Malaria incidence reduction and surveillance:

Zambia’s experience

Web: www.nmcc.org.zm www.makingmalariahistory.org

Email: malaria@nmcc.org.zm

Historical context: The malaria fight

• A little over a decade ago, global leaders began coming together to fight malaria in Africa.

• Despite the fact that malaria is one of the leading killers of young children, it was the first time in years anything had been done to control the disease.

Historical context: The malaria fight

• Using the “Scale-Up for Impact” approach to rapidly deliver life-saving tools, many countries were able to quickly bring down malaria illnesses and deaths

Stratification of Malaria in Zambia

Data from Zambia’s Data from Zambia’s National Malaria Indicator has shown a steady decrease in parasitemia in young children.

Now, the country is working to establish large areas entirely free from malaria, with the long-term goal of eliminating the disease.

The goal: Malaria elimination

• It is an exciting time for the malaria community – countries like Zambia are demonstrating that for the first time in history, we have the potential to eliminate malaria in Africa.

Baseline transmission

Reduced transmission

Mass Screen and Treat

Near-zero transmission

Community case management

with household re-screen and

treat

Universal LLIN coverage

So what will it take to end malaria?

Adapted from WHO Global Malaria Programme: Community-based transmission reduction of malariaMay 2011 - DRAFT

STEP 1Zambia Rapid Reporting system

STEP 2Clear parasites from people

STEP 3Surveillance as an intervention

STEP 4All cases identified, investigated and cleared.

Document elimination

Zambia is piloting new strategies to stop malaria transmission

Rapid reporting informs decision-making, identifies gaps in coverage, and targets resources.

Information collected through rapid reporting includes:

• Coartem by pack size (dispensed and balance on hand)

• RDT stocks (tested and balance on hand)

• Clinical and confirmed malaria cases• Total outpatient attendance at health

clinics

Establishing Rapid Reporting systems

Why mobile phones?

Information that used to take 3 to 4 months to reach the central level now only takes one week. Data is sent by health facilities over low cost, Java-enabled mobile phones to a server that is accessed by district health officials who are able to view and respond to the local malaria situation in near-real time.

Mass testing and treating for malaria

• Once a rapid reporting system is in place, health workers test every member of a household for malaria and treating positive cases.

• Data is collected using PDAs and smartphones. The Test & Treat approach is unique in that it looks both for people who have symptoms and for those who don't but who are infected (asyptomatics).

Actively investigating malaria cases

• In areas of very low burden (as determined by the data from rapid reporting) surveillance is the approach: positive cases investigated and contained.

• A systematic approach to follow up on individual cases—in very low burden areas to pursue each incidence of confirmed malaria—will be informed by the experience of surveillance now taking place in Lusaka.

COMMUNITY

HEALTH FACILITY

MOBILE PHONE

REPORTING

CHW INDICATORS

CLINIC INDICATORS

PASSIVE: PATIENT SEEKS OUT CLINICSymptomatic individuals tested at the clinic

Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment

ACTIVE: CHW CONDUCTS TEST AND TREATTest as many individuals living around the positive case as

possible (1 day / 2 boxes)Record : Name, Age, Sex, Address, Symptoms, Travel, Result,

Treatment

PASSIVE: PATIENT SEEKS OUT CHWSymptomatic individuals tested by CHW

Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment

Malaria Surveillance for Elimination

EHT

DataCHW

POSITIVE

POSITIVE

* - Travel History

Next steps

• Document evidence and approaches from Zambia’s malaria elimination efforts

• Defining and establishing malaria free zones• Continue pushing malaria elimination strategic

thinking• Optimize strategies for intervention delivery• Focusing on reducing parasite reservoirs at

community level• Work more broadly with partners to improve

diagnostics and drug delivery

Conclusion• This approach will ultimately create the space needed to establish malaria-

free zones. As Zambia again serves as the pace-setter for malaria prevention and control it will be important to provide evidence of the feasibility and cost of these steps, and to document the entire process for the benefit of Zambia, other countries and the global malaria community. The ultimate goal? A world free from malaria.