upon all stakeholders to recognise and revitalise the involvement of high-burden countries in Africa, which account for approximately 70% of the global malaria burden as we put an end to this killer disease. 

As we try to address and control the COVID-19 pandemic, let us not forget to equally invest in building and supporting resilient health systems that protect and advance progress against further outbreaks of existing infectious diseases like malaria.

Whereas the efforts to contain the spread of the coronavirus should be appreciated, the government should not neglect the interventions and delivery of other health services including prevention and treatment of malaria. This therefore means that governments must put in place avenues to make delivery of all health services accessible, acceptable, available and of good quality.  

Experience from previous disease outbreaks has shown the disruptive effects on health service delivery if diseases such as malaria are ignored. For example, the 2014-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone, undermined malaria control efforts and led to a massive increase in malaria-related illness and death in the three countries. COVID-19 pandemic reports from the World Health Organization (WHO) show that in Africa, which carries more than 90% of the global malaria burden, 37 countries had reported cases of the Coronavirus as of 25th March, 2020. To contain the spread of the Coronavirus, most of these African countries declared several measures including continuous lockdowns which are a threat to accessing health services.  

In recent days, there have been reports of the suspension of insecticide-treated nets (ITN) and indoor residual spraying (IRS) campaigns in several African countries due to concerns around exposure to COVID-19.^[1] Suspending such campaigns will leave many vulnerable populations at a greater risk of malaria, particularly young children and pregnant women. WHO strongly encourages countries not to suspend the planningfor – or implementation of – vector control activities, including ITN and IRS campaigns, while ensuring these services are delivered using best practices to protect health workers and communities from COVID-19 infection. Modifications of planned distribution strategies may be needed to minimize exposure to the coronavirus.

Also, delivery of intermittent preventive treatment in pregnancy (IPTp), seasonal malaria chemoprevention (SMC), and intermittent preventive treatment in infants (IPTi) should be maintained provided that the best practices for protecting health workers – and other front-line workers – from COVID-19 are followed. Ensuring access to these and other core malaria prevention tools saves lives and is an important strategy for reducing the strain on health systems in the context of the COVID-19 response.  

There have been reports of disruptions in the supply chains of essential malaria commodities – such as long-lasting insecticidal nets, rapid diagnostic tests and antimalarial medicines – resulting from lockdowns and from a suspension of the importation and exportation of goods in response to COVID-19. 

Coordinated action is required to ensure the availability of key malaria control tools, particularly in countries with a high burden of the disease, and that efforts to limit the spread of COVID-19 do not compromise access to malaria prevention, diagnosis and treatment services.

There are also reports of people taking heavy doses of malaria treatment of Chloroquine like in Nigeria which recorded chloroquine poisoning after Mr. Trump endorsed it for coronavirus^[2] treatment despite the insufficient data to assess the efficacy of either of these medicines in treating patients with COVID-19, or in preventing them from contracting the coronavirus although  there are ongoing clinical trials being conducted in response to COVID-19, including studies looking at the use of chloroquine and its derivative, hydroxychloroquine, for treatment and/or prevention.^[3]

Since 2000, the world has made historic progress against malaria, saving millions of lives however, half the world still lives at risk from this preventable and treatable disease, which costs a child’s life every two minutes. Malaria is increasingly a disease of poverty and inequality, with the most vulnerable at greatest risk of dying from a mosquito bite – particularly pregnant women and children under five in sub-Saharan Africa. In 2018, nearly 900,000 children in 38 African countries were born with a low birth weight due to malaria in pregnancy, and children under five still accounted for two-thirds of all malaria deaths worldwide. Therefore, all governments and states should maintain access to proven, life-saving malaria prevention tools, including insecticide-treated mosquito nets, indoor residual spraying of insecticides and preventive therapies for vulnerable groups as they impose the various restrictions during the COVID19 pandemic.

