1. Malaria in Zambia A refresher 2012

2. Scope of Presentation  Background on Malaria  Overview of malaria in Zambia  Interventions  Impact  Active Case Detection  Case Management  Clinical features  Treatment  Prevention

3. 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

4. Lifecycle

5. 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

6. A new malaria map, calls for new approaches Type 1 –very low Type 2 –low Type 3 –mod/high 3 transmission zones

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

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

9. 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. 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

11. ACTIVE CASE DETECTION

12. 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

13. 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

14. CASE MANAGEMENT

15. 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)

16. 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

17. 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

18. 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

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

20. 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

21. The end Zambia’s vision is to be a Malaria free country!