_{By Dan Kajungu}

In many low- and middle-income countries, mortality data remains a critical gap in public health planning, often leaving a significant portion of the population “invisible” in official records. In Uganda, where national death registration completeness has historically hovered around a mere 20%, Makerere University Centre for Health and Population Research (MUCHAP) is leading a transformative initiative. By leveraging the infrastructure of the Health and Demographic Surveillance System (HDSS), MUCHAP has demonstrated how academic research frameworks can be integrated into national systems to strengthen Civil Registration and Vital Statistics (CRVS).

A Bridge between research and governance

The core of this success lies in the collaboration between Makerere University’s infrastructure and government agencies, specifically the National Identification and Registration Authority (NIRA). This partnership, supported by the Uganda National Public Health Institute (UNPHI) and international partners like the Bloomberg Philanthropies Data for Health Initiative at the CDC Foundation, aimed at aligning local death recording practices with the legal requirements of the Registration of Persons Act (ROPA) 2015.

By utilizing the existing MUCHAP Iganga Mayuge HDSS platform, which has monitored births and deaths in the Iganga and Mayuge districts since 2005, the project demonstrated the use of a decentralized notification process. This model utilises Village Health Teams (VHTs) who already serve as HDSS scouts and part of the Ministry of Health systems as official death notifiers. These VHTs assist households in completing official NIRA notification forms at the household/community level, which are then verified by local leaders and submitted to District Registration Offices.

Impact: From 20% to over 70% completeness

The results of this collaboration have been profound. In the pilot sub counties in the districts of Iganga and Mayuge, death registration completeness reached 73–79%, a dramatic improvement over the prevailing national estimates. During the study period, 2,992 deaths were officially registered within the national CRVS system.

Key drivers of this success included:

• Reduced barriers: Decentralization brought the registration process closer to home, with an average travel distance of only 4–5 km for notification, compared to the significant distances previously required to reach district offices.
• Cost savings: Families reported that the community-based process eliminated unofficial fees and high transportation costs, facilitating essential cultural and legal tasks like property inheritance and appointing heirs.
• Advanced surveillance: The project proved that local health personnel could successfully conduct verbal autopsies (VA) in non-HDSS settings, providing critical data on causes of death that were previously unavailable for home-based deaths.

Sustainability and future potential

The MUCHAP-IMHDSS model is designed for long-term sustainability and national scalability. By embedding these tasks within the routine activities of VHTs and local leaders, the process becomes streamlined and cost-effective over time. The project also highlights that community sensitization is vital to maintaining trust and ensuring high participation rates, particularly in rural areas.

Looking forward, this initiative serves as a scalable blueprint for the rest of Uganda and other low-resource settings. Future engagements are expected to focus on:

1. National scale-up: Applying the lessons learned from Iganga and Mayuge to the entire country to close the mortality surveillance data gap.
2. Integration with health systems: Linking the CRVS data with broader health information systems to enhance pandemic preparedness and routine public health actions.
3. Regional leadership: Aligning with the Africa CDC’s initiative to strengthen mortality surveillance across the continent, positioning Uganda’s university-led model as a regional gold standard.

The HDSS-CRVS integration Project Leader Dr. Dan Kajungu who is the Executive Director of MUCHAP emphasised that “through this work, Makerere University has again proved that academic infrastructure is not just for research, but a vital engine for building resilient national governance and health systems”. This work was disseminated at the 2026 CRVS Research Forum in Bangkok, Thailand and can be accessed at https://shorturl.at/8JLTd

Dan Kajungu Msc PhD is the Executive Director MUCHAP

On a day when the world declares it can and must end malaria, new research from Eastern Uganda shows climate change is working against us and that the evidence to fight back exists right here at home

Special Feature | World Malaria Day, 25 April 2026

_{By Health and Science Correspondent}

Today, 25 April 2026, Uganda joins the rest of the world in marking World Malaria Day under the global theme: “Driven to End Malaria: Now We Can. Now We Must.” It is a rallying cry rooted in genuine optimism. Since 2000, 2.3 billion malaria cases and 14 million deaths have been averted globally. Forty-seven countries have been certified malaria-free, and between 2000 and 2024, the number of malaria-endemic countries fell sharply from 108 to 80.

