Early Results of Integrated Malaria Control and Implications for the Management of Fever in Under-Fi
Early Results of Integrated Malaria Control and Implications for the Management of Fever in Under-Five Children in Zambia
Background: Zambia has taken lead in implementing integrated malaria control so as to attain the National Health Strategic Plan goal of "reducing malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010". The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been removed by providing free malaria prevention and treatment services.
Methods: Data involving all under-five children reporting at the health facility in the first quarter of 2008 was evaluated prospectively. Malaria morbidity, causes of non-malaria fever, prescription patterns treatment patterns and referral cases were evaluated
Results: Malaria infection was found only in 0.7% (10/1378), 1.8% (251378) received anti-malarial treatment, no severe malaria cases and deaths occurred among the under-five children with fever during the three months of the study in the high malaria transmission season. 42.5% (586/1378) of the cases were acute respiratory infections (non-pneumonia), while 5.7% (79/1378) were pneumonia. Amoxicillin was the most prescribed antibiotic followed by septrin.
Conclusion: Malaria related OPD visits have reduced at Chongwe rural health facility. The reduction in health facility malaria cases has led to an increase in diagnoses of respiratory infections. These findings have implications for the management of non-malaria fevers in children under the age of five years.
Malaria accounts for 50% of outpatient attendances and 20% admissions in Africa. In sub-Saharan Africa alone, annual malaria deaths are estimated at 1.3 million for all age groups. This has resulted into high expenditures on malaria control. WHO estimates show that countries may spend more than 40% of their health budget on malaria treatment and prevention. This increase in health care expenditure and the negative effects of malaria on productivity slows down economic growth for these countries. Not only does malaria have a negative impact on economic growth at national level, but it also affects the income levels of poor households. Thus, integrated malaria control is high on the health agenda, as described in the Abuja declaration of 2000.
In Zambia, malaria accounts for about 4 million cases (confirmed and unconfirmed) with approximately 6,400 deaths reported at health facilities country-wide. The case fatality rates among hospital admissions are estimated to be 40/1,000. It is for this reason that malaria has taken centre stage in the National Health Strategic Plan (2006) and the fifth National Development Plan (2006). The main goal for malaria control is "to reduce malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010".
In order to achieve these goals, the Ministry of Health through the national malaria control programme is implementing integrated malaria control. The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), encouraging the use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been addressed, all malaria services (treatment and prevention) are offered free-of-charge. In April 2006, the government removed user fees in all 56 rural districts of Zambia.
All these interventions are known to be effective tools for malaria control. Further, studies in South Africa showed that ACT has the potential to reduce expenditure on malaria treatment. Studies conducted elsewhere have demonstrated that both IRS and ITNs are effective prevention strategies in various settings In country studies have shown that ACT is a cost-effective treatment for malaria. Utzinger and colleagues demonstrated that integrated malaria control resulted into better health for the community and higher productivity for the mining sector on the copperbelt in Zambia.
The Malaria indicator survey for 2008 report indicates that 75% Zambians own at least one ITN, 62% women received two or more doses of IPT, more than 77% of households in IRS designated districts were sprayed. Further, in a health facility survey conducted in 104 health facilities in Zambia, it was found that 60% of the health facilities used ACT (artemether-lumefantrine), 73% had diagnostic capacity and at least 42% of children with uncomplicated malaria were treated with ACT. An assessment on the impact of user fees removal on health facility utilisation found that from 2006 to 2007, there was an increase in utilisation of rural health facilities in the order of 7% and 55% for under-five and over-five years populations respectively. Thus, both the population and health facility surveys have shown that malaria control interventions are reaching the service delivery points and the community members are having access. The malaria control programme has received financial and technical support from various multilateral, bilateral and private organisations.
In as much as evidence on process and outcome indicators exists, there has been less documentation of the impact of scaling-up malaria control in Zambia. As a result, a prospective study on the impact of scaling up malaria control is being conducted in various sites. This paper presents a case study of one particular rural district in Zambia where malaria control has began to show positive results at health facility level.
