Zambia: Progress and Challenges towards SUFI
Zambia: Malaria Distribution Map
Survey-Based Progress Tracking
| Indicator | 2000 | 2001-2002 | 2004 | 2006 |
| % of households with at least one mosquito net of any type | - | 27 | - | 50 |
| Household availability of at least one insecticide-treated net | - | 14 | 27 | 44 |
| % of children under five years of age sleeping under any type of mosquito net | 6 | 16 | - | 27 |
| % of children under five years of age sleeping under an insecticide-treated mosquito net (ITN) | 1 | 7 | 7 | 23 |
| % of pregnant women aged 15-49 years sleeping under an ITN | - | 8 | 12 | 24 |
| % children under five years of age with fever receiving any anti-malarial medicines | - | 52 | - | 58 |
| % children under five years of age with fever receiving any anti-malarial medicines promptly (within 24 hours) | - | 37 | - | 37 |
| Children with fever receiving any anti-malarial medicines | 58 | 52 | - | 58 |
| % of women who received IPT (treatment with at least 2 doses of SP/Fansidar) during pregnancy | - | - | 54 | 61 |
Source: MICS 1999; DHS 2001-2002; National DHS 2004; MIS 2006
- I. Epidemiological background
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Parasite (Plasmodium) types Plasmodium falciparum accounts for more than 90% of all infections. Main vector (mosquito) types Anopheles gambiae is the major malaria vector Unstable malaria transmission Mainly occurs in the districts on the higher altitude plateau, specifically Mpika, Serenje, Mkushi, Kapiri Mposhi, Chibombo, Mazabuka, Monze, Choma, and Lusaka. This is due to breaks in transmission of malaria during the cold, dry season, resulting in lowered malaria immunity, unstable transmission, and predisposition to outbreaks. Total population 12,160,516 (2007) Population at risk 12,160,516 (2007) ~ 100% of the Population lives in areas at risk of malaria Pregnant women at risk of malaria 593,181 (2007) Children under five at risk of malaria 2,471,588 (2007) Transmission Malaria transmission in Zambia is predictably seasonal with the rainy season beginning in November-December and lasting through April into May; this is followed by a cool dry season in June-July and a hot dry season in August-October. Number of reported clinical malaria / fever cases 4,446,000 (2007) Reported malaria episodes per year 4,940,000 (2006) Malaria deaths (all ages) 6,484 (2006) Child under 5 malaria mortality 3,342 (2006) Infant mortality (per 1000) 168 (2001-2002) - II. Current Policy and Strategy
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Case management Malaria Case Management will be improved at community and health facilities through:
- Prompt recognition, diagnosis and effective anti-malarial treatment using artemisinin-based combination therapy (ACTs) as 1st line treatment - currently artemether-lumefantrine (AL) is being used in all public health facilities countrywide for uncomplicated malaria. Oral quinine is the second line treatment of malaria and parenteral quinine is used to treat severe malaria.
- A drug efficacy monitoring system is in place with current estimates of treatment failures to antimalarials (based on WHO 28-day protocol with PCR correction) indicating that the first line treatment has a low failure rate: CQ 52%, S.P 25%, A-L 2%. (NMCC 2005).
- Increased diagnostic capacity
- Ensure that health care providers make more targeted use of ACTs for confirmed malaria cases. Currently, 16% of facilities are equipped with microscopy, but this does not always translate into slide confirmation for suspected malaria cases. In addition to efforts to scale-up microscopy as the gold standard for malaria diagnostics, an increasing supply of Rapid Diagnostic Tests (RDTs) is being used in more peripheral facilities to support malaria diagnostics.
Prevention - Insecticide-treated mosquito nets (ITNs). The national ITN strategy is to rapidly scale-up coverage through:
- A rolling nationwide mass distribution campaign of LLINs to all households.
- Long-term sustainability of net delivery will be ensured through: ongoing distribution of highly-subsidized LLINs to pregnant women and children under five at antenatal clinics; an equity program to provide free LLINs to vulnerable populations such as households with orphans and vulnerable children, people living with HIV/AIDS, and the poorest of the poor; commercial sector sales of LLINs.
- In combination with net distribution, the program focuses on promoting utilization of ITNs through increased Information, Education and Communication (IEC) and Behaviour Change Communication (BCC) activities.
- Taxes and tariffs: Regardless of the distribution channel used, the government has eliminated all taxes and tariffs on ITNs and net retreatment kits.
