Socio-demographic characteristics of respondents
Out of 255 respondents who participated in this study, 130 (51%) were male, while the females were 125 (49%). Of these, 204 (80%) were students while 51 (20%) were staff. Majority, 194 (76%) were in the age category of 18-25 years while the minority, 23 (9%) were above 35 years. The respondents belonged to 11 nationalities namely; Ugandans 140 (55%), Nigerians 43 (16%), Somalis 18 (7%), Malawians 15 (6%), Kenyans 13 (5%), Sudanese 13 (5%), Rwandese 2 (1%), Tanzanians 2 (1%), Arabs 2 (1%), Indians 2 (1%), Comoros 5 (2%). The highest level of education attained by the respondents was PhD, 8 (3%), while the lowest was Uganda Certificate of Education (UCE) (6%). The results are summarized in Table 1 below.
Malaria prevalence in IUIU community from August to December 2019
Out of the 4396 clients who attended IUIU HC III to seek treatment between August and December-2019; 559 (12.7%), were diagnosed with malaria, hence a prevalence of 12.7%. Among the malaria positive cases, 472 were students, in the age group of 20 to 40 years; Of these; 300 (63%) were females while 172 (37%) were males. The Staff contributed 87 (2%) of the malaria positive cases, belonging to the age category of 23-73; 55 (63.2%) were females and 32 (36.8%) were males. The highest prevalence (17.6%) was reported in the month of December while the lowest (7.5%) was reported in November (Table 2).
Prevalence trends of malaria in the IUIU community
Figure 2 below indicates that the malaria prevalence among students (Fig. 2a) and staff (Fig. 2b) kept on fluctuating in the study period from August to November 2019, with a sharp increase in December. However, the general forecast trend (represented by dotted straight lines) shows that on average, the malaria prevalence across the period of study was fairly constant in each group. Among staff, the malaria prevalence first dropped to zero in November before sharply increasing to 18% in December (Fig. 2b).
Combined prevalence of malaria among students and staff of IUIU
Like in the case of group specific prevalence rates for students and staff (Fig. 2a and Fig. 2b), the combined prevalence rate showed a generally fluctuating trend from August to November, followed by a sharp increase in December. However, the forecast trend of the combined prevalence showed a slightly clear upward rise across the study period of August to December, as shown by the dotted line (Fig. 3).
Comparison of malaria prevalence rates among students and staff in the IUIU community
Figure 4, displays the malaria prevalence among students as compared to that of the staff in the IUIU community. Though the prevalence rates for the two groups followed a generally similar trend across the study period, the malaria prevalence rates among the staff were slightly lower than those of the students, with the exception of December, where it rose to 18 % among staff as compared to 17.6% among the students.
Comparison of malaria prevalence rates of IUIU community with the national prevalence rate in Uganda
The overall prevalence of malaria in IUIU community from August to December 2019, (12.7%) (Table. 2), was found to be higher than the 7% national malaria prevalence for Uganda, recently reported among the 41,034,354 registered population of Ugandans (15,24); the statistical significancy of the difference between the two prevalence values was evaluated (Table 3).
Consequently, the group specific malaria prevalence, as well as the combined prevalence rates were higher than the national prevalence rate throughout the study period, except for the staff whose prevalence dropped to 0.0% in November (Fig. 5).
Practices and methods used for malaria prevention and control in the IUIU Community
The practices and methods used for controlling malaria among members of the IUIU community were examined in order to gauge if they paused safety concerns in regards to escalation of malaria.
As shown in Figure 6, sleeping under insecticide treated bed nets and timely closing of windows and doors were the most reported practices undertaken by the community of Islamic university in Uganda; these were reported by 245, 96% and 242, 95% respectively. Timely testing and treatment of malaria were other practices reported frequently by the respondents at 209, 82%, followed by spraying using insecticides 176, 70%. The latter was majorly practiced by the males as it was reported at 140, 55% and it was highly undertaken by the single respondents at 196, 77% compared to the 59, 23% among the married clients. The use of herbs and herbal products was the least used (38, 15%), approach in the prevention and control of malaria among the IUIU community (Fig. 6).
Association between malaria control methods and/or practices, and the malaria status of the members of IUIU community
It was hypothesized that the practices and methods mentioned by respondents in this study (Fig. 6), did not have a statistically significant effect on control and prevention of malaria among the IUIU Community. Cross tabulations of each malaria control and prevention practice were done with a Chi-square statistic to test the statistical significance of the possible associations. The Chi-square results reported at a 5% significance level revealed that most practices did not help in preventing or controlling malaria in IUIU community (P-values > 0.05); except timely testing and treatment (χ2 = 5.562, P-value = 0.02), as shown in table 4.
Malaria diagnosis and treatment practices among members of IUIU community
Only 122, 48% of the respondents reported that they strictly utilize laboratory diagnosis to confirm malaria infection, and that they only take medicines prescribed by physicians. Other respondents reported not to seek prior medical consultation when they develop malaria symptoms; for instance, 41, 16% reported that they buy and consume antimalarial drugs from pharmacies/drug shops, while 20, 8% consume herbal medicine. About 89 (35%) of the respondents were aware of the names of common antimalarial drugs, and 15 (6%) were aware of the drugs which are no longer effective in treating malaria. Less than half, 83 (32%) reported that they buy and keep antimalarial medicines as a way of being prepared for malaria episodes, while 107 (42%) reported stopping to consume the prescribed anti-malaria drugs immediately when the symptoms get disappear or start to cease. One hundred and seventy-three (173, 68%), respondents reported that they commonly receive malaria treatment from the IUIU health center III; 26, 10% get treatment from other health centers outside IUIU; while 56, 22% of the respondents receive medical treatment from both IUIU health center III and other health centers outside IUIU (Table. 5).
