WITH dramatic increases in funding and intense momentum towards reducing the malaria burden in recent years, Zambia is almost at the verge of being declared malaria free.

According to the World Health Report this year, Malaria deaths reported from health facilities in Zambia have declined by 66 per cent.

This result along with other supporting data indicates that Zambia has reached the 2010 Roll Back Malaria target of more than 50 per cent reduction in malaria mortality compared to 95 per cent in 2000.

Although, still too early to register the impact, Zambia joins the ranks of four African countries among them Rwanda, Tanzania and Sao Tome and Principe who have achieved major reductions in malaria deaths through accelerated malaria control activities.

In sub-Saharan Africa, malaria has remained a major cause of death in children and pregnant women.

The Abuja 2000 Declaration on Roll Back Malaria declares the disease accounts for about one million deaths in Africa and 50,000 in Zambia annually.

In Zambia it has had a negative impact on economic growth as well as the attainment of the Millennium Development Goals (MDGs), therefore reaching the target is like a dream come true.

National Malaria Control Centre (NMCC) acting coordinator, Mulakwa Kamuliwo says efforts to control malaria are beginning to pay off with significant increases in the proportion of people sleeping under insecticide-treated mosquito nets (ITNs) and the Indoor Residual Spraying (IRS) exercise.

Dr Kamuliwo says Zambia's commitment to the scale up malaria control programmes is on-going until the country is declared malaria free adding that 2009 and 2010 IRS plan will be extended to 56 districts.

The current IRS exercise (2008 and 2009) is covering about 36 districts in total," he says.

He disclosed that Zambia's most notable achievement is the decrease in the malaria parasite prevalence in children under the age of five.

"Malaria deaths in children under the age of five has reduced by almost half and nationwide surveys shows that parasite prevalence has declined too.

"Cases of children with severe anaemia have also reduced. Mind you, most moderate and severe anaemia in children is caused by malaria," he disclosed.

Dr Kamuliwo notes that solid advances in intervention coverage, coupled with significantly strengthened capacity and infrastructure to plan and manage rapid malaria control scale-up have positioned Zambia for sustained success in tackling the disease.

Besides the ITNs and IRS, the change and adoption of first line treatment routine that has seen a change in the malaria policy treatment, brought about this significant reduction in malaria deaths.

The decline in Zambia was especially steep after more than three million long-lasting insecticidal nets were distributed between 2006 and 2008.

By 2006-2007, large amounts of insecticide-treated nets and ACT were distributed and IRS was taking place in 15 of 72 districts in Zambia.

This intervention came after the realisation that malaria related deaths had dramatically increased in the last decades, prompting the Government to review its efforts to prevent and treat malaria.

The success of the malaria roll back programme is, to a large measure, attributed to the Konkola Copper Mines (KCM) initiative on which the national anti-malaria drive has been fashioned after.

KCM introduced the satellite project to reduce the incidence of malaria in towns in which it operates as part of the company's corporate responsibility strategy.

The robust programme conducted in four districts namely Chililabombwe, Chingola, Nampundwe and Kitwe involves spraying more than 36,500 houses within a 10-kilometre radius before the peak transmission period in January and February.

And since the programme started nine years ago, there has been a significant drop, of about 60 per cent in malaria cases over the last four years.

For instance in 2002 not a single death from malaria was reported in Chililabombwe and Chingola.

"Malaria cases have gone down in all the areas we have been operating in and this has contributed to increased productivity by reducing employee absenteeism due to malaria illness," KCM Malaria Control manager Paul Banda said.

According to the KCM Malaria Annual Report for 2008, an IRS campaign conducted at the end of 2008 reduced the incidence rates of malaria to 115/1000 for Chingola and 125/1000 for Chililabombwe from incidence rates of 68/1000 for Chingola and 135/1000 for Chililabombwe in 2000.

Mortality has been maintained at nil for the last five years from 16 /1000 for Chililabombwe and 7/1000 for Chingola in 2000.

KCM has applied an inter-sectoral partnership model in collaboration with National Malaria Control Centre, Environmental Council of Zambia (ECZ), District Health Management Teams, Local Authorities, World Health Organisation (WHO), Tropical Diseases Research Centre (TDRC) and the community.

