Transcript Slide 1

Zambia National
Malaria Indicator
Survey 2008:
Summary of results
National Malaria Control Centre,
Lusaka Zambia
http://www.nmcc.org.zm
Collaborations
• Ministry of Health
– National Malaria Control Centre, District and Provincial Health Offices
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Central Statistics Office
PATH MACEPA
PMI, USAID, CDC
World Bank
WHO
UNICEF
University of Zambia (UNZA)
GFATM
RBM MERG
Progress in malaria control
measured in household surveys
Progress on;
• Malaria Prevention; ITNs, IRS
• Malaria Diagnosis, Treatment and Care
• Malaria In Pregnancy; through Intermittent
Preventive Therapy (IPTp)
Progress as of 2008 - interventions
percent
0
10
20
30
40
50
60
70
80
% children with fever in previous two weeks
% febrile child took antimalarial
% febrile child took antimalarial promptly
% febrile child took Coartem
% febrile child had finger/heel prick
12.7
10.9
71.5
% HHs with ≥ 1 net
62.3
% HHs with ≥ 1 ITN
% HHs with ≥ 2 ITNs
% HHs sprayed last 12 months (IRS)*
30.9
42.7
76.2
68.33
% HHs with at least one net or IRS
% HHs with at least one ITN or IRS
% U5 sleeping under net
% U5 sleeping under ITN
% PW sleeping under net
% PW sleeping under ITN
47.5
41.1
45
43.2
80
% PW taking any IPT
% PW taking IPT 2x
66.1
90
100
Progress since 2006 - interventions
percent
0
10
20
30
40
50
60
70
80
% children with fever in previous two weeks
% febrile child took antimalarial
% febrile child took antimalarial promptly
% febrile child took Coartem
% febrile child had finger/heel prick
12.7
10.9
71.5
% HHs with ≥ 1 net
62.3
% HHs with ≥ 1 ITN
% HHs with ≥ 2 ITNs
% HHs sprayed last 12 months (IRS)*
30.9
42.7
76.2
68.33
% HHs with at least one net or IRS
% HHs with at least one ITN or IRS
% U5 sleeping under net
% U5 sleeping under ITN
% PW sleeping under net
% PW sleeping under ITN
47.5
41.1
45
43.2
80
% PW taking any IPT
% PW taking IPT 2x
66.1
90
100
Progress - impact
• Malaria incidence – improvements in measuring
incidence occurring
• Malaria parasitemia prevalence decreased:
– National = 54% decrease
– Urban: 4.6% to 4.3% = 7% decrease
– Rural: 29.0% to 12.4% = 57% decrease
• All cause mortality for children under age 5
(U5MR)
– 29% decrease comparing the periods ~1998-2002 to
2002-2007 (ZDHS)
How does Zambia NMCP decide where
to go next?
• With interventions? We know that…
– Getting close, but have not hit any population-based targets for
ITNs, IRS, IPT2
• ITN – remove bottlenecks in procurement
– Catch up, keep up, hang up - quantify the replacement needs
nationally
• IRS being applied more to urban, less malarious areas,
– To date not able to measure impact through HH surveys like MIS
• SP supply continuity
– Not really measuring prompt effective treatment well nationally
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Smaller-scale assessments available
Facility versus household measurement
Due to fever versus ‘true’ malaria measurement
Drug diagnostic quantification, procurement and supply
management
How does Zambia NMCP decide where
to go next?
• With impact? Some issues to consider…
– Impact to date is likely a result of applying multiple
interventions consistently
• In rural areas, mostly a combination ITNs + having an
effective drug for facility-based treatment
– Impact from ITNs has mostly been measured
• Not likely to be able to measure as much of its contribution
again as we already have
– Easier to measure a change from 22% to 10% than
from 10% to 5% (or less) parasitemia
– Must wait another ~5 years for U5MR measurement
What should the Zambia NMCP do?
• Continued focus on increasing coverage of prevention
interventions
– Hit a target! especially with ITNs, IRS, IPT
– Consider applying IRS to areas with more malaria
• IRS targeting during spray campaigns based on incidence (?)
• Make treatment and diagnosis more available
– Scaling up treatment
• What does this mean? Moving into communities?
• Home management of malaria
• Active case detection
– Moving to treating ‘real’ malaria and parasitic infections
– Training, training, training
• Combination of interventions
– At least 2 simulatenously
What should the Zambia NMCP do?
• Measurable impact going forward
– Another MIS will only be useful if additional measures
to reduce parasitemic infections are undertaken
– And even then, MIS will only be useful down to ~5%
level of parasite prevalence
– Countries/areas below ~5% level should transition to
surveillance and case reporting
• The majority of Zambian population (in urban areas) already
needs this
• Development of a more robust surveillance system for
malaria incidence monitoring and foci detection
Important points
• Households surveys are critical to measure progress
against national/local coverage and impact targets,
especially during scale up and maintenance phase of
malaria control
• Quality surveys attempt to strengthen design and
measurement issues to maximize inference and validity
• Luckily, many procedures and methods have been
standardized to help simplify the process
• Zambia NMCP has many tools/equipment available to
help
• Remarkable progress has been made in Zambia and has
been documented in MISs in 2006 and 2008
References
• The MIS 2006 and 2008 reports and
lessons learned are available on the
National Malaria Control Centre website
– http://www.nmcc.org.zm
• RBM Monitoring and Evaluation Reference
Group website
– http://www.rollbackmalaria.org/merg