- Type of nets: The national policy also endorses the use of LLINs over ITNs or bundled nets.
- Indoor residual spraying (IRS) is now supported in 15 target districts, representing mainly urban and peri-urban areas. The insecticides used in the IRS program are deltamethrin, lambda-cyhalothrin, and alpha-cypermethrin for use on walls of modern houses with cement plaster and paint, and dichloro-diphenyl-trichloroethane (DDT) for mud or pole/grass walled homes.
- Malaria in pregnancy. Prevention during pregnancy is delivered as a package using intermittent preventive treatment (IPTp) with Sulfadoxine-Pyrimethamine (SP),ITNs; and Anaemia prevention. IPTp is given at routine antenatal clinic visits. This work is largely coordinated with the Reproductive Health Unit at the Ministry of Health. The National Strategy on MIP aims at strengthening the malaria component of focused antenatal care (FANC) and supporting roll-out of FANC at all health facilities.
Information, Education & Communication / Behaviour Change Communication The malaria IEC/BCC activities are coordinated by an IEC working group and include:
- Event planning for main activities (such as Africa Malaria Day, SADC Malaria Week, Child Health Week).
- Assisting with community sensitization efforts, such as the Malaria Indicator Survey (MIS) and training of journalists and radio workers (through MACEPA funding).
- Each malaria intervention (ITNs, IRS, IPTp, and Case Management) requires a package of IEC/BCC materials and the skills and resources to deliver the messages in an effective manner. These communication channels include television, community radio, dissemination and placement of posters, distribution of educational materials through health facilities and community based organizations. The Community radio stations and theatre or drama for action have proved especially valuable in rural areas.
- III. Primary interventions
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[+] Insectiside-treated nets (ITNs)
- IV. Challenges and Priority support needs (2008 - 2010)
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Challenges
- Despite the systematic approach to evaluating local information and the efficient change in policy to ACTs, there has not been any significant improvement in prompt effective case management of malaria over the past 5 years;
- Given that effective scale up of prevention services is proceeding increased emphasis on improved coverage of case management with particular attention to local community support will be an area of focus in the coming years.
The National Malaria Control Plan addresses the need to:
- strengthen national, provincial, and district-level capacity to manage,
- plan, and implement malaria programs,
- address human resource needs,
- ensure that there is an established planning and forecasting framework for projecting funding needs and tracking health expenditures,
- develop capacity at all levels of the health systems to manage storage and distribution of malaria commodities,
- reinforce coordination among partners. In addition, the plan notes the importance of robust IEC/BCC efforts to increase awareness and demand for malaria control and treatment services among households;
- another important challenge is the community M&E System which is still very weak. Most of the current malaria data is facility based, and yet most of the malaria illness and death occur in the home;
- to strengthen home management of malaria, a deliberate effort is being made to strengthen the ability of community health providers to collect the small amount of key information, collate this and report in an accurate and timely fashion.
- V. Key RBM Partners in Zambia
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- The Ministry of Health;
- WHO;
- The Global Fund;
- The World Bank Malaria Booster Program;
- US Government through USAID
- U.S. President's Malaria Initiative;
- MACEPA (with support from the Bill and Melinda Gates Foundation);
- JICA (Japan International Cooperation Agency);
- UNITAID
- Churches Health Association of Zambia (CHAZ);
- Zambia Malaria Foundation (ZMF) and their many non-governmental organizations (NGOs);
- The Malaria Consortium;
- NetMark
- The R.A.P.I.D.S (Reaching HIV/AIDS Affected People with Integrated Development and Support is a consortium of five NGO partners: Africare, Catholic Relief Services (CRS), Expanded Church Response (ECR), Salvation Army and World Vision)
- The "SWAps partners"
Key Donor Roles: Areas of Support to the National Malaria Control Program**
Program Area GFATM
Rounds 1&4World Bank MACEPA JICA WHO UNICEF US PMI ITNs X X X X X X IRS X X X X IPTp X Diagnostics X X ACTs X X X IEC/BCC X X X X M&E X X X Health Systems Strengthening X Program Management X X X X Source: NMCC Zambia, MIS report 2006
** PMI report
For questions, contact:
Dr Elisabeth Chizema, National Malaria Control Programme Manager
Dr Vonai B. Teveredzi, RBM Partnership Focal Point for Southern-African Regional Network
Ms Nadia Lasri, RBM Partnership facilitation
Dr James Banda, RBM Partnership facilitation Coordinator