Zambia has made progress in reducing malaria incidence through several strategies: 1) Establishing rapid reporting systems using mobile phones to collect malaria data from health facilities on a weekly basis to inform decision making. 2) Implementing mass testing and treating of entire households for malaria to clear parasites from communities. 3) Conducting active surveillance of malaria cases by investigating all positive cases and containing transmission in low burden areas. 4) The goal is to establish large malaria free zones in Zambia and ultimately eliminate malaria in the country by optimizing intervention delivery and reducing parasite reservoirs.

1. Malaria incidence reduction and
surveillance:
Zambia’s experience
Web: www.nmcc.org.zm
www.makingmalariahistory.org
Email: malaria@nmcc.org.zm

2. Historical context: The malaria fight
• A little over a decade ago, global
leaders began coming together to
fight malaria in Africa.
• Despite the fact that malaria is one
of the leading killers of young
children, it was the first time in years
anything had been done to control
the disease.

3. Historical context: The malaria fight
• Using the “Scale-Up for
Impact” approach to rapidly
deliver life-saving tools,
many countries were able
to quickly bring down
malaria illnesses and deaths

4. Stratification of Malaria in Zambia
 Data from Zambia’s  Data from Zambia’s
National Malaria
Indicator has shown a
steady decrease in
parasitemia in young
children.
 Now, the country is
working to establish
large areas entirely
free from malaria,
with the long-term
goal of eliminating
the disease.

5. The goal: Malaria elimination
• It is an exciting time for the malaria
community – countries like Zambia are
demonstrating that for the first time in history,
we have the potential to eliminate malaria in
Africa.

6. Baseline transmission
Reduced transmission
Mass Screen and Treat
Near-zero transmission
Community case
management with
household re-
screen and treat
Universal LLIN coverage
So what will it take to end malaria?
Adapted from WHO Global Malaria Programme: Community-based transmission reduction of malaria
May 2011 - DRAFT
STEP 1
Zambia Rapid Reporting system
STEP 2
Clear parasites from people
STEP 3
Surveillance as an intervention
STEP 4
All cases identified, investigated and cleared.
Document elimination

7. Zambia is piloting new strategies to
stop malaria transmission

8. Rapid reporting informs decision-
making, identifies gaps in coverage, and
targets resources.
Information collected through rapid
reporting includes:
• Coartem by pack size (dispensed and
balance on hand)
• RDT stocks (tested and balance on
hand)
• Clinical and confirmed malaria cases
• Total outpatient attendance at health
clinics
Establishing Rapid Reporting systems

9. Why mobile phones?
Information that used to
take 3 to 4 months to reach
the central level now only
takes one week. Data is
sent by health facilities
over low cost, Java-enabled
mobile phones to a server
that is accessed by district
health officials who are
able to view and respond
to the local malaria
situation in near-real time.

10. Mass testing and treating for malaria
• Once a rapid reporting
system is in place, health
workers test every member
of a household for malaria
and treating positive cases.
• Data is collected using PDAs
and smartphones. The Test
& Treat approach is unique
in that it looks both for
people who have symptoms
and for those who don't but
who are infected
(asyptomatics).

11. Actively investigating malaria cases
• In areas of very low burden (as determined by the data from rapid
reporting) surveillance is the approach: positive cases investigated and
contained.
• A systematic approach to follow up on individual cases—in very low
burden areas to pursue each incidence of confirmed malaria—will be
informed by the experience of surveillance now taking place in Lusaka.

12. COMMUNITY
HEALTH FACILITY
MOBILE PHONE
REPORTING
CHW INDICATORS
CLINIC INDICATORS
PASSIVE: PATIENT SEEKS OUT CLINIC
Symptomatic individuals tested at the clinic
Record: Name, Age, Sex, Address, Purpose, Comment*, Result
Treatment
ACTIVE: CHW CONDUCTS TEST AND TREAT
Test as many individuals living around the positive case as
possible (1 day / 2 boxes)
Record :
Name, Age, Sex, Address, Symptoms, Travel, Result, Treatmen
t
PASSIVE: PATIENT SEEKS OUT CHW
Symptomatic individuals tested by CHW
Record: Name, Age, Sex, Address, Purpose, Comment*, Result
Treatment
Malaria Surveillance for Elimination
EHT
Data
CHW
POSITIVE
POSITIVE
* - Travel History

13. Next steps
• Document evidence and approaches from
Zambia’s malaria elimination efforts
• Defining and establishing malaria free zones
• Continue pushing malaria elimination strategic
thinking
• Optimize strategies for intervention delivery
• Focusing on reducing parasite reservoirs at
community level
• Work more broadly with partners to improve
diagnostics and drug delivery

14. Conclusion
• This approach will ultimately create the space needed to establish
malaria-free zones. As Zambia again serves as the pace-setter for malaria
prevention and control it will be important to provide evidence of the
feasibility and cost of these steps, and to document the entire process for
the benefit of Zambia, other countries and the global malaria community.
The ultimate goal? A world free from malaria.