Interventions regularly implemented by IUIU to prevent malaria
Waste management and disposal within IUIU, was the most frequently reported activity that most respondents (120, 47%), observed being undertaken by the university to promote malaria prevention. The least reported intervention was leveling of potholes around IUIU premises, 20, 8% (Fig. 7).
Risk Factors for Malaria spread in IUIU Mbale campus
Risk factors for malaria spread in the community of IUIU Mbale campus were investigated by, (i) subjecting the respondents to questionnaires and (ii) conduction an observational survey around the IUIU premises.
Awareness of the community about risk factors for malaria spread in IUIU
When examined about their knowledge of the factors that potentially predispose individuals to the risk of contracting malaria in IUIU, the majority, 214, 84% of respondents agreed that low/poor utilization of insecticide treated bed nets was a major factor. This was followed by the dumping of garbage, 196, 77% around residences; while the fact that malaria is a transmissible disease was the least reported risk factor among the respondents, 71, 28% (Table. 6).
Exploration of possible association between Risk factors and ever suffered from Malaria within the study period in IUIU community
To establish the plausible risk factors that could potentially increase malaria spread in IUIU among those in table 6 above, a bivariable analysis was conducted using cross tabulations with a chi-square test. The variable “Ever suffered from malaria while in IUIU” was taken as a proxy response variable. The variable that registers a significant relationship at the bivariable analysis could further be tested at the multivariable level to arrive at the independent effect of each significant factor on the potential spread of malaria. Results of the bivariable analysis are reported in Table 8 below.
The Chi-square test was performed against the hypothesis that each of the stated risk factors had no statistically significant relationship with one’s suffering from malaria in IUIU community. The research results reported in Table 8, do not give evidence for possible statistical associations between each of the plausible risk factors and the proxy outcome variable since all the computed probability values (P- values) were greater than 0.05, the chi-Square test significance level at 95% confidence interval. The multivariable analysis was therefore not conducted.
Awareness about malaria diseases management among members of IUIU community
Misdiagnosis was the most widely known cause of high malaria burden, 216, 85%; while self-medication was the least known, 23, 9% (Fig. 8).
Challenges affecting malaria treatment, prevention and control in IUIU community
The most frequently reported challenges encountered in the undertaking of malaria control approaches were those linked to the use of mosquito nets, viz; difficulty in hanging the bed nets since such provisions are not considered when designing the students’ beds and/or bed rooms, 255 (100%), mosquito nets were reported to be too expensive to be owned by some of the students 156 (61%), getting mosquito bites before entering bed 171 (67%), and bed nets get damaged very fast 224 (88%). Other challenges mentioned by the respondents were; high cost of medicines and insecticides 105 (41%), limited mandate to manipulated the IUIU environment by the students 87 (34%), allergic reactions to some common antimalarial drugs 10 (4%), limited access to authentic health information 8 (3%), and the inability to recognize whether the commercial bed nets are treated with genuine insecticides 8 (3%).
Factors that potentially influence malaria spread in IUIU that were revealed through observational survey
From the observational survey conducted by the research staff in this study, the following were found to potentially influence malaria spread in the IUIU community.
Malaria prevention resources observed in the on-campus residences
Among the 198, 78% respondents that allowed the research staff to examine their mosquito nets, 38 (19%), possessed bed nets with damages that were big enough to permit potential entry of mosquitos (Fig. 9.1); all the respondents affected by this anomaly were students.
Further, one of the students’ on-campus hostels was found to possess damaged wire meshes, which potentially provide a porous route for entry of mosquitoes Fig. (9.2).
All the resident staff (n = 6), declined to allow the research team to examine their malaria prevention equipment and housing facilities. In the University guest house, all the beds were found covered with appropriate mosquito nets and the facilities were regularly cleaned.
Waste management and disposal
Though daily collection of garbage and general cleaning of the University premises were observed throughout the entire study period, the garbage was deposited in large masses at open sites, close to selected residences, near IUIU HC III (Fig. 9.3).
Stagnant water and liquid wastes
Thought the potholes in the university compound were repaired regularly to eliminate mosquito breeding spots, stagnant water in the swamp close to some students’ hostels, as well as stationary liquid wastes in trenches were observed (Fig. 9.4a and Fig. 9.4b).
Richness of vegetation cover was observed at IUIU main campus, ranging from trees and shrubs to herbs (Fig. 9.5). Regular pruning of some vegetation was observed across the study period.
Malaria management and control in IUIU lecture rooms
Though the University offers some evening courses, with lectures occurring beyond 8:30pm, there were no any observable measures established to prevent entry of mosquitoes into the lecture rooms, and prevention of malaria in general.
Malaria management and control within IUIU HC III
The diagnostic laboratory at IUIU HC III was found to contain functional equipment that were routinely used for malaria diagnosis through microscopy-based approaches. These included; electric microscopes, microscope slides, Giemsa stains, laboratory staff, and well written standard operating procedures (SOPs).
Copies of Uganda’s Ministry of Health (UMoH) treatment guidelines, as well as the recommended antimalarial drugs such as; Coartem (Tabs), Duocotoxin (Tabs), Quinine (injection and Tabs), Artesunate (Injection), and Fansidar (Tabs), were found to be available for use during prescription and treatment of malaria. All the hospital beds 8 (100%), in this health center contained insect treated mosquito nets that were found not to possess any damages. The medical records were well kept using the format availed by the UMoH, incorporated in the University’s database called IUIU-Electronic Resource Planning (ERP). The facility was relatively clean, and all windows and ventilators contained appropriate wires meshes to safeguards patients and staff against mosquito bites.