Emmanuel Chanda | University of Zambia (original) (raw)
Papers by Emmanuel Chanda
Malaria Journal
Background The primary malaria vector-control interventions, indoor residual spraying and long-la... more Background The primary malaria vector-control interventions, indoor residual spraying and long-lasting insecticidal nets, are effective against indoor biting and resting mosquito species. Consequently, outdoor biting and resting malaria vectors might elude the primary interventions and sustain malaria transmission. Varied vector biting and resting behaviour calls for robust entomological surveillance. This study investigated the bionomics of malaria vectors in rural south-east Zambia, focusing on species composition, their resting and host-seeking behaviour and sporozoite infection rates. Methods The study was conducted in Nyimba District, Zambia. Randomly selected households served as sentinel houses for monthly collection of mosquitoes indoors using CDC-light traps (CDC-LTs) and pyrethrum spray catches (PSC), and outdoors using only CDC-LTs for 12 months. Mosquitoes were identified using morphological taxonomic keys. Specimens belonging to the Anopheles gambiae complex and Anophel...
Zoonoses, 2022
Emerging infectious diseases are one of the greatest public health challenges. Approximately thre... more Emerging infectious diseases are one of the greatest public health challenges. Approximately three-quarters of these diseases are of animal origin. These diseases include classical zoonoses maintained in humans only via transmission from other vertebrates (e.g., rabies) and those initiated by a successful one-off zoonotic event (host-switch) in conjunction with efficient human-to-human transmission (e.g., H1N1 influenza). Here, we provide a systematic review, in conjunction with a meta-analysis and spatial risk modeling, to identify the major characteristics of past epidemics of animal origin and predict areas with high future disease emergence risk. Countermeasures against future pandemics of animal origin must focus on several key mechanisms. First, the eco-epidemiological contexts favoring spillover events must be clearly establish. Second, pathogen surveillance must be scaled up, particularly in taxa and/or eco-geographic areas with high disease emergence risk. Third, successful...
Additional file 2. STROBE Statement
Additional file 1. Topics of the analysis with corresponding survey questions
Malaria Journal
Background Countries in the southern Africa region have set targets for malaria elimination betwe... more Background Countries in the southern Africa region have set targets for malaria elimination between 2020 and 2030. Malaria vector control is among the key strategies being implemented to achieve this goal. This paper critically reviews published entomological research over the past six decades in three frontline malaria elimination countries namely, Botswana Eswatini and Namibia, and three second-line malaria elimination countries including Mozambique, Zambia, and Zimbabwe. The objective of the review is to assess the current knowledge and highlight gaps that need further research attention to strengthen evidence-based decision-making toward malaria elimination. Methods Publications were searched on the PubMed engine using search terms: “(malaria vector control OR vector control OR malaria vector*) AND (Botswana OR Swaziland OR Eswatini OR Zambia OR Zimbabwe OR Mozambique)”. Opinions, perspectives, reports, commentaries, retrospective analysis on secondary data protocols, policy bri...
Malaria Journal, 2014
Background: Anti-malarial drug resistance continues to be a leading threat to ongoing malaria con... more Background: Anti-malarial drug resistance continues to be a leading threat to ongoing malaria control efforts and calls for continued monitoring of the efficacy of these drugs in order to inform national anti-malarial drug policy decision-making. This study assessed the therapeutic efficacy and safety of artemether-lumefantrine (AL)(Coartem®) for the treatment of uncomplicated Plasmodium falciparum malaria in two sentinel high malaria transmission districts in the Eastern Province of Zambia in persons aged six months and above, excluding women aged 12 to 18 years. Methods: This was an observational cohort of 176 symptomatic patients diagnosed with uncomplicated Plasmodium falciparum mono-infection. A World Health Organization (WHO)-standardized 28-day assessment protocol was used to assess clinical and parasitological responses to directly observed AL treatment of uncomplicated malaria. DNA polymerase chain reaction (PCR) analysis for molecular markers of AL resistance was conducted on positive blood samples and differentiated recrudescence from re-infections of the malaria parasites. Results: All patients (CI 97.6-100) had adequate clinical and parasitological responses to treatment with AL. At the time of enrolment, mean slide positivity among study participants was 71.8% and 55.2% in Katete and Chipata, respectively. From a mean parasite density of 55,087, 98% of the study participants presented with zero parasitaemia by day 3 of the study. Fever clearance occurred within 24 hours of treatment with AL. However mean parasite density declines were most dramatic in participants in the older age. No adverse reactions to AL treatment were observed during the study. Conclusion: AL remains a safe and efficacious drug for the treatment of uncomplicated Plasmodium falciparum malaria in Zambia, endemic for malaria, with some provinces experiencing high transmission intensity. However, the delayed parasite clearance in younger patients calls for further sentinel and periodical monitoring of AL efficacy in different areas of the country.
