1. Malaria in Gulu, Uganda 2014. By: Sarah Francke University of Kansas SON

2. Uganda Population: 35,918,915 Population: 35,918,915 o Age structure- 0 to 14yrs: 48.7% o Median age- 15.5yrs. o Mother’s mean age at first birth- 18.9yrs. o Total fertility rate- 5.97 children born/woman. o Urbanization- o Urbanization- 15.6% of total population. https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html http://www.nationsonline.org/map_small/uganda_africa.jpg

3. Gulu Population- 154,300. Population- 154,300. Region- Northern Uganda. Region- Northern Uganda. o Remote area of the country. o War-torn region. o High levels of civil unrest. Sub region- Acholi sub-region. Sub region- Acholi sub-region. Main tribal inhabitants- Acholi (80%). Main tribal inhabitants- Acholi (80%). Life expectancy- 56.8yrs. Life expectancy- 56.8yrs. Available hospital service- Available hospital service- o St. Mary's Hospital Lacor o Gulu Regional Referral Hospital o Gulu Independent Hospital http://www.ubos.org/ http://daneenleidig.blogspot.com/2009/09/where-is-gulu-uganda.html

4. St. Mary’s Lacor Hospital 482 bed-hospital with 3 peripheral health centers. 482 bed-hospital with 3 peripheral health centers. Cares for 300,000+ patients each year. Cares for 300,000+ patients each year. Over half all patients served the last years were children and pregnant women. Over half all patients served the last years were children and pregnant women. One quarter of all children fail to reach age five due to poverty-related illnesses such as: malaria. One quarter of all children fail to reach age five due to poverty-related illnesses such as: malaria. http://www.lacorhospital.org/

5. International Experience Objectives 1. To study the disease process and describe the epidemiology of malaria 2. To identify the most at-risk populations for malarial infections and fatalities. 3. To identify the signs and symptoms of malarial infections. 4. To study the treatment options and identify strategies of care for malaria. 5. To evaluate the availability of prevention options and discuss community and system strategies to address malaria. 6. Identify barriers to treatment of malaria.

6. Malaria Parasitic infection of erythrocytes in the bloodstream. Parasitic infection of erythrocytes in the bloodstream. Carried and transmitted by the female anopheline mosquito. Carried and transmitted by the female anopheline mosquito. Transmitted in 108 countries inhabited by 3 billion people in total. Transmitted in 108 countries inhabited by 3 billion people in total. White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383 (9918), 723-735.

7. Populations at Risk Residents of impoverished areas- Residents of impoverished areas- o Lack of availability of bed nets. o Lack of treatment of residential structures with insecticide. Neonates- highest risk for morbidity and mortality are those ranging from 0 to 28 days of life. Neonates- highest risk for morbidity and mortality are those ranging from 0 to 28 days of life. Children in the poorest families have a 50% higher risk of dying from a malarial infection. Children in the poorest families have a 50% higher risk of dying from a malarial infection. Rumisha, S. F. (2014). Relationship between child survival and malaria transmission: an analysis of the malaria transmission intensity and mortality burden across Africa (MTIMBA) project data in Rufiji demographic surveillance system, Tanzania. Malaria Journal, 13(1), 124-147.

8. Symptomatology Incubation, symptomless period of 12-14 days. Incubation, symptomless period of 12-14 days. Early symptoms: Headache, joint aches, fever, nausea, vomiting, and general malaise. Early symptoms: Headache, joint aches, fever, nausea, vomiting, and general malaise. End-stage symptoms: Severe anemia, palpable spleen (r/t erythrocyte sequestration), tremors, brain damage, and death. End-stage symptoms: Severe anemia, palpable spleen (r/t erythrocyte sequestration), tremors, brain damage, and death. White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383 (9918), 723-735.

9. Early Diagnoses Rapid Diagnostic Blood Test (RTD) used for adult diagnosis. Rapid Diagnostic Blood Test (RTD) used for adult diagnosis. Blood smear used for infant diagnosis. Blood smear used for infant diagnosis. Reduced number of deaths when antimalarial medication regimen is started within 24 hours of presentation of a fever. Reduced number of deaths when antimalarial medication regimen is started within 24 hours of presentation of a fever. Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic reviews, 1-21.

10. Treatment Three treatments of IV Quinine every 8 hours. Three treatments of IV Quinine every 8 hours. o Dilute with Dextrose 5% in water. o Requires hospitalization and observation. Oral Quinine three times daily for seven days. Oral Quinine three times daily for seven days. o Patient may be discharged with medication or required to remain hospitalized based on status. Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic reviews, 1-21.

