Barriers and opportunities to addressing social determinants of malaria in Wakiso District, Uganda

Malaria remains a significant public health threat in sub-Saharan Africa, particularly in Uganda, where it is the leading cause of morbidity and mortality. There is limited evidence on factors related to social determinants within ongoing malaria control efforts in the country. This study explored barriers and opportunities in addressing the social determinants of malaria in Uganda. A qualitative study was conducted in Wakiso district. Data were collected through 10 focus group discussions with community members and community health workers (CHWs), 11 in-depth interviews with heads of households, and 14 key informant interviews with local leaders, health officials, and non-governmental organisation (NGO) staff. Participants were purposively selected based on their knowledge and experience regarding malaria. Data were thematically analyzed using Atlas.ti. (version 6) and Nvivo (version 14). The study identified three key barriers and two opportunities to addressing the social determinants of malaria. The barriers were: 1. a curative-focused approach in national policies and private healthcare highlighting minimal commitment in addressing these determinants; 2. inadequate coordination among government institutions and partner organisations in addressing social determinants of malaria; and 3. complacency at both community and government levels due to malaria’s endemic nature. The opportunities identified were: 1. the presence of multiple stakeholders actively involved in malaria control including the Ministry of Health and other entities such as NGOs; and 2. the existence of robust government structures at national, district, and community levels including CHWs, health inspectors, malaria focal persons and the model homes initiative which provide a strong foundation to address social determinants of malaria in the country. Despite opportunities in addressing the social determinants of malaria, several barriers were identified. Overcoming these barriers requires a shift towards integrated public health strategies that advocate prevention, foster robust coordination, and leverage stakeholder engagement including communities to contribute to malaria elimination.