Study Theme: Malaria and Childhood Illness

Battling Malaria and Childhood Illness in Uganda: Our Experiences

Aditya Bhave, Han Zhang, Robert Walyaula

Hello! Over the past few weeks, we have spent much time learning about the public health issues that surround malaria and childhood illnesses. This blog post details our journey on how we answered pertinent public health questions about our topic.

Our initial dive into this area started in the rural district of Rakai, where we visited Kalisizo Hospital and met Dr. Suliaman and Dr. Patrick. They were the ones on the front lines of the battle against malaria and we learned much as they took us on a tour of the pediatric ward of the hospital. The doctors told us of how in resource-limited hospitals such as the one in Kalisizo, the medical staff took the Integrated Management of Childhood Illnesses (IMCI) approach towards their patients. The idea of this approach, according to Dr. Suliaman was to “use the senses in order to diagnose and cover a wide variety of conditions.” In other words, doctors tried to treat conditions based on just the signs and symptoms the child presented. Although this approach is not as accurate as a laboratory diagnosis, it helped protect the child from a spectrum of conditions.

After examining literature, we found that despite nationwide training, IMCI adherence rates for the assessment and physical examination remained low in Uganda. Furthermore, poor or low adherence may be one of the important reasons for not achieving the goal of lowering child mortality.

The doctors said that over time, medical staff have been better able to identify and care for malaria and other major childhood diseases. However Dr. Suliaman said that  "Although there has been a reduction in mortality and morbidity of malaria, the prevalence has not changed.”

Dr. Suliaman with us at Kalisizo Hospital

The doctors also told us about the tendency of households to prefer alternative or tribal medicine as opposed to modern medicine. This is a bit of a gray area in the Ugandan health care system as herbalists - those who mix different herbs to create treatments - can be licensed and officially recognized by the Ugandan government. Dr. Patrick told us about how there is not much knowledge about the effectiveness of herbal medicine as there has been limited scientific research done. However, in many communities, it is common for there to be witch doctors or spiritual healers that charge to heal people with diseases. The root cause behind people seeking these treatments is that when a child gets sick, parents sometimes believe that they are possessed by a demon instead of actually being sick. These healers are unlicensed and not recognized by the government. Another interesting aspect that Dr. Patrick pointed out was that these healers often had higher levels of education than the average in the town and often held a high reputation among the community.

To learn more about the role of spiritual healing practices in Uganda, we took a site visit to Christ Witness Church in Kampala to speak to the head pastor Michael and the founder of the church Dr. Abed Bwanika. On another note, Dr. Bwanika is a well-known figure in Ugandan politics, having run for President of Uganda and coming in third place in the elections for the last two cycles. He also serves as the President of the People's Development Party, a major political party in Uganda. Father Michael told us that it is common for people with a variety of illnesses to come to the church to get blessed. He claimed that there have been many cases in which after he had prayed for someone, they were cured of their disease almost immediately after. These anecdotes included malaria and even HIV. However, he said that he did not discourage people from seeking medical care, saying that "God works and heals people through doctors as well." Blessings at Christ Witness Church were free, but Father Michael said that there are other churches that charge for them, which he was extremely displeased with. He also said that there are other churches that discourage people from seeking medical care from doctors in order to get them to keep coming back and pay them for extra blessings. Dr. Bwanika told us a personal anecdote of how he was healed of malaria as a child through the church. He claimed that he could never get malaria ever again "even if 1000 infected mosquitoes bit me." He even said that he did not use a mosquito net when he slept because he believed that the blessing of the church permanently cured him. It was clear from this interaction that their belief in spiritual healing was very deep but was primarily based on personal anecdotes.

Dr. Bwanika at Christ Witness Church

Our final site visit was to Good Life Child Center, a Ugandan NGO that works with fishing communities in the Eastern region of Uganda that works to promote community awareness and management of common children and adolescent health issues. Their main focuses were on the prevention of malaria and teenage pregnancy. We spoke with Betty, the local site director about the organization's role in the community. She also told us about her vision of focusing on education and prevention to fight malaria, as she believed these were the root causes for people getting the disease in the first place. When asked about beliefs in alternative medicine, she reiterated what the doctors at Kalisizo told us about witch doctors and healers, but she believes that the trend has been changing and that "more people are beginning to embrace modern medicine."

Our team meeting with Betty from Good Life Child Center

Throughout our three weeks here, we learned much about the issue of malaria and childhood illnesses from a variety of perspectives. Through collaborative efforts from governmental, nongovernmental, and civilian agencies, the systematic infrastructure has been established to combat those diseases. However, lack of education and resources still present significant challenges to achieving universal high-quality prevention and treatment program for malaria and childhood diseases in Uganda. We look forward to coming back doing further research and devising new contextualized interventions.