Reveal takes aim at malaria parasite through mass drug administration campaigns in Southern Province, Zambia

By Parysa Oskouipour on September 18, 2019 in Health Data Systems, Malaria, News

Deep in Zambia’s Southern Province, in a town a three-hour drive away from the district’s largest city and economic hub (Siavonga), lies Manchamvwa Health Facility. This clinic serves as the focal point for the health needs of hundreds of people who live in the surrounding villages, and as such, is often overwhelmed with the many health needs of its patients. Malaria season in particular tends to put a great strain on the facility, with peak periods in previous years seeing anywhere from 100 to 200 cases per month.

Over the last couple of years, the Government of the Republic of Zambia (GRZ), with the assistance of Akros and PATH’s Bill and Melinda Gates Foundation-funded Malaria Control and Elimination Partnership in Africa (MACEPA), have been working with the National Malaria Elimination Program district staff to overcome these numbers and improve the health of the local community by using geospatial technology to optimize indoor residual spraying (IRS) campaigns. Recently, the two organizations teamed up again to be the first to ever use Reveal’s spatial intelligence approach to maximize reach and ensure accountability in a mass drug administration (MDA) campaign that distributed antimalarials to the doorstep of each community member in three districts of Southern Province.

Lake Kariba’s still, glistening waters at sunset.

The recent history of malaria in Southern Province is one of resounding progress thus far. Due to its proximity to Lake Kariba’s glistening, still water, it is unfortunately a heavily malaria-burdened region by nature. But malaria in this region is highly seasonal, linked to the annual arrival of rainfall from December to April, leaving ample overgrowth and standing water—prime mosquito-breeding real estate. This seasonality provides an attractive window through which most interventions have taken aim. The result has been an impressive decrease in prevalence of malaria parasitaemia among children less than five years of age, from 15.5% in 2006, to 5.5% in 2010, and 0.0% in 2018.1,2 Trends like these make Southern Province appealing as a prime candidate for malaria elimination. However, despite overall improvement in the province’s malaria burden at large, districts directly adjacent to the lake are still at higher risk, as malaria cases have shown to be persistently high in some health facilities despite ongoing interventions.

To propel Southern Province closer to elimination, in 2014 MACEPA supported the national program with a malaria MDA research study in the Southern Province districts lining Lake Kariba, an area with an estimated population of 300,000 people. The rapid malaria reduction in the study area resulted in Zambia adding MDA to its arsenal of interventions in 2017. The country’s experience of malaria MDA—two rounds with one month in between doses­—has shown it to be an effective intervention in areas with a strong foundation of vector control, case management, and surveillance. Recognizing that MDA campaigns are most effective when every household and individual in the targeted region are reached, MACEPA engaged Akros for its technical expertise in introducing Reveal as a novel approach to maximize the impact of MDA for malaria control and elimination in this area.

Zambia and Southern Africa Celebrate First Open Defecation Free District

By Akros Media on April 22, 2015 in News, Water and Sanitation Health

On 24 April 2015, Chienge will host a national celebration to mark the historic achievement of becoming the first district in Zambia and Southern Africa to be declared Open Defecation Free (ODF). With three chiefdoms in the districts becoming ODF at the same time, Chienge’s verification also makes Zambia the second country in Africa, after Kenya, to realize such an ambitious goal. The district moved from a low baseline coverage of 12% to the now verified 98% population reach (this includes all 13 wards being verified and certified as ODF by the Ministry of Local Government and Housing working with UNICEF.

The celebration is part of the “ODF Zambia by 2020” Campaign which has seen Zambia make progress on improving sanitation coverage with chiefdoms leading the way. So far, 10 chiefdoms have been declared ODF, an important factor in reducing disease outbreaks such as diarrhea in communities.

Diarrhea is the second leading cause of death for children under 5, globally, and one of the significant contributors is the lack of access to adequate sanitation and appropriate hand washing facilities. In Zambia, approximately 40 children die each day because of a lack of access to sanitation and clean water and 40% of those affected are stunted – notably because of fecal-oral transmission of diseases. The negative outcomes disproportionately impact Zambia women and girls, who face additional risks to their safety when defecating outdoors or attempting to reach far away toilets. In the economic context, Zambia loses ZMW 946 billion annually due to poor sanitation, according to the review conducted by the Water and Sanitation Program (World Bank, 2012).

The Honorable Minister of Local Government and Housing, Mr. John Phiri, commented, “We are inspired by this landmark achievement which shows that by using community participatory approaches such as Community- Led Total Sanitation (CLTS), and effective sector collaboration at different levels, huge milestones can be made towards a defecation free Zambia. We salute their Royal Highnesses Senior Chief Mununga, Senior Chief Puta and Chieftainness Lambwe Chomba, for their distinguished leadership that has resulted in having the first ODF district in Zambia and other countries in the Southern African Region.”

“A lack of sanitation in the most vulnerable populations often translates to lack of good health, and a loss in economic and educational opportunities – outcomes that disproportionately affect the quality of a woman’s and child’s life and future,” stated Dr. Hamid El-Bashir Ibrahim, Country Representative for UNICEF. “This is why the district of Chienge achieving its open defecation free status is an important milestone in Zambia’s history, not only because of what it means for the health of over 100,000 residents in the district, but also because it demonstrates the great capacity of the Zambia communities and their traditional leaders to realize their own innovative solutions. I can only admire such a remarkable display of collective government prioritization, collaboration, and mobilization that have made this milestone possible.”

While the long-term health and development impacts of this achievement are still emerging, remarkably, Chienge was able to leap between its abysmal starting point to its currently outstanding coverage over just the course of one year – stakeholders watch with great interest as the district, which historically recorded almost yearly outbreaks of cholera, passes the 12-month mark with zero confirmed cases of cholera recorded.

