ZAMBIA'S SIGNIFICANT PROGRESS FIGHTING MALARIA THROUGH THE

UNCLAS LUSAKA 000226


AIDAC

AID/W FOR AFR/SA MAJORIE COPSON, GH ADMIRAL ZEIMER, RENE SALGADO,
RICHARD GREENE; AF/S FOR MATT SHIELDS; PASS TO CDC FOR KATHERINE
TAN, BOB WIRTZ

E.O. 12958: N/A
TAGS: EAID SOCI TBIO PREL ZA
SUBJECT: ZAMBIA'S SIGNIFICANT PROGRESS FIGHTING MALARIA THROUGH THE
PRESIDENT'S MALARIA INITIATIVE

1.Summary: The success of Zambia's scaled up malaria control
efforts, together with their accurately measured impact, has drawn
international attention. Since 2006, malaria parasitic prevalence in
children dropped 54% and anemia in children under five, a common
indicator of malaria, dropped 62%. While the attention is welcome,
it also raises the bar as Zambia and its partners work to continue
to roll out interventions to more of the country. Long-term funding
by the government and donors and sustained political will must
continue if the goals of malaria control and eventual elimination
are to be achieved. End Summary.


2. Zambia became a focus country under the President's Malaria
Initiative (PMI) in December 2006. In Zambia, USAID has provided
over $38 million in malaria funding since FY 2007, including $14.9
million for FY 2008. PMI funding for FY 2009 is approximately $14.7
million. The country has a very strong National Malaria Control
Program and an effective in-country partnership upon which PMI
builds. Other important partners include the Global Fund, World
Bank, the Gates-funded Malaria Control and Evaluation Partnership in
Africa (MACEPA),WHO, Clinton Foundation, faith-based organizations
and UNICEF.


3. Most of Zambia's 12 million people are at risk for malaria. The
risk is higher during the rainy season (Nov-Mar) in many parts of
the country. The number of malaria cases reported declined in 2008.
However, malaria still accounts for 45% of outpatient visits, 45%
of hospital admissions, 47% of overall disease burden among pregnant
women, and 50% of disease burden among children under-five years of
age. Malaria also has a serious economic impact on Zambia,
accounting for 6.8 million Disability Adjusted Life Years, or DALYS,
lost. This is higher than the losses due to acute respiratory
infections (5.4 million) or HIV/AIDS (3.2 million). The high
morbidity levels contribute to decreased productivity through
absenteeism and lowered output.

Recent results


4. Zambia uses four core proven prevention and treatment measures
to achieve the PMI planned goals of 85% coverage in these measures
and a 50% decrease in mortality due to malaria. These approaches
are: indoor residual spraying (IRS),distribution of insecticide
treated bed nets, provision of rapid diagnostic testing, and
effective therapy and preventive treatment of pregnant women.


5. Indoor residual spraying: The Government of Zambia reestablished
its IRS program in 2003 after a hiatus of thirty years. The IRS
program builds on the successful intervention by Konkola Copper
Mines (KCM),which began in 2001. The KCM program significantly
reduced morbidity and mortality in mining towns in the Copperbelt
Province, providing much of the evidence for the MOH and the NMCC to
reinstate a broader IRS program in Zambia. Currently Zambia uses the
highly effective insecticides DDT and pyrethroids. Strict human
health and environmental safeguards are in place to comply with the
Environmental Council of Zambia, WHO and USAID regulations and
guidelines. With PMI support, in 2008 the Government of Zambia
(GRZ) sprayed over 760,000 homes, representing 95% of targeted homes
and protecting approximately 4.2 million people in 15 districts
across Zambia.


6. Since PMI's inception in Zambia the program has purchased and
distributed nearly one million insecticide treated bednets (ITN) to
protect Zambians while they sleep. PMI, working through partner
organizations, distributes ITNs nationwide through antenatal
clinics, and in the Northwestern Province through a mass
distribution campaign.


7. In support of the diagnosis and effective treatment of malaria
patients, since 2008 PMI has purchased and distributed 253,000
courses of Coartem (artemether-lumefantrine combination therapy),a
highly effective malaria treatment, and over 1.6 million rapid
diagnostic kits to assure that patients are properly diagnosed.


8. PMI funds have trained health care workers and raised public
awareness on the importance of prenatal care and intermittent
preventive therapy with Fansidar (sulfadoxine-pyrimethamine) during
pregnancy to prevent malaria's negative impacts on both the mother
and her baby. These impacts include maternal anemia, spontaneous
abortion, low birth weight (a major risk factor for death during the
first month of life) and still birth. More than 60% of pregnant
women throughout Zambia have received two or more doses of the
preventive medicine.


9. In addition to these malaria control measures, PMI uses a
nationwide information education campaign with community components
to engage the public on the importance of utilizing Zambia's malaria
control interventions. PMI also supports the government's malaria
monitoring and evaluation program which provides data on malaria
rates.


10. These scaled-up malaria control measures have had a dramatic
impact on malaria in Zambia. The Zambia Malaria Indicator Survey
(MIS) was conducted in 2006 and 2008. The PMI-supported 2008 MIS
surveyed over 4,400 homes and tested children under five years for
malaria and anemia. The changes between the two surveys indicate
remarkable progress in the past two years: 1) parasite prevalence
in under fives, measured by a rapid diagnostic test, decreased by
54% from 22% to 10%; 2) severe anemia in under fives decreased by
62% from 13% to 5%; 3) the proportion of under fives who slept under
an insecticide treated net increased by 66% from 23% to 38%, among
pregnant women the proportion increased by 69% from 24% to 40%; and
4) the number of houses sprayed with IRS in past 12 months increased
58% from 27% to 43%.


11. Zambia's scaled-up malaria control efforts and their accurately
measured impact have drawn international attention. While this
attention has been welcome, it also raises the bar as Zambia and its
partners work to continue to roll out interventions including IRS
and ITNs to more remote parts of the country. The GRZ continues to
prioritize malaria and is in the process of preparing a Round Nine
Global Fund proposal for malaria. The World Bank continues to fund
malaria programs in Zambia and plans to do so through at least 2011.
Long-term funding by the government and donors and sustained
political will must continue if the goal of eliminating malaria as a
public health threat is to be achieved.

BOOTH