Uganda is not one of those success stories, not yet. Malaria is endemic in 96% of Uganda, accounting for 29.1% of outpatient visits and 39.5% of hospital admissions, with over 17,556 estimated malaria deaths annually, the highest burden falling on children under five years of age. And on this World Malaria Day, a new alarm has been sounded from the heart of one of Uganda’s most malaria-burdened communities, not by foreign researchers, not by a distant global health organisation, but by scientists at Makerere University, drawing on two decades of data they have collected in the villages of Iganga and Mayuge in Eastern Uganda.

Their message is urgent: climate change is silently and measurably worsening Uganda’s malaria crisis. But this is the equally important half of the story. They have now identified the precise conditions under which children die, and exactly how long in advance those deaths can be predicted. Uganda has, for the first time, a scientifically validated early warning system for climate-driven malaria mortality. Whether the country chooses to use it is now a question of political will, not scientific capacity.

The study and the platform that made it possible

Published in BMC Public Health in August 2025, the study — “Climate-driven malaria mortality among children in malaria-endemic areas of Uganda” — was led by Dan Kajungu of Makerere University‘s Centre for Health and Population Research (MUCHAP). It analysed 14 years of weekly malaria death data from January 2008 to December 2022 matched against climate variables, using a sophisticated time-series statistical approach called the Distributed Lag Non-linear Model.

The data came from the Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS), the population research platform that Makerere University has operated continuously since 2005. The IMHDSS population cohort collects data from 65 villages located within an area of 155 square kilometres, monitoring a population of close to 100,000 people. The site has 23 health facilities, including two general hospitals, and a bimodal tropical climate with rainfall seasons from March to May and September to November.

What makes the IMHDSS extraordinary and what made this study possible is its method of capturing deaths. Rather than relying on hospital registers that miss the majority of rural deaths, malaria deaths were identified using verbal autopsies and the InterVA algorithm, a probabilistic tool that uses verbal autopsy questionnaires and Bayesian statistical techniques to estimate the probabilities of various causes of death based on signs and symptoms reported by bereaved families. Three different WHO verbal autopsy tools are used, tailored for neonates, children, and adults respectively.

In other words, when a child dies in a village in Iganga, the IMHDSS knows about it. It interviews the family. It determines why the child died. And it has been doing this, without interruption, for twenty years. The result is a dataset that is both scientifically rare and profoundly Ugandan, generated here, about us, by our own researchers.

A total of 858 malaria-related deaths were recorded in the Iganga-Mayuge districts between 2008 and 2022. Of these, 53% were among males and 47% females. The vast majority, about 73% occurred among children under five years of age, while the fewest deaths occurred among those aged 15 to 49 years. Males exhibited higher mortality proportions across all age groups, except among the elderly.

Eight hundred and fifty-eight deaths. Each one a child or adult with a name, a family, a community. Each one counted.

The finding that changes everything: Uganda now has a malaria early warning system

The scientific heart of this study, the finding that every health planner, every district malaria coordinator, and every Minister of Health in Uganda should understand is this: the researchers have identified the exact temperature and rainfall thresholds at which malaria deaths among children rise, and how many weeks in advance those deaths can be predicted.

The study found an increased mortality risk across all ages at a lag of 11 to 12 weeks following exposure to rainfall above 646 mm. Higher risks of malaria mortality were also observed at a lag of 5 to 11 weeks when temperatures ranged between 25.2°C and 29.9°C. Critically, the relative risk of malaria mortality in children under five years and children aged between 5 and 14 years was more sensitive to temperature than to rainfall.

Read that again, slowly. When temperatures in Eastern Uganda climb into the range of 25.2°C to 29.9°C, children begin dying of malaria five to eleven weeks later. When extreme rainfall events exceed 646 mm, deaths rise eleven to twelve weeks after that exposure. Uganda’s meteorological service measures temperature and rainfall continuously. Uganda’s health system manages malaria interventions. These two systems have never been formally connected, but the science to connect them now exists.

