Malaria Control in Zambia. October 27, 2005

Transcription

1 October 27, 2005

2 Country Background Landlocked country located in south-central Africa Pop. over 10 million, 62% urban, 753,000 sq km. Mostly high plateau with flat or undulating terrain Nine Provinces, 72 Districts 80% of population lives on less than $1 per day

3 Malaria epidemiology and impact More than 3.5 million malaria episodes each year 50,000 malaria-related deaths Transmission intense during rainy season Largest cause of morbidity and mortality Primary cause of work and school absenteeism Highest burden is on school age children and pregnant women from anemia

4 Vector Main malaria vectors are A. gambiae, A funestus and A. arabiensis Adult ecology fresh water due to human and agricultural activities and wetlands Adult feeding human and animal feeder, indoor and outdoor resting and feeding habits Larva ecology fresh temporary/semi-permanent habitats

5 Vector control Past efforts During the 1950s-70s, Zambia successfully implemented integrated vector management using IRS and larval control methods (chemical and biological) Mining companies, mostly located in urban centers, were actively involved Communities, municipalities and commercial groups participated actively Synthetic pyrethroids and carbamates were introduced in late 1970s, but 4 times more expensive leading to fewer structures sprayed

6 Malaria control Recent experience Integrated approach, involving ITN distribution, IRS, larviciding and environmental management, with development of strong partnerships Improvements in treatment efficacy with change in health policy from Chloroquine to ACT Increased financial resources available for malaria control e.g. Global Fund, HIPC, other donors Improved monitoring and evaluation framework being developed

7 Malaria control Moving Forward Scale up of the national malaria program, integrated within the health sector-wide approach Further expansion of traditional and non-traditional partnerships Greater focus on improving coverage and use of interventions, leading to better malaria outcomes

8 Three components in the Malaria Booster Strengthening the health system and malaria service delivery availability of bed nets, insecticide sprays, environmental management and safeguards, improved diagnosis capacity, human resources Active community engagement advocacy, awareness campaigns, distribution campaigns, capacity building Program management--- technical leadership, monitoring and evaluation, guidelines, policies, institutional strengthening for financial management and procurement

9 Potential adverse health impact Insecticides DDT, pyrethroids, larvicides No evidence for adverse health impact of proper DDT use for IRS in malaria control Government of Zambia has committed to phasing out the use of DDT in the long term; no evidence of resistance so far Alternatives to DDT are being used and evaluated Safeguards are in place to ensure the proper use, disposal and monitoring

10 Safeguards--Policy and regulatory bodies Established health policy, malaria and vector control policy Environmental Council National Malaria Control Center Ministry of Health, Environmental Health Unit Environmental Protection and Pollution Act-Pesticides and Toxic substances Regulations, 1994

11 Safeguards Technical and institutional Adequacy of human resources, institutional structures Vector management guidelines Strict eligibility criteria for IRS and monitoring Safe transport and disposal of residual insecticides, equipment, protective clothing Vector susceptibility surveillance, insectaries Operational research and alternatives

12 Conclusions Malaria is a significant development challenge Effective malaria control will involve a multiplicity of tactics, particularly increased ITN distribution and usage, IRS and other interventions. Potential adverse impacts of insecticide use can be mitigated with the existence of sound policies and regulations, better technical and institutional capabilities, and effective monitoring during implementation.