Given its positive outcome KCM's Roll Back Malaria Programme has been recommended as a model for malaria eradication in Zambia.

So far, KCM has spent over US$2million dollars in the residual spraying of houses,larvicidal spraying,dambo clearing and insecticide treated bed nets.

The community too, has been very supportive.

In the case of KCM, promotional programmes are done on radio to enlighten the public before the spraying.

Most households opened-up their homes for spraying without resistance, said KCM Spray operator Rosemary Makoba.

Mrs Chalwe Mofya who lives in Lulamba Township, about nine kilometres away from Chingola town centre says, she and her family of 12, had until now, been constant malaria patients.

Like many other families in the community, her family was a regular at Lulamba Health Centre.

But the situation has been different since the 54-year-old widow opened her home to indoor spraying.

It has been four years since any member of her household has suffered from malaria.

At first Mrs Mofya was against spraying because of the smell and inconvenience that came with it but all that has changed.

"I hated this business of cleaning the walls and shifting property in the house," she said.

At national level, the community has been appreciative save for a few pockets of resistance attributable to insufficient or poor sensitisation.

Ms Grace Ziwa of Lusaka's Garden Township says her family has become accustomed to sleeping under an insecticide treated net such that whenever she is too tired to unfold it, her six-year-old daughter would remind her to do so.

Having been a victim of malaria, Ms Ziwa says she has been taking preventive measures to ensure that her daughter was malaria free.

Her first-born son died of severe malaria in 2002.

"Malaria niyoipa. ine mwana wanga mwamuna wa first anafa na malaria mu 2002 pamene apa pa clinic yathu. Ati malaria yenze inangena maningi, (Malaria is bad, my first born son died of malaria in 2002 at our clinic here. I was told he had severe malaria)," recalls Ms Ziwa.

However, due to convincing evidence of the failing effectiveness of chloroquine, Government initiated a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT).

This saw Zambia switching to coartem from chloroquine because the malaria parasite had become resistant to chloroquine.

On Malaria Day, which is celebrated annually on April 25 in Zambia, Health Minister Kapembwa Simbao said Government is committed to increasing coverage of key malaria control interventions and reducing the burden of malaria throughout the country.

"We will endeavour to continue to build on progress made and ensure that malaria control is addressed as part of a health systems strengthening effort to ensure that ACTs will reach all persons with suspected malaria thereby ensuring universal coverage," Mr Simbao said.

In countries with moderate and low transmission malaria, it appears that the Roll Back Malaria target of a more than 75 per cent reduction is within reach several years before 2015.

Aggressive malaria control measures as in Zambia may enable African countries to make rapid progress towards the Millennium Development Goals target of reducing child mortality by two thirds by 2015.

This is a remarkable achievement and a tribute to the hard work and commitment of the Ministry of Health and its partners to combat malaria.

It is hoped that all countries affected by malaria will intensify and sustain malaria control and elimination efforts in order to meet the 2010 goal of 100 per cent coverage.

History has it that accelerated malaria control activities started in Zambia in 2003 when approximately 500 000 insecticide-treated nets were distributed and artemisinin-based combination therapy (ACT) started in seven pilot districts through a grant from the Global Fund.

Since then, the Ministry of Health has further expanded malaria control activities with grants worth US$ 120 million from the Global Fund and support from partners including the President's Malaria Initiative (PMI), the Malaria Control and Evaluation Partnership in Africa (MACEPA) and the World Bank Booster Program for Malaria Control in Africa.

Zambia stands as an example of what the least developing countries can achieve throughout Africa through the combination of universal access to insecticide bed nets and effective malaria medicines.

FACT FILE

• Malaria deaths decline by 66 per cent

• Malaria deaths in children reduced by half

• Zambia achieves 50 per cent reduction in malaria mortality joining Rwanda, Tanzania, Sao Tome and Principe

• Malaria causes one million deaths in Africa and 50,000 in Zambia annually

• Malaria remains major cause of death in children and pregnant women in sub-Saharan Africa

• Indoor Residual Spraying (IRS) in 36 districts, to extend to 56 districts in 2010

• Three million insecticide treated nets distributed in 2006-2008

• Mortality zero for last four years in Chingola and Chililabombwe

• KCM malaria roll back achieves 60 percent drop in malaria cases in last 4 years.