This is what a malaria early warning system looks like. Not a foreign technology imported at great expense. Not a satellite system requiring international expertise to interpret. A Ugandan scientific finding, produced from Ugandan data, that tells Ugandan health authorities: when you see these weather conditions, stock your health centres, distribute your bed nets, deploy your community health workers, and prepare, because the deaths are coming in six to twelve weeks if you do not act.

On this World Malaria Day, when the global community declares that ending malaria is now possible, Uganda has precisely this tool in its hands. The only question is whether it will use it.

Climate change is not a future threat, it is already killing children

The global theme for World Malaria Day 2026 carries urgency partly because climate change, conflict, and humanitarian crises continue to drive malaria resurgence and disrupt essential services. The Makerere study puts specific, local flesh on that global warning.

Malaria is climate-sensitive, changes in temperature, rainfall patterns, and relative humidity affect the dynamics and intensity of malaria transmission by influencing the habitats of mosquitoes and parasites and their biological growth cycle. Climate remains an indirect cause of malaria mortality by affecting parasite development during periods of high rainfall and temperatures, leading to increased transmission, morbidity, and severe malaria outcomes.

The malaria parasite Plasmodium falciparum, the species responsible for almost all malaria deaths in Uganda requires specific temperature ranges to complete its development inside the Anopheles mosquito. Too cold, and development slows or stops. Too hot, and it also stops. But within the range that Eastern Uganda increasingly inhabits, and will inhabit more frequently as global temperatures rise, the parasite thrives, multiplies, and kills.

The World Malaria Report 2025 warns that drug resistance is now confirmed in four African countries including Uganda, where artemisinin partial resistance has been detected. Insecticide resistance to pyrethroids – the main chemical on bed nets is now confirmed in 48 out of 53 reporting countries. As the tools Uganda currently relies on including bed nets, indoor spraying, artemisinin-based drugs face mounting biological resistance, the importance of climate-informed prevention strategies grows exponentially. Deploying interventions at exactly the right time, guided by weather data, becomes not just efficient but essential.

The children most at risk: a finding that demands a policy response

Among the study’s most striking findings is the specific vulnerability of school-age boys. A group almost entirely absent from Uganda’s current malaria prevention architecture.

Male children aged between 5 and 14 years were found to be more vulnerable to temperature-related malaria mortality compared to females in that age group and compared to children under five years. Rainfall did not have a significant association with malaria mortality in children.

Uganda’s National Malaria Control Programme, like most in sub-Saharan Africa, has historically concentrated resources on two priority groups: children under five and pregnant women. These groups are undeniably vulnerable and deserve protection. But this study shows that school-age boys are dying from temperature-driven malaria at rates that demand their inclusion in prevention strategies.

School-aged children between 5 and 14 years have higher malaria prevalence, with 70% carrying the malaria parasite asymptomatically in high transmission settings. They carry the parasite silently, sustaining transmission in their communities, and they die when temperatures rise, particularly the boys, who in rural Uganda spend more time outdoors, sleep less consistently under nets, and receive less parental health supervision than their sisters as they grow older.

The study’s area is itself among the most heavily burdened in Uganda. The Iganga-Mayuge area has a malaria prevalence rate of 39.4% in children under five years old, making it one of the areas in Uganda most severely impacted by malaria, and the disease is the leading cause of mortality in children there. In such a high-transmission setting, the combination of asymptomatic carriage, temperature-driven transmission spikes, and inadequate prevention coverage for school-age children is a formula for preventable death.

On World Malaria Day 2026, as Uganda declares its commitment to ending malaria, the national malaria strategy must be updated to reflect this evidence. School-based distribution of insecticide-treated nets, school health programmes that include malaria education and early symptom recognition, and targeted community outreach for families with boys aged 5 to 14 are not optional additions, they are evidence-based necessities.

The platform: Makerere‘s IMHDSS as a national asset for malaria elimination

None of the findings in this study would have been possible without the IMHDSS and on World Malaria Day, it is worth being explicit about what that platform represents for Uganda’s future.

