On the trail of two very different parasites in Uganda

NEW YORK — Tonight I’m flying to Uganda for GlobalPost’s Special Report on child mortality, The Seven Million. I’ll be examining the heavy toll taken on Ugandan children’s health by two pernicious, but very different, sorts of parasites.

The first is the Plasmodium parasite, the mosquito-borne microorganism that causes malaria. The second are corrupt government officials, whose theft of international aid prompted foreign donors to withdraw roughly 90 percent of their contributions to the Ugandan budget in the 2013-14 fiscal year.

Uganda is one of the world’s most hospitable places for Plasmodia. According to Uganda’s Malaria Control Programme, more than 90 percent of its territory is at high risk for the parasite’s transmission. The majority of the nation’s population, estimated the 2005-2010 Uganda Malaria Strategic Control Plan, lives in areas where they will receive an average of more than 50 infective mosquito bites each year.

The results of this exposure have been deadly. Malaria is Uganda’s leading cause of illness and mortality, according to the United States Agency for International Development (USAID), and young children are among the most likely to die from infections. Statistics on the number of children under five who have succumbed to malaria in Uganda vary hugely – from 18,966 child deaths in 2010, according to the Child Health Epidemiology Reference Group, to 70,000 to 100,000 child deaths each year, according to the government’s 2005-2010 strategic control plan – but both place the disease among the top two causes of child mortality in the country.

In recent years, Uganda has embarked on a nationwide effort to reduce the disease’s toll, bolstered by heavy international support. Uganda was one of the initial countries targeted in the 2005 launch of George W. Bush’s President’s Malaria Initiative (PMI), a USAID program intended to slash malaria by half in 15 African countries. Since its launch, PMI has invested more than $200 million in combating malaria in Uganda, and along with the Ugandan government and The Global Fund it remains one of the top funders of malaria programs in the country.

The combined efforts to combat malaria have saved countless lives, although Uganda still lags behind many other African countries. From 2006 to 2011, according to PMI’s Uganda country profile, distribution campaigns helped increase the proportion of Ugandan households with at least one insecticide-treated mosquito net from 16 percent to 60 percent, and the proportion of Ugandan children under five who slept under these nets increased from 10 percent to 43 percent. Most crucially – due to a variety of factors that extend well beyond malaria — verall child mortality rates dropped from 137 to 90 deaths under five for every 1000 live births.

But last fall, a devastating report by Uganda’s Office of the Auditor General cast the future of an array of Ugandan government programs – including its malaria efforts – in doubt. The report found that $13 million of foreign aid earmarked for reconstruction of the country’s war-torn north had been stolen by officials in the Office of the Prime Minister, in some cases to fund lavish personal expenses. Great Britain, Uganda’s biggest foreign donor, as well as Ireland, Sweden, Norway, Denmark and Germany, all pulled the plug on their 2013-14 support for the government. According to a report by Reuters, the withdrawn funds reflected 93 percent of international aid in Uganda’s budget. Foreign aid accounted for about a quarter of Uganda’s total budget last year.

It remains unclear how the revelations about parasitic officials will affect the battle against Plasmodia. Notably, PMI says it is maintaining its support: in large part because it works primarily with NGOs to deliver services, rather than government programs. The Ugandan government has indicated it is considering raising taxes to make up the shortfall. It has also repaid several European countries whose aid was stolen and announced measures to combat corruption which it hopes will lead to the restoration of foreign support, possibly even before the cuts take effect.

But barring a quick turnaround by donors, a back-of-the-envelope calculation – based on Reuters’ report of a 90 percent cut that left about $20 million in foreign aid – suggests $180 million is in line to be lost. Such sweeping reductions would likely have significant consequences for malaria programs.

Over the next two weeks, I’ll be meeting with health officials and experts, and traveling to rural clinics and communities to examine the front lines of Uganda’s battle against child malaria. The country must inoculate itself on two fronts to protect the lives of its children – and neither of its infections relents easily.