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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 Central Statistics Office PATH MACEPA

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Zambia National Malaria Indicator Survey 2008: Summary of results

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Zambia national malaria indicator survey 2008 summary of results l.jpg

Zambia National Malaria Indicator Survey 2008:Summary of results

National Malaria Control Centre, Lusaka Zambia

http://www.nmcc.org.zm


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Collaborations

  • Ministry of Health

    • National Malaria Control Centre, District and Provincial Health Offices

  • Central Statistics Office

  • PATH MACEPA

  • PMI, USAID, CDC

  • World Bank

  • WHO

  • UNICEF

  • University of Zambia (UNZA)

  • GFATM

  • RBM MERG


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Progress in malaria control measured in household surveys


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Progress on;

  • Malaria Prevention; ITNs, IRS

  • Malaria Diagnosis, Treatment and Care

  • Malaria In Pregnancy; through Intermittent Preventive Therapy (IPTp)


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Progress as of 2008 - interventions


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Progress since 2006 - interventions


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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)


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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

      • Smaller-scale assessments available

      • Facility versus household measurement

      • Due to fever versus ‘true’ malaria measurement

      • Drug diagnostic quantification, procurement and supply management


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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


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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


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What should the Zambia NMCP do?

  • Measurable impactgoing 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


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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


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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


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