Abstract
BackgroundMalaria burden in Uganda has declined disproportionately among regions despite overall high intervention coverage across all regions. The Uganda Malaria Indicator Survey (MIS) 2014–15 was the second nationally representative survey conducted to provide estimates of malaria prevalence among children less than 5 years, and to track the progress of control interventions in the country. In this present study, 2014–15 MIS data were analysed to assess intervention effects on malaria prevalence in Uganda among children less than 5 years, assess intervention effects at regional level, and estimate geographical distribution of malaria prevalence in the country.MethodsBayesian geostatistical models with spatially varying coefficients were used to determine the effect of interventions on malaria prevalence at national and regional levels. Spike-and-slab variable selection was used to identify the most important predictors and forms. Bayesian kriging was used to predict malaria prevalence at unsampled locations.ResultsIndoor Residual Spraying (IRS) and Insecticide Treated Nets (ITN) ownership had a significant but varying protective effect on malaria prevalence. However, no effect was observed for Artemisinin Combination-based Therapies (ACTs). Environmental factors, namely, land cover, rainfall, day and night land surface temperature, and area type were significantly associated with malaria prevalence. Malaria prevalence was higher in rural areas, increased with the child’s age, and decreased with higher household socioeconomic status and higher level of mother’s education. The highest prevalence of malaria in children less than 5 years was predicted for regions of East Central, North East and West Nile, whereas the lowest was predicted in Kampala and South Western regions, and in the mountainous areas in Mid-Western and Mid-Eastern regions.ConclusionsIRS and ITN ownership are important interventions against malaria prevalence in children less than 5 years in Uganda. The varying effects of the interventions calls for selective implementation of control tools suitable to regional ecological settings. To further reduce malaria burden and sustain malaria control in Uganda, current tools should be supplemented by health system strengthening, and socio-economic development.
Highlights
Environmental factors, namely, land cover, rainfall, day and night land surface temperature, and area type were significantly associated with malaria prevalence
To further reduce malaria burden and sustain malaria control in Uganda, current tools should be supplemented by health system strengthening, and socio-economic development
Malaria remains one of the leading public health burdens in the world despite the remarkable achievements made towards its control and prevention since the beginning of the second millennium
Summary
Bayesian geostatistical models with spatially varying coefficients were used to determine the effect of interventions on malaria prevalence at national and regional levels. Uganda is a land locked country located in East Africa, and shares borders with South Sudan to the north, Kenya to the east, Democratic Republic of Congo to the west, and Tanzania and Rwanda to the south. It lies between latitudes 10 south and 40 north of the equator, with altitude ranging from 620 m to 5,111 m above sea level, and mean annual temperatures between 14 ̊C and 32 ̊C. The proportion of population of children age less than 5 years is 17.7% [14]
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