The IMHDSS platform has measured various indicators about coverage and uptake of national interventions including the coverage and utilisation of immunisation and vaccines, mosquito nets for malaria vector control, household income improvement, and family planning, and other behaviour change interventions at community level, strengthening the evaluation of burden of disease at the subnational level.

For malaria specifically, the IMHDSS has now produced the most granular mortality data in Uganda’s history capturing not just how many children die, but exactly which weather conditions preceded those deaths, which sex and age group is most vulnerable, and what the biological and epidemiological mechanisms are that connect climate to the grave. This is the kind of intelligence that a National Malaria Control Programme needs to move from reactive crisis management to proactive, evidence-driven prevention.

Scarcity of quality data remains a key development bottleneck in low and middle-income countries, and the Iganga-Mayuge HDSS represents a Makerere University platform for research and research training with a population-based cohort that longitudinally generates data for evidence-based decisions and policy.

Uganda’s malaria elimination goal, to bring mortality to zero will not be achieved by effort and goodwill alone. It requires data. It requires the kind of longitudinal, community-level, cause-of-death data that only a platform like the IMHDSS can generate. And it requires the institutional will to connect that data to the decisions that determine whether children live or die.

What must happen now

The global call on World Malaria Day 2026 is clear: “Now We Can. Now We Must.” For Uganda, the Makerere climate-malaria study translates that call into three specific and achievable actions.

First, the Ministry of Health and Uganda National Meteorological Authority must establish a formal, operational malaria early warning system. One that uses real-time weather monitoring to trigger predetermined health system responses when temperature and rainfall thresholds identified by this research are breached. The science is ready. The infrastructure for meteorological monitoring exists. What is needed is the institutional bridge between them.

Second, Uganda’s National Malaria Control Programme must extend its prevention focus to include school-age children, particularly boys aged 5 to 14, in all high-transmission areas. Bed net campaigns must reach schools, not just health centres and antenatal clinics. Community health workers must be equipped to identify and treat malaria in this age group as a priority.

Third, and most fundamentally, the Government of Uganda must formally recognise and domestically resource the IMHDSS as national public health infrastructure. The 2024 global malaria funding of US$3.9 billion was less than half of the US$9.3 billion target, leaving a projected shortfall of US$5.4 billion that leaves the response dangerously under-resourced. In a world where international health financing is under historic pressure, Uganda cannot afford to have its most powerful evidence-generation platform dependent entirely on foreign philanthropy. The IMHDSS is a Ugandan asset. It must be funded as one.

Today, children in Iganga and Mayuge are alive who might not be, because the research generated by the IMHDSS informed the malaria interventions that reached their communities. Today, Makerere scientists have given Uganda a tool, a climate-based early warning system for malaria deaths that no other country in East Africa currently possesses.

Now we can. Now we must.

The evidence is there. The science is done. The only thing Uganda needs now is the will to act on it.

“Climate-driven malaria mortality among children in malaria-endemic areas of Uganda” is published open-access in BMC Public Health, Volume 25, Article 2825, August 2025. Full text available at: https://link.springer.com/article/10.1186/s12889-025-23678-0

The Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) is operated by MUCHAP, Makerere University. Contact: info@muchap.mak.ac.ug or dkajungu@muchap.mak.ac.ug| Tel: +256 772 207127 (Dr. Dan Kajungu)

A joint study between Makerere University School of Public Health (MakSPH) and The Open University, UK, is investigating a possible link between maize cultivation and malaria risk in Uganda, as evidence increasingly points to livelihoods and everyday economic activities as key drivers of transmission of the disease.

The research initiative was advanced during a stakeholders’ workshop held on April 15, 2026, at MakSPH’s Resilient Africa Network in Kololo, where a team led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings on the social determinants of malaria. The meeting brought together academics, policymakers, and practitioners to examine how agricultural practices, particularly maize farming, may be shaping malaria patterns in both rural and urban settings in Uganda.

