Malaria in Zambia

A refresher2012

Scope of Presentation

Background on Malaria Overview of malaria in Zambia

Interventions Impact

Active Case Detection Case Management

Clinical features Treatment Prevention

Background

• Malaria is a disease caused by a tiny parasite• Transmitted through an infected bite of a

female anopheles mosquito• The malaria parasites enter and leave the

body through mosquito bites• An adult mosquito will only have parasites if it

has bitten a person infected with malaria• The parasites have a life cycle in humans as

well as in a mosquito

Lifecycle

Overview of Malaria in Zambia

• Malaria is common throughout Zambia

• Seasonal and geographical differences

• A leading cause of death and sickness in children

• <5 years and pregnant women most at risk

• In 2010– 4.2 million cases – 4384 deaths reported

A new malaria map, calls for

new approaches

Type 1 –very low

Type 2 –low

Type 3 –mod/high

3 transmission zones

Percentage malaria parasite prevalence by province among children under age five years (Zambia 2006–2010)

Confirmed malaria cases, 2011 Year to date, by health facility

Key Interventions

• Insecticide Treated Nets (ITNs), namely LLINs • Indoor Residual Spraying (IRS), 72 districts

(2011)• Intermittent Preventive Treatment of Pregnant

women (IPTp)• Case management

10

Impact • 50% reduction in malaria mortality.• Need to sustain control over time• Reversal in Luapula, Northern and Eastern

Provinces• Specific interventions based on zoning to

sustain gains

Target: 5 malaria free zones in Zambia by 2015

ACTIVE CASE DETECTION

Objectives

• Work with districts and local communities • Train community health workers to – Test for malaria– Treat positive cases

• Implement systematic campaign strategies at the rural health centre level

Reduce the parasite reservoir

• Actively look for people who transmit malaria but may have no symptoms

• Test in the community• Treat all confirmed cases• Enhanced surveillance

CASE MANAGEMENT

Clinical features

• Incubation period is 10 – 14 days• Characterized by fever which may be

continuous, periodic or irregular• Malaria may manifest as – an acute uncomplicated disease– a severe complicated disease

• Check blood to confirm the infection– Rapid Diagnostic test (RDT) – Parasite slide (microscopy)

Uncomplicated Malaria

• Early symptoms are usually non-specific • Fever is the most common symptom, but could be

from another infection• Headache, aching joints, back pain, nausea and

vomiting and general discomfort usually accompany fever.

• Patient may not have a fever but may have a history of fever

Severe Malaria

Examples of life threatening conditions are: Cerebral malaria General convulsions Unconsciousness Severe vomiting Excessive bleeding Extreme weakness• Fever >temperature of more than 38°C

Treatment

• For uncomplicated malaria:– Artemether –Lumefantrine combination

(Coartem)– Control fever: fanning, sponging or paracetemol– Take entire course of medicine– If drug is spat out within 30 min, repeat dose.– If persistent vomiting : REFER TO HEALTH CENTRE

• For severe malaria:– REFER TO HEALTH CENTRE

Coartem Dosage

Coartem is not recommended in children less than 5 kg (less than 2 months old)

Prevention

• Malaria is a preventable disease:– Insecticide treated nets (ITNs)– Indoor residual spraying (IRS)– Intermittent Presumptive Treatment in pregnancy

(IPTp)– Proper treatment of malaria– Personal protection e.g. protective clothing– Environmental management• Clear stagnant waters, fill in pools and ponds, clear

vegetation

The end

Zambia’s vision is to be a Malaria free country!