World Malaria Day 2026: Makerere scientists have found the countdown clock for when Ugandan children will die from malaria: The question is whether anyone is listening
Makerere University scientists have found the countdown clock for when Ugandan children will die from malaria: The question is whether anyone is listening. Photo: Nano Banana 2
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)
Makerere University School of Public Health, in collaboration with Jhpiego, invites applications for 49 short-term positions under the Scaling the Optimal Use of Multiple ACTs to Prevent Antimalarial Drug Resistance (STOP-AMDR) Project.
The short-term assignments will support data collection in Buikwe and Busia districts, with some national-level activities. Applicants are encouraged to review the requirements for their preferred position before applying.
Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, has shared findings from its study of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge districts to strengthen district preparedness for future outbreaks.
The Africa-Europe CoRE is a partnership co-led by MakSPH and the Centre for Research on the Epidemiology of Disasters at UCLouvain, Belgium. It brings together universities in Africa and Europe to strengthen research, training and preparedness for pandemics and other public health shocks.
The district-level dissemination meetings, held from 10 to 14 August 2026, brought together more than 100 local government, health and security officials, Village Health Teams, implementing partners and community representatives. The meetings enabled stakeholders to validate the district-level findings, identify practical actions and provide feedback for the study’s final analysis and national dissemination.
Mr. Philliam Jabim shares the Mpox response study findings with participants during the dissemination meeting in Nakasongola District on 12 August 2026.
Uganda confirmed its first two Mpox cases on 24 July 2024 at Bwera Hospital in Kasese District. The Ministry of Health declared an outbreak on 2 August 2024. As documented in the study, the response involved health workers, communities, local governments, security agencies, political leaders, and implementing partners.
In response to the outbreak, a MakSPH research team led by Prof. Rhoda Wanyenze, Dr. Rawlance Ndejjo, Dr. Steven Kabwama and Mr. Douglas Bulafu conducted a study in May 2025 to assess Uganda’s Mpox response, including its policies, interventions, strategies and challenges, and generate lessons to inform recovery and strengthen preparedness for future public health emergencies.
Using purposive sampling, the research team conducted 20 key informant interviews and five focus group discussions in each of the four districts, drawing perspectives from western Uganda in Kasese, northern Uganda in Amuru, central Uganda in Nakasongola and eastern Uganda in Mayuge.
Participants and the MakSPH research team at the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026.
The study, titled Assessment of the Mpox Response in Uganda: Documenting Challenges, Lessons and Innovations to Strengthen Emergency Preparedness and Response Capacities, was funded by the Government of Uganda through the Makerere UniversityResearch and Innovation Fund (Mak-RIF).
“This study is helping us move beyond recounting the Mpox response to identifying the actions that districts and national partners can take before the next outbreak. By validating the findings with stakeholders who led and experienced the response, we are ensuring that the evidence reflects local realities and can inform stronger surveillance, risk communication, coordination and community engagement,” said Mr. Bulafu, who led the MakSPH team during the dissemination meeting in Amuru.
Mr. Douglas Bulafu engages participants during the Mpox response study dissemination meeting in Amuru District on 10 August 2026.
In Amuru, the 10 August meeting brought together over 25 stakeholders from the district health team, political leadership, security agencies, Village Health Teams, implementing partners and the community. On the same day, a second MakSPH team, led by Mr. Keneth Sebukeera and Mr. Filimin Niyongabo, convened stakeholders in Kasese for a parallel validation meeting. The consultations then continued in Nakasongola on 12 August and concluded in Mayuge on 14 August, extending the study’s engagement across all four districts.
Across the districts, stakeholders said the results reflected their experience during the outbreak. They pointed to strengths in leadership, coordination, community engagement and partner support, while also describing gaps in documentation, logistics, diagnostic access, staffing, risk communication, public trust and continuity of essential health services.
They also noted inconsistent implementation of the World Health Organization (WHO) 7-1-7 target, which calls for detecting a suspected outbreak within seven days, notifying public health authorities within one day and completing early response actions within seven days.
The MakSPH research team, led by Mr. Keneth Sebukeera and Mr. Filimin Niyongabo, with participants during the Mpox response study dissemination meeting in Kasese District on 10 August 2026.