“This has been an absolute team effort. Spearheaded by the strong leadership and commitment of the three chiefs, our tireless Community Champions, EHTs and CHAs, Sub-Chiefs, Headmen and head women, Ward Councillors, all District WASHE Committee members including the District Administration and key line Ministries and District Staff, especially our RWSSP Focal Point person and the proud and hard-working communities of Chienge District, with excellent support from facilitating NGO Akros, PDHID and provincial and national line ministries, “says Chienge District Council Secretary Mr Kauchingu.

Chienge is the first in the line of ODF districts to be verified in the upcoming months, which includes Lunga, Samfya, and Mumbwa to be confirmed soon.

The National Rural Water Supply and Sanitation Program is led by the Ministry of Local Government and Housing, in partnership with the Ministry of Chiefs and Traditional Affairs, Ministry of Community Development, Mother and Child Health, and the Ministry of Education, Ministry of Health. The leadership is supported by many cooperating partners and NGOs in the sector, particularly by UNICEF and the UK Department for International Development (DFID) for the Community-Led Total Sanitation (CLTS) program currently found in 67 rural districts, with a view to expanding into more districts this year. NRWSSP is committed to addressing the underlying causes of diarrhea and other waterborne diseases through a package of Water, Sanitation and Hygiene (WASH) interventions that include the evidence-based participatory approach of CLTS.

Zambia to Celebrate World Malaria Day in Livingstone

By Akros Media on April 20, 2015 in Malaria, News

World Malaria Day is celebrated each year on April 25, commemorating the work that has gone into fighting the disease and driving efforts to continue towards its elimination. The theme for this year is “Invest in the future, eliminate malaria.” Zambia will be commemorating the event this year in Livingstone with round table discussions, visits to community health centers, and entertainment all aimed at spreading the malaria elimination agenda.

“World Malaria Day commemorates where we are in the malaria fight and where we are headed,” said Anna Winters, CEO of Akros, an organization working in several facets of malaria control and elimination here in Zambia. “Zambia has made huge strides such that some areas of the country are closing in on elimination,” she said.

Over the past four years Akros has been working with the Government of Zambia on an innovative, community-level malaria surveillance system that leverages community health workers (CHWs) to:

  1. Find, treat and, report all malaria infections in the community
  2. Reduce the burden of outpatient care and staff work load at the health facility through expanding access to malaria diagnosis and treatment by CHWs at the community level

“Community-level malaria surveillance has helped to ensure the district data is a true reflection of the malaria burden because the data is generated by both the Health Facilities and the Community Health Workers,” said Dr. Mwaba Phallon B., District Medical Officer of Kazungula District. “In fact, there are more cases being recorded at the Community level than the health facilities. This helps the district in planning for malaria control activities effectively based on a true representation of the hot spots. Unveiling cases at the community level as well as active detection of cases in the area surrounding the index case also ensures that the parasite is eliminated very quickly without allowing it to multiply. This way, it is envisaged that malaria elimination could be achieved if the program is sustained,” said Dr. Mwaba.

This community-level malaria surveillance approach has already been implemented in 11 districts in Zambia’s Central, Southern, and Western Provinces. 1,500 CHWs have been trained in follow-up, treatment, and reporting protocols required by the system, and the program has already led to an incredible 45.5% increase in the number of malaria cases identified and treated, a huge step forward for Zambia’s malaria elimination agenda. This strategy has also enhanced real time reporting by using a reactive case detection (RCD) protocol and instant transmission of information using phones into the DHIS2 database.

This year’s World Malaria Day commemoration will be held in Kazungula district beginning with a show case of elimination interventions at Kabuyu where Akros, in partnership with the Government and PATH/MACEPA, has worked with CHWs to implement community level malaria surveillance. This occasion is scheduled for 24th April, 2015 beginning at 08:00 hrs and will enable attendees to witness how these intervention efforts are practically deployed in the fight to eliminate malaria. This will be followed by a March Past, song and dance and speeches on Saturday in Livingstone at Mukuni Park.

Handover of over 1,000 bicycles for malaria elimination program

By Akros Media on February 5, 2015 in Malaria

The elimination of malaria in five areas of Zambia by 2015 remains an ambitious goal for the Government of Zambia. The National Malaria Control Center (NMCC) under the Ministry of Health is implementing a 3-step strategy in parts of Southern Province to achieve this goal. The first step involves regular and rapid reporting of health facility malaria-related data on a weekly basis. This information, along with other sources is used to decide where Steps 2 and 3 are implemented. Step 2 involves a mass test and treat campaign, where whole villages are tested and treated for malaria if found with the parasite. This activity is targeted at medium to high malaria burden areas mainly along the Lake Kariba area. Step 3 involves the use of volunteer community health workers (CHWs) to follow up on malaria positive patients found at either health facility or health post levels. The CHWs test the patients’ households and their immediate neighbors. This activity has been rolled out in several districts of Southern and parts of Central Province where malaria cases are relatively low, such Kazungula, Namwala, Itezhi-tezhi, and Choma. CHWs carry out this activity voluntarily, and have diligently done so despite having to traverse vast distances in some cases. The NMCC and its partners have recognized this specific challenge and have procured over 1,000 bicycles for CHWs working in Choma, Pemba, Kalomo, Zimba, Monze, Mazabuka, Chikankata, Mumbwa, and Shibuyunji districts. This will hopefully ease some of the difficulties they face in trying to follow up on these cases in their communities.

The bicycles being given away are painted a bright orange representing the “Test4Life” Campaign, which urges the community at large to get tested for malaria before receiving treatment. The Government and its partners remain committed to eliminating malaria in these regions and ultimately in the whole country.