The work builds on a growing body of research linking malaria to economic activity. One such study, led by the two researchers and published in Global Public Health in December 2025, found that livelihood activities such as farming, livestock keeping, and night-time work significantly influence malaria exposure. The study identified agriculture, especially maize cultivation near homes, as a key factor associated with increased mosquito density and heightened infection risk.

At the workshop, Dr. Musoke said the new inquiry reflects a broader shift in how malaria is understood, outlining how livelihoods, particularly agriculture, shape exposure through multiple pathways, from crop production and water use to the timing of daily activities that coincide with peak mosquito biting hours. These patterns, he argued, extend risk beyond what conventional interventions, such as insecticide-treated nets and indoor spraying, are designed to address.

Uganda remains one of the countries most affected by malaria, with the disease accounting for a significant share of outpatient visits, hospital admissions, and deaths. It is consistently ranked among the leading causes of illness and mortality, particularly among children under five and pregnant women. Despite sustained investment in prevention and treatment, including widespread distribution of insecticide-treated nets and indoor residual spraying, transmission remains high in many parts of the country. This persistence has increasingly drawn attention to factors beyond conventional interventions, including the role of livelihoods, environment, and everyday exposure to mosquitoes.

“As researchers, our role is to generate evidence, and that evidence should inform decision-making,” Dr. Musoke said. “We do not work in isolation. What we hear from stakeholders matters. We are bringing together different sectors, disciplines, and institutions because this work is still in progress, and we intend to build it collaboratively. Increasingly, research requires not just academics, but policymakers, implementers, and communities to be part of the process.”

The collaboration with The Open University has been central. Dr. Deane said the idea of examining the relationship between maize and malaria emerged from several years of joint research on social determinants with MakSPH. He pointed to a gap in malaria research, which has largely focused on biomedical and indoor interventions, while overlooking the role of livelihoods and outdoor exposure.

“We cannot continue relying solely on bed nets, spraying, and treatment,” Dr. Deane said. “These remain essential, but they are not sufficient for elimination. There is significant outdoor malaria transmission, particularly among adults, and that is linked to how people live and work.”

He added that maize presents a complex case. As one of Uganda’s most widely grown staple crops, it is central to both food security and household income, making it impractical to separate farming from living spaces. This, he said, underscores the need to better understand the relationship and develop responses grounded in evidence and local realities.

Evidence presented during the workshop drew on both community experiences and existing scientific literature. Prior qualitative research by the team found that mosquito populations increase during maize growing seasons, particularly in the evenings. Scientific studies also show that maize pollen can enhance mosquito survival and longevity, potentially increasing their capacity to transmit malaria.

Previous work in Wakiso district further situates maize within a wider set of risk factors. Findings show that agriculture, including crop production and animal husbandry, can create conditions that support mosquito breeding through stagnant water, water storage practices, and environmental changes. These risks are compounded by outdoor activities in the early morning and evening, when exposure is highest. The research also points to the growing role of urban agriculture, which is bringing crop cultivation and potential mosquito habitats closer to residential spaces, altering traditional patterns of transmission.

Ms. Doreen Nabwire Wamboka, in-charge at Namayumba Epicentre Health Centre III in Wakiso District, said the discussions challenged long-held assumptions that malaria is a “well-understood” condition.

“I used to think malaria had been fully researched, that we already knew what we needed to know,” she noted. “I now see that what has been studied is the conventional side of it. There are emerging factors we have not paid attention to. This work is opening up new ways of thinking, even about things we take for granted, like the crops we grow around our homes. We treat malaria as ordinary, yet it is still one of the most common conditions. Understanding these connections could change how we approach the disease.”

The initiative will now combine spatial analysis, entomological studies, and community-based research to better understand how maize cultivation influences malaria risk. It will also involve farmers and other stakeholders in shaping potential interventions, reflecting a broader shift toward co-produced solutions.

The workshop, funded by The Open University, marked an important step in refining this research agenda. As the work progresses, its findings could inform policy and practice not only in Uganda, but also in other malaria-endemic countries where maize is widely cultivated. For now, the research signals a shift from isolated interventions to a more integrated understanding of how livelihoods and environments drive malaria transmission.

View on MakSPH