The 24, 2 hours initiative: a game changer in malaria mortality reduction

Malaria is the largest contributor to morbidity and mortality in Uganda. Severe malaria accounts for 15-20% of hospital admissions and an average of 6% of malaria cases were hospitalized in 2023. Delayed treatment of uncomplicated malaria cases is a major contributor to disease progression to severe form that may result in complications or death. The '24,2 Hours Initiative" highlights the need for timely access to and use of quality-assured case management services to maximize impact within the critical "golden" timeframe. It aimed at ensuring that uncomplicated malaria cases receive treatment within 24 h and that severe cases get urgently necessary pre-referral treatment followed by immediate referral, or injectable treatment and supportive care within 2 h of arrival at a health facility. Besides, it highlights importance of starting post discharge malaria services within 24 h after severe malaria cases are discharged from hospital. The initiative emphasizes a patient-centered approach for malaria case management and continuity of care for severe malaria cases across pre-referral care, after-referral treatment, and post-discharge follow-up. Moreover, providing free, community-based malaria case management (CMCM) for all age groups is a key strategic shift proposed by the initiative. This measure aims to improve affordability and accessibility for low-income households while enhancing equity in access to primary health care. The initiative is designed in line with a results-based management approach, supported by a robust monitoring and evaluation system to ensure quality assurance of case management, effective service coverage, and the translation of interventions into practice.This paper introduces the "24.2 Hours Initiative", which was launched in Uganda, it outlines its components and discusses evidence from the literature on malaria case management gaps in Uganda as well as relevant solutions. The principles guiding this initiative may be applicable to other high endemic regions, including sub-Saharan Africa, if adapted to the local context and aligned with national malaria treatment policies.