The malaria burden continues to be very high in Uganda, despite recent studies showing that prevalence rates are decreasing across many parts of sub-Saharan Africa, a new study notes.

The findings of the study, published in the American Journal of Tropical Medicine & Hygiene, highlight the need for more aggressive methods of controlling the disease in high transmission areas of sub-Saharan Africa.

While access to the most current malaria medications has increased dramatically in Uganda, the use of other recommended interventions is less widespread, according to the authors of the study.

For example, the study shows that only up to 36 per cent of households have at least one long lasting insecticide-treated bednet, while only 6-7 per cent reported receiving indoor residual spraying with insecticides between 2006 and 2011.

To prevent the further burden of the disease, the scientists say that there is a need to scale up campaigns to distribute insecticide-treated bednets and spray homes with insecticides, while considering new interventions such as using malaria drugs.

“The use of both longlasting insecticide treated nets and artemisinin-based combination therapies may be sufficient for minimising the severity of disease, improving child health and reducing childhood mortality at the level of an individual,” says the report.

The report, however, suggests that in areas with high transmission intensity, reducing morbidity will require enhanced community-wide coverage of these interventions, and consideration of additional interventions.

These include expanding indoor residual spraying (IRS), larval source management (which involves both the modification of water habitats and the direct application of larvicides to control mosquito production) and other novel vector control strategies, chemoprevention (the use of chemical agents, drugs or food supplements to prevent disease) at the individual and/or community level, mass drug administration, and/or an effective vaccine.

“Our findings suggest that current efforts at controlling malaria may not be as effective as previously believed in high-transmission areas, where the disease is the biggest threat,” said Grant Dorsey, a co-author of the study, and professor of infectious diseases at the University of California, San Francisco in the US.

The study was conducted by scientists from Makerere University in Uganda, the University of California, San Francisco, Durham University in the UK, the University of Oxford and the London School of Hygiene and Tropical Medicine. It gathered surveillance data over 24 months — from August 2011 to September 2013.

Initially, 755 children aged between six months and 10 years with differing malaria characteristics were enrolled from 300 houses, randomly selected from three areas of Uganda.

Episodes of malaria per person per year rose from an average of 0.97 to 1.93 in the moderate-transmission in one area, and from an average of 2.33 to 3.30 in a high-transmission rural area near the southeastern border with Kenya.

The families were provided with bednets and had access to 24-hour medical care free of charge at a designated study clinic for episodes of fever.

The children were also routinely tested for malaria every three months, irrespective of whether they had symptoms. Mosquito specimens were also collected monthly from light traps strategically placed in each house to estimate the percentages of mosquitoes in the study areas that were carriers of malaria.

Healthcare workers provided over 2,500 treatments for malaria over the course of the study.

“Children in our study experienced a significantly high rate of infection, and that rate increased in the two rural areas,” said Prof Dorsey. “Based on prior data, our higher transmission sites are likely to be representative of most of Uganda and perhaps of most other rural areas in sub-Saharan Africa as well.