Malaria Journal, 2020
Botswana has in the recent past 10 years made tremendous progress in the control of malaria and t... more Botswana has in the recent past 10 years made tremendous progress in the control of malaria and this informed re-orientation from malaria control to malaria elimination by the year 2020. This progress is attributed to improved case management, and scale-up of key vector control interventions; indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, insecticide resistance, outdoor biting and resting, and predisposing human behaviour, such as staying outdoors or sleeping outdoors without the use of protective measures, pose a challenge to the realization of the full impact of LLINs and IRS. This, together with the paucity of entomological data, inadequate resources and weak community participation for vector control programme implementation delayed attainment of Botswana’s goal of malaria elimination. Also, the Botswana National Malaria Programme (NMP) experiences the lack of intersectoral collaborations and operational research for evidence-based decision m...
American Medical Journal, 2013
Malaria remains a serious global public health problem and a leading cause of morbidity and morta... more Malaria remains a serious global public health problem and a leading cause of morbidity and mortality in sub Saharan Africa. In Zambia the disease is endemic with stable transmission, accounting for 40% of all outpatient attendances and is responsible for 20% deaths among children under five. Scaling up of scientifically proven high impact preventive, curative and supportive interventions and deploying the three-ones strategy: one coordinating mechanism; one implementation plan and one monitoring plan which is key for increased and successful publicprivate sector partner coordination, strengthening and mobilization. There has been marked impact in the reduction of the annual number of malaria deaths by over 60% and malaria cases by 66% (2000-2008), underfive malaria deaths by 41% (2006-2008), parasite prevalence among children under five from 22 to16% in 2010 and severe anemia rates in children by 56% (2006-2010). Intermittent presumptive treatment in pregnancy uptake has reached the RBM target at 86%. With these achievements, the country has surpassed targets set by: (i) the Abuja Declaration and (ii) the RBM of reducing the global malaria burden by 50% by 2010. The achievements can be attributed to increased advocacy, communication and behaviour change, efficient partnership coordination including strong community engagement, increased financial resources and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. Maintaining the momentum and the gains is critical as the programme strives to achieve universal coverage of evidence-based and proven interventions. The country offers some unique models and experiences that could really benefit other programmes in the region. Community-level integrated entomological and active case surveillance, prompt effective treatment and sustained high levels of contemporary malaria prevention tools is pivotal to the long-term success of malaria control and future malaria elimination. However, there is great need for sustained, predictable, regular resources and broadening the partnership base. To ensure sustainability, Government needs to remain on the driving seat and committed to malaria control in terms of funding.
Journal of Public Health and Epidemiology, 2012
Unprecedented increased mosquito bites were observed in urban and peri-urban areas of Lusaka Dist... more Unprecedented increased mosquito bites were observed in urban and peri-urban areas of Lusaka District and there was a perceived increase in malaria which necessitated a study in 2009 to determine the mosquito biting and malaria situation within urban and peri-urban settings. We analysed water bodies as sources of mosquito larvae (vegetable gardens, sewerage maturation ponds and foot paths) and, weather factors for possible effects on mosquito densities, species distribution and reviewed laboratory confirmed malaria cases and interventions implemented in the previous five years from 2009. We collected high densities of Culex quinquefasciatus mosquito larvae (mean; 250 per scoop) from sewerage maturation ponds overgrown with water hyacinth-an aquatic vegetation and collected large numbers of adult Cx. quinquefasciatus indoor (mean: 14.2, range: 2.8 to 34 per room) and up to 2,000 Cx. quinquefasciatus outdoor in one open structure. However, we did not find adult Anopheles in any of these collections but we found Anopheles larvae along a footpath in one peri-urban location. There was no evidence of increased malaria cases despite reported increased mosquito biting but a districtwide and nationwide decline in malaria trends. A combination of factors; human and environmental, created suitable micro-habitats that increased densities of the Culex mosquito but not malaria vector species within urban and peri-urban settings. An intensified surveillance, monitoring and evaluation measure is vital to understanding malaria situation and delivering effective malaria interventions in different epidemiological settings.
