Clustered deaths attributed to severe malaria and poor health-seeking behaviors in mid-western Uganda, June–September 2025

Title : Clustered deaths attributed to severe malaria and poor health-seeking behaviors in mid-western Uganda, June–September 2025

Abstract:

Background: In August 2025, clusters of deaths were reported in Mubende, Kakumiro, and Kyankwanzi districts, mid-western Uganda. Cases presented with fever, severe headache, and body weakness followed by rapid progression to death. We investigated to determine the cause, magnitude, contributing factors, and recommend public health measures.

Methods: A suspected case was defined as acute onset of ≥2 symptoms (fever, headache, dizziness, abdominal pain, vomiting, or weakness) in a resident of selected parishes in the 3 districts from June–September 2025. Cases were identified through records review and house-to-house searches in the affected parishes. We collected information on demographics, symptoms, exposures, and health-seeking behaviors. Samples (blood, urine, stool) were collected and tested for infectious and toxicological causes. We analysed malaria surveillance data to assess trends and patterns of malaria.

Results: We identified 57 cases from 46 households with the first case on 16 June 2025. Thirteen (23%) died, with 8 (62%) dying within 24 hours of symptom onset. Most were primary school pupils (60%) aged 6–18 years (65%). One-third of households had multiple cases, and 57% lacked mosquito nets. Forty (70%) first sought care at drug shops/clinics, and 12 (21%) self-medicated. Plasmodium falciparum was detected in 14/22 (64%) samples while all tested negative for viral hemorrhagic fevers and toxicological agents. Crucially, malaria surveillance data showed case counts consistently exceeded the epidemic threshold from week 1–27 of 2025. Compared to the same period in 2024, the current year recorded a persistent monthly increase in malaria cases and test positivity rate confirming an upsurge.

Conclusion: We concluded that the clustered deaths were caused by severe malaria, exacerbated by poor health-seeking behaviors and inadequate mosquito net use. Targeted community outreaches with risk communication on mosquito net use and health seeking behaviors are critical to reducing transmission and improving early case detection.

Keywords: Malaria, Clustered deaths, Outbreak investigation, Uganda.

Biography:

Dr. Michael Mutegeki is a Medical Doctor and Infection Prevention and Control (IPC) Officer at the Ministry of Health, Uganda, where he coordinates IPC activities across all levels of the health system. He holds a Master of Public Health from Uganda Martyrs University and a Certificate in IPC with the Infection Control Africa Network (ICAN). He is currently a Field Epidemiology Fellow with the Uganda Public Health Fellowship Program.

With over eight years of experience in clinical practice and health systems strengthening, He has served at both facility and national levels. He has been actively involved in Uganda’s Ebola and COVID-19 responses, contributing both as a frontline clinician and as a national coordinator under the Case Management Pillar. His professional interests lie in infection prevention, health leadership, and strengthening emergency preparedness and response capacities across the health sector.