WHO is monitoring the fast-evolving situation of the COVID-19 epidemic and needs to advise the countries in the malaria-endemic regions on how to establish and effectively execute public health policies. Preventive measures for COVID-19, including case and contact tracing, quarantine and screening, as well as education to encourage good hand hygiene practices, should be in place. Additional and pre-emptive measures must be taken for malaria control in these countries, anticipating the potential challenge that would be faced by the public health system during an outbreak of COVID-19.

Malaria is still a global scourge that is preventable but it’s a disease that is curable. Let’s not forget it during this period as we battle to avert the spread of the COVID 19 pandemic. 

---

^[1] https://www.who.int/news-room/q-a-detail/malaria-and-the-covid-19-pandemic

^[2] https://edition.cnn.com/2020/03/23/africa/chloroquine-trump-nigeria-intl/index.html

^[3] https://www.who.int/news-room/q-a-detail/malaria-and-the-covid-19-pandemic

CEHURD participated in the 9th Africa Conference on Sexual Health & Rights held in Kenya between 12th – 14th February, 2020 which was partly sponsored by the Aids Foundation of South Africa (AFSA).

The Conference aimed at addressing challenges that people living in urban informal settlements and slums face in accessing basic services to health and their wellbeing, education, decent employment, food and shelter, protection from abuse and other human rights.

AFSA, the host of the Sex Rights Africa Network (SRAN), runs the #HappyFlowMonday campaign on menstrual health and hygiene.

Ms. Ruth Ajalo, our Program Officer attended this conference and through SRAN, has developed an article on the importance of water and safe sanitation in maintaining Menstrual Hygiene Management (MHM).

See link to the article here:
https://bit.ly/3a7hP8g

By Rose Wakikona

The health care system in Uganda has historically suffered gross neglect and has been crippled by under funding and lack of political will, this has greatly affected women and their reproductive health, the situation has since escalated with the measures taken to curb the COVID-19 pandemic, which has seen the country being put into lock down with a curfew imposed between 7:00pm and 6:30am, also no public or private transportation is being allowed save for cargo, to use private transport one needs permission from the Resident District Commissioner (RDC), who is only one in every district and to get to the RDC one has to walk, sometimes several kilometers.

The effect of these directives has negatively impacted on women’s health since the media has been awash with stories of women delivering babies on sidewalks because they cannot get transport to health facilities, they also cannot travel to the health facility to get antenatal and postnatal care. Contraceptives are not considered an emergency and are therefore inaccessible during this time and even when a woman manages to get to a health facility, there are no health workers because they are all trying to deal with COVID-19 or have failed to come to work because of the ban on transport. We have seen people living with HIV failing to get lifesaving medicine because they cannot get transport to the health facility.

The historic gross neglect of women’s reproductive health has led to damning statistics as can be seen in the persistently high maternal mortality ratio currently at 336 per 100,000 live births (UDHS) which means 16 women die every day while performing their maternal function. These deaths are majorly because of lack of basic maternal health commodities like gloves, syringes, blood, medicines etc. which enable a woman give birth safely. The restrictive laws and policies on women specific health care needs has persistently seen women being denied access to quality health care, this can be seen in the limited access to family planning services like contraceptives which continue to suffer persistent stock outs affecting continuous access.

Equally in 2016 the Parliament of Uganda issued a ban on Comprehensive Sexuality Education both in and out of school environments affecting access to critical health information for women and leading to an increasing number of unwanted pregnancies among teenagers which currently stands at 25%, a significant number of which end up in unsafe abortions estimated at 314,304 abortions per year, which translates into 800 unsafe abortions per day posing a serious public health human rights and social equity dilemma that affects millions of women.

The situation is further worsened when in 2018 the Government of Uganda turned a public service into a private service at the Mulago Specialised Women’s and Neonatal Hospital when they insisted on charging fees before a woman can access services at this public hospital, with women already being economically disempowered many have been locked out of receiving critical care because there is no public wing. This has been made more dire with the turning of Mulago Specialised Women’s and Neonatal Hospital into a treatment center for COVID-19 patients who wish for more comfort.