Emerging Infectious Diseases, 2016
Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their ... more Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their control is reliant mainly on the use of chemical insecticides. Only a few classes of insecticides are available for public health use, and the increased spread of insecticide resistance is a major threat to sustainable disease control. The primary strategy for mitigating the detrimental effects of insecticide resistance is the development of an insecticide resistance management plan. However, few examples exist to show how to implement such plans programmatically. We describe the formulation and implementation of a resistance management plan for mosquito vectors of human disease in Zambia. We also discuss challenges, steps taken to address the challenges, and directions for the future.
Parasites & Vectors, 2016
Background: Botswana significantly reduced its malaria burden between 2000 and 2012. Incidence dr... more Background: Botswana significantly reduced its malaria burden between 2000 and 2012. Incidence dropped from 0.99 to 0.01 % and deaths attributed to malaria declined from 12 to 3. The country initiated elimination strategies in October 2012. We examine the progress and challenges during implementation and identify future needs for a successful program in Botswana. Methods: A national, rapid notification and response strategy was developed. Cases detected through the routine passive surveillance system at health facilities were intended to initiate screening of contacts around a positive case during follow up. Positive cases were reported to district health management teams to activate district rapid response teams (DRRT). The health facility and the DRRT were to investigate the cases, and screen household members within 100 m of case households within 48 h of notification using rapid diagnostic tests (RDT) and microscopy. Positive malaria cases detected in health facilities were used for spatial analysis. Results: There were 1808 malaria cases recorded in Botswana during 26 months from October, 2012 to December, 2014. Males were more frequently infected (59 %) than females. Most cases (60 %) were reported from Okavango district which experienced an outbreak in 2013 and 2014. Among the factors creating challenges for malaria eradication, only 1148 cases (63.5 %) were captured by the required standardized notification forms. In total, 1080 notified cases were diagnosed by RDT. Of the positive malaria cases, only 227 (12.6 %) were monitored at the household level. One hundred (8.7 %) cases were associated with national or transnational movement of patients. Local movements of infected individuals within Botswana accounted for 31 cases while 69 (6.01 %) cases were imported from other countries. Screening individuals in and around index households identified 37 additional, asymptomatic infections. Oscillating, sporadic and new malaria hot-spots were detected in Botswana during the study period. Conclusion: Botswana's experience shows some of the practical challenges of elimination efforts. Among them are the substantial movements of human infections within and among countries, and the persistence of asymptomatic reservoir infections. Programmatically, challenges include improving the speed of communicating and improving the thoroughness when responding to newly identified cases. The country needs further sustainable interventions to target infections if it is to successfully achieve its elimination goal.
Malaria journal, Jan 2, 2015
Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spray... more Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, malaria-endemic countries, including Eritrea, have struggled to effectively deploy these tools due technical and operational challenges, including the selection of insecticide resistance in malaria vectors. This manuscript outlines the processes undertaken in consolidating strategic planning and operational frameworks for vector control to expedite malaria elimination in Eritrea. The effort to strengthen strategic frameworks for vector control in Eritrea was the 'case' for this study. The integrated vector management (IVM) strategy was developed in 2010 but was not well executed, resulting in a rise in malaria transmission, prompting a process to redefine and relaunch the IVM strategy with integration of other vector borne diseases (VBDs) as the focus. The information sources for this study included all available data...