In Kasese, stakeholders highlighted gaps in documentation, financial and logistical resources, and human resources. They identified Village Health Teams and grassroots, religious and cultural leaders as important resources for community surveillance and risk communication. They called for stronger collaboration between technical and non-technical leaders, engagement with traditional healers, greater use of local radio for public sensitisation, and better facilitation of district epidemic response teams to reach distant communities.
Amuru participants called for proactive preparedness in the border district, citing misinformation and rumours as barriers to risk communication. They urged timely, accurate information from health workers and other authorities; training in disease surveillance and grant writing to strengthen capacity and resource mobilisation; and compassionate care, psychosocial support and community awareness to reduce stigma and support survivor reintegration.
During the meeting in Nakasongola, stakeholders identified Community Health Workers and Community Health Extension Workers as potential resources for strengthening community surveillance and addressing workforce shortages. Given the district’s position around Lake Kyoga and along the Kampala-South Sudan transit corridor, they also called for stronger documentation, note-taking and reporting, accurate real-time information, closer communication with the Ministry of Health, and collaboration among technical, political, religious and community leaders.
Ms. Eunice Vivian Asingo, Senior Nursing Officer at Nakasongola Health Centre IV, contributes to the discussion during the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026.
Ms. Eunice Vivian Asingo, Senior Nursing Officer at Nakasongola Health Centre IV, called for a permanent, adequately resourced outbreak-management centre to help protect routine services during future epidemics. “We appeal for better facilities to manage epidemics and outbreaks. At Nakasongola Health Centre IV, spaces previously used for outbreak management have been repurposed for other services, and we have limited staff. During the Mpox response, colleagues assigned to manage patients later returned to the general team, creating fear among staff already under pressure,” she said.
In Mayuge, Dr. Basembeza highlighted leadership, coordination and surveillance structures operating from district to community level as important factors in the response. He said the structures enabled the district to receive and respond quickly to community alerts. “Whenever there is a rumour or an alert, we are able to respond. Within 20 minutes, we had a response because of the structure we have,” Dr. Basembeza said.
Based on the findings, the research team recommends increased preparedness financing, stronger community engagement, decentralised diagnostic services through stronger district laboratory capacity, and improved health information and research systems.
Across the four districts, stakeholders reaffirmed that trusted community structures and coordinated action across sectors are essential to strengthening outbreak preparedness.
Every academic year, a new group of students enters Makerere University School of Public Health (MakSPH) with different professional backgrounds, questions and ambitions. For the School, each cohort adds to a growing community of professionals and researchers shaping public health practice, policy and research in Uganda and beyond.
On Friday, 7 August 2026, MakSPH held its orientation for newly admitted students for the 2026/2027 academic year at the MakSPH Auditorium. The orientation introduced students to the School’s academic programmes, leadership, departments, academic administration, student support services and expectations for university life.
For this academic year, ending July 2027, Makerere University admitted more than 370 students to academic programmes hosted at MakSPH. The intake comprised 75 students in the Bachelor of Environmental Health Science, the School’s only bachelor’s programme, 277 across the nine master’s programmes, and 21 across the two doctoral programmes, PhD by Research and PhD by Coursework and Research.
Dean Prof. Rhoda Wanyenze (centre) with MakSPH staff, student leaders and new students during orientation for the 2026/2027 academic year.
The master’s intake includes 103 students in the Master of Public Health by Distance Education, the highest enrolment for the year, followed by 59 in the Master of Public Health Full-Time. The remaining students joined programmes in Biostatistics, Environmental and Occupational Health, Health Informatics, Health Services Research, Monitoring and Evaluation, Nutrition, and Public Health Disaster Management. Together, the programmes reflect the breadth of knowledge and skills needed to address public health challenges and bring together students pursuing further training from diverse professional backgrounds.
Welcoming the new cohort, MakSPH Dean Prof. Rhoda Wanyenze urged students to approach their studies with purpose, discipline, and resilience, and focus on what they would be able to do with the knowledge and skills they acquire.
“Please find time to enjoy your journey. I know you’re looking ahead to exams and so many other pressures, but let this journey also be one that you enjoy in terms of what you learn and how you grow, so that you leave here better, not because of the paper that you took but because of the capability that you pick up during your time with us.”
