UBOS’ Malaria Indicator Survey; One in Three Children Under Five Had Fever Recently, Malaria Still Rising in Uganda

By Ben Musanje

A new malaria survey in Uganda has revealed worrying trends among children under five. Thirty-one percent of children in this age group had a fever in the two weeks before the survey, highlighting how common childhood illnesses remain in the country. Caretakers sought advice or treatment for 84 percent of these children, but only 54 percent received help on the same day or the next, raising concerns about timely care.

Among those who received care, 42 percent went to public health facilities, while 61 percent sought help from private clinics, hospitals, or pharmacies. The survey shows that the most common sources of treatment were private hospitals and clinics (45 percent), government health centers (27 percent), and pharmacies or drug shops (15 percent). Reasons for not seeking care included lack of money (33 percent), having medicine at home (23 percent), or believing the child was not very ill (22 percent).

Testing for malaria remains crucial, and the survey found that 57 percent of children with recent fever had blood taken from a finger or heel for testing. Urban children were slightly more likely to be tested (60 percent) than rural children (55 percent). Testing rates varied by region, with Karamoja leading at 81 percent and Busoga the lowest at 42 percent. Mothers’ education also influenced testing: 75 percent of children whose mothers had more than secondary education were tested, compared with 55 percent for those whose mothers had only primary education or no formal education.

Treatment practices are improving. Among children who received antimalarial drugs, 87 percent were given the recommended artemisinin-based combination therapy (ACT), 12 percent received artesunate injections, and 3 percent received quinine injections. The use of ACTs has increased sharply from 63 percent in the 2018–19 Uganda Malaria Indicator Survey to 87 percent in the current 2024–25 survey. Younger children under six months were less likely to receive ACTs (77 percent), while children aged 36–47 months had the highest coverage (91 percent).

Malaria prevalence in children remains high. According to microscopy, 13 percent of children aged 6–59 months were infected, up from 10 percent in the 2018–19 survey. Rapid diagnostic tests (RDTs) showed 21 percent prevalence, while more sensitive real-time PCR testing identified 17 percent. Most infections were caused by Plasmodium falciparum (85 percent), but the survey also recorded P. malariae (4 percent), P. ovale (2 percent), P. vivax (less than 1 percent), and mixed infections (10 percent).

The survey highlighted regional and demographic differences. Malaria prevalence rises with age, from 6 percent among babies aged 6–8 months to 16 percent among children 48–59 months. Rural children were more than twice as likely to have malaria (16 percent) as urban children (7 percent). Regions with the highest rates included Lango (32 percent) and Karamoja (26 percent), while Kampala and Kigezi recorded the lowest prevalence (less than 1 percent and 1 percent, respectively). Seasonal malaria chemoprevention districts still showed high prevalence (26 percent), more than double the national average, indicating ongoing challenges despite intervention programs. Children of mothers with more than secondary education had the lowest malaria prevalence at 1 percent, compared with 17 percent among children whose mothers had no formal education.

Experts note that these findings underline the importance of timely care, proper testing, and the use of ACTs to reduce the impact of malaria on young children. Health officials emphasize that understanding regional patterns, improving access to testing, and encouraging caregivers to seek treatment immediately are critical steps in the fight against malaria.

The 2024–25 Uganda Malaria Indicator Survey was conducted by the Uganda Bureau of Statistics (UBOS) in collaboration with the Ministry of Health. The survey provides essential data for monitoring malaria prevalence, improving fever management strategies, and tracking progress toward national malaria reduction goals. (For comments on this story, get back to us on 0705579994 [WhatsApp line], 0779411734 & 041 4674611 or email us at mulengeranews@gmail.com).