Malaria Journal, 2015
Background: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards ... more Background: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards malaria control with the view of transitioning from reduction of the disease burden to elimination. This paper reports on the level of achievement as highlighted by the follow-on, malaria-endemic area representative, survey that aimed to provide data and to assess progress on malaria indicators and parasite prevalence at household level across the country. Methods: In 2012, data were collected using a two-stage stratified cluster random sample of 1887 households in 96 clusters (villages in rural areas and census enumeration areas in urban centers) during a malaria indicator and prevalence survey in Eritrea. The survey determined parasite prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll-Back Malaria Monitoring and Evaluation Reference Group household and women's questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics. Results: The results of the survey showed that 90 % (95 % CI 89-91) of households owned at least one mosquito net. The proportion of the population with access to an insecticide-treated net (ITN) in their household was 55 % (95 % CI 54-56). The utilization of ITNs was 67 % (95 % CI 65-70) for children under 5 years and 60 % (95 % CI 58-63) for pregnant women (OR: 0. 73(95 % CI 0.62-0.85); P = 0.52). Only 28 % (95 % CI 26-30) of households were covered by indoor residual spraying (IRS) the previous year with significant heterogeneity by zoba (Debub 50 % (95 % CI 45-54) vs Gash Barka 32 % (95 % CI 28-36); OR = 0. 47 (95 % CI 0.36-0.61), P = 0.05). Malaria parasite prevalence was low; 1.1 % (95 % CI 0.9-1.3) in the general population and 1.4 % (95 % CI 1.0-2.0) in children under five and 0.7 % (95 % CI 0.4-1.1) among women aged 15-49 years. Only 19 % (95 % CI 15-26) of children under five had fever in the 2 weeks preceding the survey, with 61 % (95 % CI 54.1-67.1) seeking treatment from a health facility. Data on knowledge levels show that 92 % reported that malaria is transmitted by mosquitoes, 92 % mentioned that the use of mosquito nets could prevent malaria, 47 % knew malaria prevention medication, 83 % cited fever as a sign and symptom of malaria, and 35 % had heard or seen malaria awareness messages. Conclusion: Notwithstanding confounders, the observed low malaria parasite prevalence could be associated with malaria intervention coverage, access and utilization as well as high and equitable knowledge levels in the population. This indicates that Eritrea is on the right track towards pre-elimination. However, technical and infrastructure capacity should be strengthened to facilitate implementation, surveillance, monitoring, and evaluation.
Malaria Journal, 2015
Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector... more Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi. Case description: The National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the 'case' for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases. Discussion: Malawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country. Conclusions: The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.
Geospatial Health, 2015
Malaria is an important health burden in Zambia with proper diagnosis remaining as one of the big... more Malaria is an important health burden in Zambia with proper diagnosis remaining as one of the biggest challenges. The need for reliable diagnostics is being addressed through the introduction of rapid diagnostic tests (RDTs). However, without sufficient laboratory amenities in many parts of the country, diagnosis often still relies on non-specific, clinical symptoms. In this study, geographical information systems were used to both visualize and analyze the spatial distribution and the risk factors related to the diagnosis of malaria. The monthly reported, district-level number of malaria cases from January 2009 to December 2014 were collected from the National Malaria Control Center (NMCC). Spatial statistics were used to reveal cluster tendencies that were subsequently linked to possible risk factors, using a non-spatial regression model. Significant, spatio-temporal clusters of malaria were spotted while the introduction of RDTs made the number of clinically diagnosed malaria cas...
Asian Pacific journal of tropical biomedicine, 2014
To establish the appropriateness of malaria case management at health facility level in four dist... more To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. Out of 4 891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI 95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI 95 21.3.1-23.7) were not subjected to any malaria test. Of the 2 247 malaria cases reported...
ISRN Preventive Medicine, 2013
The Zambian national malaria control programme has made great progress in the fight against Malar... more The Zambian national malaria control programme has made great progress in the fight against Malaria. The country has solid, consistent, and coordinated policies, strategies, and guidelines for malaria control, with government prioritizing malaria in both the National Health Strategic Plan and the National Development Plan. This has translated into high coverage of proven and effective key preventive, curative, and supportive interventions with concomitant marked reduction in both malaria cases and deaths. The achievements attained can be attributed to increased advocacy, communication and behaviour changes, efficient partnership coordination including strong community engagement, increased financial resources, and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. The three-ones strategy has been key for increased and successful public-private sector partner coordination, strengthening, a...
Malaria Journal
Background The primary malaria vector-control interventions, indoor residual spraying and long-la... more Background The primary malaria vector-control interventions, indoor residual spraying and long-lasting insecticidal nets, are effective against indoor biting and resting mosquito species. Consequently, outdoor biting and resting malaria vectors might elude the primary interventions and sustain malaria transmission. Varied vector biting and resting behaviour calls for robust entomological surveillance. This study investigated the bionomics of malaria vectors in rural south-east Zambia, focusing on species composition, their resting and host-seeking behaviour and sporozoite infection rates. Methods The study was conducted in Nyimba District, Zambia. Randomly selected households served as sentinel houses for monthly collection of mosquitoes indoors using CDC-light traps (CDC-LTs) and pyrethrum spray catches (PSC), and outdoors using only CDC-LTs for 12 months. Mosquitoes were identified using morphological taxonomic keys. Specimens belonging to the Anopheles gambiae complex and Anophel...