Abstract and Background
Abstract
Background: Zambia has taken lead in implementing integrated malaria control so as to attain the National Health Strategic Plan goal of "reducing malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010". The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been removed by providing free malaria prevention and treatment services.
Methods: Data involving all under-five children reporting at the health facility in the first quarter of 2008 was evaluated prospectively. Malaria morbidity, causes of non-malaria fever, prescription patterns treatment patterns and referral cases were evaluated
Results: Malaria infection was found only in 0.7% (10/1378), 1.8% (251378) received anti-malarial treatment, no severe malaria cases and deaths occurred among the under-five children with fever during the three months of the study in the high malaria transmission season. 42.5% (586/1378) of the cases were acute respiratory infections (non-pneumonia), while 5.7% (79/1378) were pneumonia. Amoxicillin was the most prescribed antibiotic followed by septrin.
Conclusion: Malaria related OPD visits have reduced at Chongwe rural health facility. The reduction in health facility malaria cases has led to an increase in diagnoses of respiratory infections. These findings have implications for the management of non-malaria fevers in children under the age of five years.
Background
Malaria accounts for 50% of outpatient attendances and 20% admissions in Africa. In sub-Saharan Africa alone, annual malaria deaths are estimated at 1.3 million for all age groups. This has resulted into high expenditures on malaria control. WHO estimates show that countries may spend more than 40% of their health budget on malaria treatment and prevention. This increase in health care expenditure and the negative effects of malaria on productivity slows down economic growth for these countries. Not only does malaria have a negative impact on economic growth at national level, but it also affects the income levels of poor households. Thus, integrated malaria control is high on the health agenda, as described in the Abuja declaration of 2000.
In Zambia, malaria accounts for about 4 million cases (confirmed and unconfirmed) with approximately 6,400 deaths reported at health facilities country-wide. The case fatality rates among hospital admissions are estimated to be 40/1,000. It is for this reason that malaria has taken centre stage in the National Health Strategic Plan (2006) and the fifth National Development Plan (2006). The main goal for malaria control is "to reduce malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010".
In order to achieve these goals, the Ministry of Health through the national malaria control programme is implementing integrated malaria control. The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), encouraging the use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been addressed, all malaria services (treatment and prevention) are offered free-of-charge. In April 2006, the government removed user fees in all 56 rural districts of Zambia.
All these interventions are known to be effective tools for malaria control. Further, studies in South Africa showed that ACT has the potential to reduce expenditure on malaria treatment. Studies conducted elsewhere have demonstrated that both IRS and ITNs are effective prevention strategies in various settings In country studies have shown that ACT is a cost-effective treatment for malaria. Utzinger and colleagues demonstrated that integrated malaria control resulted into better health for the community and higher productivity for the mining sector on the copperbelt in Zambia.
The Malaria indicator survey for 2008 report indicates that 75% Zambians own at least one ITN, 62% women received two or more doses of IPT, more than 77% of households in IRS designated districts were sprayed. Further, in a health facility survey conducted in 104 health facilities in Zambia, it was found that 60% of the health facilities used ACT (artemether-lumefantrine), 73% had diagnostic capacity and at least 42% of children with uncomplicated malaria were treated with ACT. An assessment on the impact of user fees removal on health facility utilisation found that from 2006 to 2007, there was an increase in utilisation of rural health facilities in the order of 7% and 55% for under-five and over-five years populations respectively. Thus, both the population and health facility surveys have shown that malaria control interventions are reaching the service delivery points and the community members are having access. The malaria control programme has received financial and technical support from various multilateral, bilateral and private organisations.
In as much as evidence on process and outcome indicators exists, there has been less documentation of the impact of scaling-up malaria control in Zambia. As a result, a prospective study on the impact of scaling up malaria control is being conducted in various sites. This paper presents a case study of one particular rural district in Zambia where malaria control has began to show positive results at health facility level.