Sexual Gender Based Violence is another area with over 1,580 cases of rape and 15,366 cases of defilement reported in 2018, but with all these the government has failed to establish and run public shelters to address the unique psycho social needs of survivors of sexual violence which has led them to fail to cope with the trauma that comes with facing sexual violence. It also leaves survivors unprepared for court processes and reintegration within the community where they face stigma and alienation. With COVID-19 the survivors cannot access critical health care needed or seek refuge at police as they usually do because of the directives made.

When asked about the plight of women delivering on sidewalks because they could not access transport to take them to a health facility, the government responded that they want to prevent disorganization and women must wait for the RDC to give them permission to go to a health facility, even at the expense of their lives. The question is, if the same government can allow cargo trucks and goods delivery services to move, why can’t they allow women going to hospital the same privilege? I can only conclude by saying it has long been demonstrated that the lives of women do not matter in this country since even cargo is given more importance, women are instead always subjected to control and left to fend for themselves.

As we celebrate the International day for Maternal health and Rights, this country needs to be reminded of the obligation it has in Article 33(3) of the Constitution of the Republic of Uganda to protect women and their rights, taking into account their unique status and natural maternal functions in society. This means that even in the face of the COVID-19 pandemic, the health of women and their rights must be protected above all, they should therefore be allowed to access health care with ease especially where it is a matter of life and death. The government should therefore exempt women going to health facilities from seeking permission to move.

The writer is a Senior programme officer at the Center for Health, Human Rights and Development.

By Nakalembe Judith Suzan

As the COVID 19 pandemic furies around the world, Gender based violence drives high and women and girls are more vulnerable to abuse than ever.  This has had serious consequences for women’s health since the pandemic has disrupted access to sexual and reproductive health and gender-based violence services at a time when women and girls need these services most”.[1]

Health care systems have been forced to channel all of their resources to combat the epidemic since it is perceived to be more pressing, despite the persistent need for adequate family planning, menstrual health resources, maternal care and protection of women form violence.

Movement restriction and lockdown while helpful in stopping the spread of the novel coronal virus has left women in abusive relationships trapped at home during the lockdown with the abuser, women usually use the gap of free movement time they need to escape the house, but the possibility of being locked up with the abuser for hours is something that should worry us all[2]

Pregnant women who need antenatal care are unsure whether to attend a clinic while some expectant mothers have been reported to have delivered by the road side others have lost their lives due to minimal and uncertain availability of transport means to health facilities.

The president of Uganda regulated movement of persons and vested the powers of authorization to the Resident City Commissioners (RCC) Resident District Commander (RDCs) and sub county chiefs for all those seeking medical care including expectant mothers whose condition often require emergency health care.

As  the country has closed schools and set travel restrictions in the wake of the corona virus pandemic, women   are facing  the burden of balancing childcare and having  to sleep  at work places as per the presidential directive, let alone full filling other marital obligations as married women.  Few men will let their wives sleep out of their home, an act that has triggered gender based violence and those who have persisted to go back home have been caught up by the curfew hours and ended up being flogged by security personals.

As CEHURD, we therefore call for an effective response to the pandemics needs to really look at gender dynamics in a meaningful way, as the pandemic is compounding existing gender inequalities, and increasing risks of gender-based violence.

1. The protection and promotion of the rights of women and girls should be prioritized.  While listing the essential services the president did not priorities legal and psychosocial services for survivors of gender based violence.  Government needs to prioritize services for the prevention and response and mitigate the consequences of all forms of   violence against women and girls.
2. Ensure that access to sexual and reproductive health services including contraceptive services is maintained, with special attention to women particularly in the context of self-isolation, when levels of intimate partner violence upsurge especially when families are placed under increased stress and relations are forced to live in confined spaces.[3]
3. We are also calling for priority testing of pregnant women with COVID-19 symptoms, isolation of pregnancy wards from confirmed COVID-19 cases, an elevation of care for any pregnant women with respiratory illnesses, and extra care for all women in delivery, in case breathing complications should arise

[1] https://www.weforum.org/agenda/2020/04/covid-19-coronavirus-pandemic-hit-women-harder-than-men/

The Author is a Programme Officer at

CENTER FOR HEALTH HUMAN RIGHTS AND DEVELOPMENT.

---