MakSPH Dean Prof. Rhoda Wanyenze addresses new students at orientation for the 2026/2027 academic year, 7 August 2026, MakSPH Auditorium, urging them to value capability over paper.
The Dean’s message speaks to the different reasons students are beginning their journeys at MakSPH. For some, the opportunity is to build on professional experience and strengthen their capacity in roles they already hold. Among them is Dr. Judith Nalukwago, a dental surgeon, former 85th Vice Guild President of Makerere University, and Makindye Division III Lord Councillor, who serves as Executive Secretary for Education, Gender and Public Health at City Hall and the Office of the Lord Mayor.
“I am back here to study a Master’s in Public Health. I am very excited. I have a clinical background and have been practising as a clinician, and it has been a joyful experience. But when I joined the journey of leadership, there were challenges because, as Executive Secretary for Public Health in Kampala, we deal with everyday people’s health challenges,” said Dr. Nalukwago, adding:
“Now I am in management and leadership, and that posed a challenge to me as an individual. I asked myself, what course can I do to add to my skills? Where can I gain skills that can help me overcome this challenge while I am dealing with people? And I remembered that we have the School of Public Health at Makerere University.”
Watch: Dr. Judith Nalukwago on why she returned to MakSPH for a Master’s in Public Health:
Her experience during the Ebola response, when she served on the task force, further highlighted the need for broader public health knowledge. She said the training would strengthen her ability to contribute to policy and public health management, particularly in her role at City Hall, where councillors develop policies, bylaws, and ordinances.
For Mr. John Othieno, the motivation is similarly grounded in applying his training to practical problems. A Software Engineering graduate who previously completed a Master’s in Health Informatics at MakSPH, he has returned to pursue a PhD under the Department of Health Policy, Planning and Management. His research focuses on using technology and health informatics to address health-system challenges, including the adoption of picture archiving and communication systems for managing healthcare imaging and data. He said he wants his research to produce solutions that can be applied beyond academia.
“I purposed that, in my academic journey, I would not do research for the sake of having it gather dust on the shelves, but that it would actually be actionable research that can be translated into action, into solutions for our population,” he said.
Watch: Mr. John Othieno on why he returned to MakSPH to pursue a PhD in Public Health:
Nalukwago and Othieno reflect the diverse professional backgrounds that come together at MakSPH, where training, research, and community engagement have been central to the School’s work for over seven decades. Their journeys point to a sustained impact on public health education, seen not only in enrolment and graduate numbers but in the skills and expertise those graduates carry into policy, research, and health systems across Uganda and the region. At the close of the 2024/2025 academic year, MakSPH enrolled 1,140 students across 12 degree programmes, more than 90 percent of them in postgraduate training.
At Makerere University’s 76th Graduation Ceremony on 25 February 2026, MakSPH presented 231 graduates, comprising seven doctoral, 195 master’s and 29 bachelor’s graduates, adding to the health workforce within the region. Among the graduates was Dr. Harriet Aber, who completed her PhD on child substance use in Uganda’s health system and shared her experience with the new cohort during the orientation. She spoke candidly about the demands of postgraduate study and the need to remain positive through its challenges.
Dr. Harriet Aber, a MakSPH PhD graduate, shares her postgraduate journey with new students at orientation, 7 August 2026, MakSPH Auditorium, urging them to maintain a positive attitude through the challenges ahead.
“It’s not a rosy journey. You’re going to have so many moments where you celebrate, where you’re happy about something, but there are also several moments when maybe you’re stuck with the paper, you have to respond to comments, the proposal is not moving, the concept is not clear. Throughout all those processes, one of the things that you just have to maintain is having a positive attitude,” Aber affirmed.
Her experience offered the new cohort a glimpse of the journey ahead, while Prof. Wanyenze’s message focused on how they could make the most of it. The Dean urged students to plan ahead, pursue research opportunities, think independently, and use artificial intelligence responsibly, while seeking mentorship and making full use of the support and opportunities available at the School.
“Our students are our colleagues, and they are our future workmates. Many of them have ended up staying with us. And I know many of you are going to stay with us in the School,” the Dean said, urging students to take seriously the relationships they build with their classmates and faculty, because “we are a network that’s bound together in the same profession.”
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