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Malaria deaths decline as cases rise

‘IF you look at the graphs, the fortunate thing is that malaria related deaths are going down but the reported cases are going up and this is probably a relief,’ says National Malaria Control Centre (NMCC) deputy director for disease surveillance control and research Mulakwa Kamuliwo.
According to the NMCC, health facilities throughout the country had recorded about five million cases of malaria captured through the routine health management system reporting in 2013.
These include confirmed tested cases and those untested but recorded as malaria while in 2014, Zambia recorded slightly over six million cases of malaria.
Dr Kamuliwo is however quick to point out that these figures were only obtained from public health facilities.
“We have challenges getting figures from the private sector and it’s not only malaria but this applies to other diseases as well,” he indicated.
Dr Kamuliwo said the rising malaria cases are a source of concern to stakeholders because of the various interventions earlier put in place to combat malaria.
He said in an interview that of particular concern is the increase in malaria cases in regions where prevalence has considerably been low.
“What is also worrying is seeing an increase of cases in the regions where traditionally we thought we are doing well (five years ago). These include the Copperbelt and some rural districts. We have seen an increase in reported cases in Western and North Western provinces.
“Traditionally in Zambia, the highest number of malaria cases is found in the north eastern region, which includes Luapula, Muchinga, Northern and Eastern provinces,” Dr Kamuliwo said.
He added that these are notorious areas where very high figures of malaria cases are recorded while the rest of the country records moderate and low figures.
On surveillance activities, Dr Kamuliwo said the NMCC has continued with various effective interventions such as indoor residue  spray (IRS), insecticide treated mosquito nets distribution and treatment of malaria throughout the country.
“As the word suggests, surveillance means looking out, we want to monitor the burden of malaria and related deaths. As a programme, we are part of the Ministry of Health management information system which is a routine type of reporting done at health facility level,” he said.
He said there are also indicators which are reported about malaria in the routine reporting which is the official source of information for the centre.
Active infection detection (AID) is also used as a surveillance system.
This is a system where a person gives information to the health facility after testing positive and followed back to the community by health workers.
Members of the household where that person comes from are also routinely screened using rapid malaria diagnostic test while surrounding households are also regularly tested.
Dr Kamuliwo said those who test positive for malaria are further tested to establish whether they have symptoms or not.
He added that health personnel also spray the area and provide insecticide treated mosquito nets.
Random mass test and treatment is also another surveillance system aimed at eliminating malaria in communities by trained voluntary community workers.
Those who test positive are treated even without symptoms and this is being done in Southern Province and some parts of Central Province where it is possible to eliminate malaria.
The NMCC has set up 10 sentinel sites in all the 10 provinces where information is gathered to give an indication of the malaria burden.
Dr Kamuliwo said medicines for malaria treatment are also regularly monitored by testing them to determine their efficacy in what is dubbed as efficacy studies.
“We normally do these studies every two years using scientific methods. At the moment and according to recent results, the medicines we are using in Zambia are still efficacious between 98 and 100 percent.
“We also monitor insecticides we use for IRS and those laced on mosquito nets. We subject them to entomological studies every year to determine their efficiency,” Dr Kamuliwo stated.
On future interventions in the fight against malaria, Dr Kamuliwo said the NMCC will continue applying key mediations of malaria control, prevention and elimination.
The countrywide IRS programmes will continue coupled with the distribution of mosquito nets which is usually done through antenatal and under-five clinics.
The NMCC, in collaboration with its cooperating partners, is also embarking on a pilot project to distribute mosquito nets in primary schools to grades one and four pupils.
This is aimed at increasing mosquito net distribution throughout the country and increase the number of people receiving mosquito nets.
Dr Kamuliwo said the centre will also continue with its efforts to eliminate malaria in Southern and Western provinces including some parts of Central Province. Mass screening and testing will also continue.
“We will continue monitoring and surveillance to ensure that our interventions are working. We have planned to conduct a malaria indicator survey which will basically assess the viability of interventions such as IRS, insecticide treated mosquito nets at community level and assess the impact”.
“The impact assessment is done by looking at the number of parasites in the community and we also test for anemia because these are some of the parameters that will indicate the burden of malaria in communities,” he said.
The logistical challenges in ensuring availability of drugs in health facilities will also be tackled.
“We do get reports of some health institutions running out of medicines for two weeks or so, when in the meantime we have sufficient stocks of medicines at the central Medical Stores. We will make sure that we have all the necessary diagnostic tools such as the malaria rapid diagnostic tests and microscopy,” he said.
According to Dr Kamuliwo, the centre is also working towards mobilising more resources to effectively combat malaria.
He said prevention, control and elimination of malaria should not be left to health workers alone but extend to individuals.
“Individuals must ensure that there is personal protection from mosquito bites because this is the only source of infection for malaria,” he belaboured.
Dr Kamuliwo said communities must realise that malaria is a bad and potentially fatal disease.
And Bill and Melinda Gates Foundation (BMGF) malaria programme director Alan Magill said Zambia is a global leader in research to accelerate malaria elimination and achieving a malaria-free world.
Dr Magill said BMGF has been proud to support efforts in the fight against malaria in Zambia over the past decade.
“We are excited to visit Zambia this week, and with the Minister of Health Dr Joseph Kasonde, we will tour areas of Luapula and Southern provinces where researchers are working with local communities to turn the tide of this deadly disease,” he said.
As Zambia commemorates the world malaria day today, the good news is that malaria is no longer the number one killer disease in the country.
It is however one of the 10 causes of death and the number one cause of hospital attendance, according to official statistics by the Ministry of Health.

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