11. Interventions Individual Interventions: Individual Interventions: o Avoid the outdoors at and after twilight. o Cover windows with screens. o Close doors early. o Sleep under insecticide-treated net. Community Interventions: Community Interventions: o Treat homes with insecticide. o Ensure availability of medications. o Distribute insecticide treated nets. System-Level Interventions: System-Level Interventions: o Malaria screenings upon early symptom appearance (available but costly). Von Seidlein, Lorenz, & Bejon, Philip (2013). Malaria vaccines: past, present and future. Archives of disease in childhood, 98 (12), 981-985.

12. Barriers to Treatment Proximity of health care facilities- Proximity of health care facilities- o Treatment will be delayed if the patient has to walk/ride a long distance to reach care. Lack of resources- Lack of resources- o If bed nets and window screens are not available then they cannot be used for prevention. Financial burdens- Financial burdens- o Supplies for prevention and medication treatment costs money that most people do not have. Clements, Archie (2013). Further shrinking the malaria map: how can geospatial science help to achieve malaria elimination? The Lancet Infectious Diseases, 13 (8), 709-718.

13. Suggestions System-level push for screening, education, disease isolation, or funding for research. System-level push for screening, education, disease isolation, or funding for research. Distribution and or sale of bed nets at more locations. Distribution and or sale of bed nets at more locations. Ensured availability of low-cost malaria treatment drugs at all health centers. Ensured availability of low-cost malaria treatment drugs at all health centers.

14. Profound Clinical Experience Community Health Center at Pabbo, Uganda Community Health Center at Pabbo, Uganda o 1,500 patients served per month in the OPD.  Patients speak a variety of 30 tribal languages. o 17 staff members run the health center with nursing and midwifery students assistance.  22 beds are available for admitted patients. o Student nurses collect health history, examine, diagnose, and prescribe medications.  Free ambulance transportation is available for referrals to Lacor main hospital for patients needing more care.

15. Profound Cultural Experience Tribal dancing- Tribal dancing- o Different tribes have unique individual dances o Certain dances are shared by larger groups –  Dances for Gulu  Dances for Uganda o Dances serve specific purposes –  Boy – Girl courtship  Welcoming  Marriage  Death

16. Concluding Points Gulu, Uganda is an area with rich history and tradition with hope- filled inhabitants. Gulu, Uganda is an area with rich history and tradition with hope- filled inhabitants. Lack of resources make the Acholi people a highly vulnerable population. Lack of resources make the Acholi people a highly vulnerable population. Malaria is a highly preventable disease when appropriate means are available. Malaria is a highly preventable disease when appropriate means are available. With enhanced system-level interventions there is hope for a brighter future. With enhanced system-level interventions there is hope for a brighter future.

17. References https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html Clements, Archie (2013). Further shrinking the malaria map: how can geospatial science help to achieve malaria elimination? The Lancet Infectious Diseases, 13 (8), 709- 718. Clements, Archie (2013). Further shrinking the malaria map: how can geospatial science help to achieve malaria elimination? The Lancet Infectious Diseases, 13 (8), 709- 718. http://www.lacorhospital.org/ http://www.lacorhospital.org/ http://www.lacorhospital.org/ Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic reviews, 1-21. Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic reviews, 1-21. Rumisha, S. F. (2014). Relationship between child survival and malaria transmission: an analysis of the malaria transmission intensity and mortality burden across Africa (MTIMBA) project data in Rufiji demographic surveillance system, Tanzania. Malaria Journal, 13(1), 124-147. Rumisha, S. F. (2014). Relationship between child survival and malaria transmission: an analysis of the malaria transmission intensity and mortality burden across Africa (MTIMBA) project data in Rufiji demographic surveillance system, Tanzania. Malaria Journal, 13(1), 124-147. http://www.ubos.org/ http://www.ubos.org/ http://www.ubos.org/ Von Seidlein, Lorenz, & Bejon, Philip (2013). Malaria vaccines: past, present and future. Archives of disease in childhood, 98 (12), 981-985. Von Seidlein, Lorenz, & Bejon, Philip (2013). Malaria vaccines: past, present and future. Archives of disease in childhood, 98 (12), 981-985. White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383 (9918), 723-735. White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383 (9918), 723-735.