Breaking the Cycle of Malaria and Domestic Strife

Kasifa Nakilima, a malaria champion in Uganda’s Busoga Region. Photos: Jimmy Adriko/PMI MRA

By: Angela Kateemu, Communications Manager, PMI Uganda Malaria Reduction Activity, with Julie Ray, Senior Editor, JSI

Kasifa Nakilima, a mother of five in Uganda’s Busoga Region, knows all too well the devastating effects of malaria. For years, her family was caught in a cycle of sickness and economic hardship that led to domestic violence.

“It got so bad that at one point, my children were so sick, they had blood traces in their urine,” recalled Kasifa. As subsistence farmers, Kasifa and her husband struggled to afford the constant treatment trips to health facilities. The financial strain took its toll, leading to tension and fights at home. Kasifa felt helpless and overwhelmed, unable to provide the care her family desperately needed.

In late 2023, a ray of hope entered Kasifa’s life in the form of Sanyu Esereda, a village health team (VHT) member who explained malaria transmission and ways to prevent it. He noted the mosquito breeding grounds around Kasifa’s home and practices that exposed the family to bites. “We removed these breeding places and agreed to sleep under mosquito nets, go to a [higher-level] health center instead of [local] clinics and drug shops, get proper tests, and complete malaria treatment when diagnosed,” Kasifa said of her family.

Kasifa shows her children how to hang the bed net, then tucks them under it.

By implementing these simple and effective measures, Kasifa’s household made a remarkable transformation. Since December, there there has been only one mild case of malaria, which the family managed at no cost. “I am very excited. I am having a better relationship with my husband because I am no longer bothering him about money for treatment.”

With the financial burden of malaria lifted, Kasifa started saving money with the village savings and loan association and became an advocate for malaria prevention in her community. She and her village are supported by the U.S. President’s Malaria Initiative (PMI) Uganda Malaria Reduction Activity (MRA), which collaborates with the Ministry of Health, districts, facilities, and communities to strengthen malaria prevention and promote health ownership, ultimately reducing malaria morbidity and mortality. The project identifies villages with high malaria burden and VHT members visit households to assess malaria enablers.

PMI MRA’s multifaceted approach to household prevention includes promoting correct usage of insecticide-treated bed nets, early initiation of antenatal care, and uptake of intermittent preventive treatment in pregnancy. It also emphasizes the importance of promptly seeking care when sick, testing for malaria before treatment, adhering to treatment regimens, maintaining environmental cleanliness, and fostering gender-balanced actions by increasing male involvement in preventive measures.

PMI MRA also educates household-level malaria champions like Kasifa on the severity of the disease and ways to prevent it through individual and collective actions. As Kasifa said, “I am a change agent because I have seen change in my own house. I was tired of fighting malaria, tired of fighting my husband because of malaria.”

In these ways, PMI MRA has reached over 63,000 households in five regions, including more than 31,300 in Busoga. These efforts help people make changes that lead to significant reductions in malaria cases, improve economic stability, and strengthen community resilience against malaria.

I am a change agent because I have seen change in my own house. I was tired of fighting malaria, tired of fighting my husband because of malaria.” — Kasifa.