Chaminuka , Lodge

1. Situation analysis for the Mid-Term Review of the NMSP 2011-2015:Relevent outcomes and impact measures Chaminuka, Lodge

2. Overview • Goals, targets, objectives • Coverage of interventions • Recommendations

3. Total malaria cases

4. Total malaria case rates

10. Malaria reported case rates by district and case counts by facility 2011

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19. Malaria indicator surveys • Household surveys every 2 years: 2006-2012 • Malaria parasitemia and severe anemia • Coverage of prevention interventions • ITNs, IRS, IPTp • Fever prevalence, uptake of diagostics and ACT treatment

20. Fever prevalence with the preceding two weeks among children under age five years (Zambia 2006–2012)

22. Severe anaemia (Hb<8g/dl) prevalence among children under age five years by urban and rural areas (Zambia 2006–2012)

23. Severe anaemia prevalence among children under age five years by province (Zambia 2006–2012).

24. Household ownership of at least one ITN by rural and urban areas (Zambia 2006–2012)

25. Household ownership of at least one ITN by province (Zambia 2006–2012).

26. Percentage of households with an ITN to sleeping space ratio of least one-to-one (Zambia 2008–2012)

27. ITN use by children under age five years by rural and urban areas (Zambia 2006–2012)

28. ITN use by children under age five years by province (Zambia 2006–2012)

29. ITN use among household members by age group (Zambia 2006–2012)

30. Households reported sprayed within the previous 12 months (Zambia 2006–2012)

31. Households reported sprayed within the previous 12 months, by province (Zambia 2006–2012)

32. Households reporting either at least one ITN or house sprayed or both (Zambia 2006–2012)

33. Women with recent births reporting coverage of IPTp two doses and three doses, by urban and rural areas (Zambia 2010–2012)

34. Fever prevalence with the preceding two weeks among children under age five years (Zambia 2006–2012)

35. Percentage of febrile children under age five years with a reported finger stick for presumed diagnostic testing services and parasitologic confirmation (Zambia 2008–2012)

36. Among febrile children taking antimalarial, the percentage of antimalarial drug taken (Zambia 2006–2012)

37. Percentage of people with recent fever who reportedly sought treatment outside of the home, across age Source: MIS 2012 woman’s questionnaire

38. Percentage of patients with suspected malaria who received a blood test for malaria, across level of care and patient age Source: HFS 2011

39. Percentage of patients who were prescribed the first line ACT (AL) across blood test results, patient age, and level of care Source: HFS 2011

40. Percentage of patients prescribed AL who demonstrated full comprehension of the drug regimen (duration, dosage, and number of times per day), across patient age and level of care Source: HFS 2011

41. Summary • Slight decrease in parasite prevalence between 2010 and 2012, but still and overall decline compared to 2006 • Improving quality ITN distributions through door-to-door campaigns, particularly in Luapula, Muchinga, and Eastern • More ITNs per household to cover all sleeping spaces • Increase in use among all ages, including U5s and PW • General shift in IRS coverage from urban to more malarious, rural areas • IPTp continues to remain high, including more than half of women receiving 3 doses during pregnancy • Trend in improving use of ACTs among antimalarials and increasing amounts of testing for febrile episodes

42. Recommendations (1) • Changes in parasite prevalence and severe anemia, while reduced in some areas, have stagnated in several key areas of the country. It is recommended to examine approaches to maximizing the use of existing prevention and treatment interventions in combinations to exact the greatest impact on localized malaria burden. • Re-establish high ITN ownership and use in areas of the country that dropped between 2010 and 2012 including Southern, Western, Central provinces provinces and encourage continued sustained coverage of ITNs uptake among all households and household members throughout the country. • The effort to reach to last 30% of households is likely to be more difficult than reaching the 70% presently reached. The National Malaria Control Program recommends house to house distribution for replacement and current strategies should align to attain highest coverage possible. Full coverage at community level benefits all members of the community, including the most vulnerable populations of children under five and pregnant women.

43. Recommendations (2) • Continue to strategically offer IRS services to areas with malaria to maximize the potential of malaria burden reduction, complementing current IRS and ITN efforts and in conjunction with an integrated vector management framework. • Continue to expand case management, including diagnostics for parasitologic confirmation of suspected malaria cases, and consider that screening populations and treating those with infection may be important to further curtail malaria transmission. This latter effort would be especially appropriate in areas with continued and persistent high levels of malaria parasitaemia and transmission to supplement existing malaria prevention interventions.