Zoonoses, 2022
Emerging infectious diseases are one of the greatest public health challenges. Approximately thre... more Emerging infectious diseases are one of the greatest public health challenges. Approximately three-quarters of these diseases are of animal origin. These diseases include classical zoonoses maintained in humans only via transmission from other vertebrates (e.g., rabies) and those initiated by a successful one-off zoonotic event (host-switch) in conjunction with efficient human-to-human transmission (e.g., H1N1 influenza). Here, we provide a systematic review, in conjunction with a meta-analysis and spatial risk modeling, to identify the major characteristics of past epidemics of animal origin and predict areas with high future disease emergence risk. Countermeasures against future pandemics of animal origin must focus on several key mechanisms. First, the eco-epidemiological contexts favoring spillover events must be clearly establish. Second, pathogen surveillance must be scaled up, particularly in taxa and/or eco-geographic areas with high disease emergence risk. Third, successful...
Additional file 2. STROBE Statement
Additional file 1. Topics of the analysis with corresponding survey questions
Malaria Journal
Background Countries in the southern Africa region have set targets for malaria elimination betwe... more Background Countries in the southern Africa region have set targets for malaria elimination between 2020 and 2030. Malaria vector control is among the key strategies being implemented to achieve this goal. This paper critically reviews published entomological research over the past six decades in three frontline malaria elimination countries namely, Botswana Eswatini and Namibia, and three second-line malaria elimination countries including Mozambique, Zambia, and Zimbabwe. The objective of the review is to assess the current knowledge and highlight gaps that need further research attention to strengthen evidence-based decision-making toward malaria elimination. Methods Publications were searched on the PubMed engine using search terms: “(malaria vector control OR vector control OR malaria vector*) AND (Botswana OR Swaziland OR Eswatini OR Zambia OR Zimbabwe OR Mozambique)”. Opinions, perspectives, reports, commentaries, retrospective analysis on secondary data protocols, policy bri...
Malaria Journal, 2014
Background: Anti-malarial drug resistance continues to be a leading threat to ongoing malaria con... more Background: Anti-malarial drug resistance continues to be a leading threat to ongoing malaria control efforts and calls for continued monitoring of the efficacy of these drugs in order to inform national anti-malarial drug policy decision-making. This study assessed the therapeutic efficacy and safety of artemether-lumefantrine (AL)(Coartem®) for the treatment of uncomplicated Plasmodium falciparum malaria in two sentinel high malaria transmission districts in the Eastern Province of Zambia in persons aged six months and above, excluding women aged 12 to 18 years. Methods: This was an observational cohort of 176 symptomatic patients diagnosed with uncomplicated Plasmodium falciparum mono-infection. A World Health Organization (WHO)-standardized 28-day assessment protocol was used to assess clinical and parasitological responses to directly observed AL treatment of uncomplicated malaria. DNA polymerase chain reaction (PCR) analysis for molecular markers of AL resistance was conducted on positive blood samples and differentiated recrudescence from re-infections of the malaria parasites. Results: All patients (CI 97.6-100) had adequate clinical and parasitological responses to treatment with AL. At the time of enrolment, mean slide positivity among study participants was 71.8% and 55.2% in Katete and Chipata, respectively. From a mean parasite density of 55,087, 98% of the study participants presented with zero parasitaemia by day 3 of the study. Fever clearance occurred within 24 hours of treatment with AL. However mean parasite density declines were most dramatic in participants in the older age. No adverse reactions to AL treatment were observed during the study. Conclusion: AL remains a safe and efficacious drug for the treatment of uncomplicated Plasmodium falciparum malaria in Zambia, endemic for malaria, with some provinces experiencing high transmission intensity. However, the delayed parasite clearance in younger patients calls for further sentinel and periodical monitoring of AL efficacy in different areas of the country.
Malaria Journal, 2020
Botswana has in the recent past 10 years made tremendous progress in the control of malaria and t... more Botswana has in the recent past 10 years made tremendous progress in the control of malaria and this informed re-orientation from malaria control to malaria elimination by the year 2020. This progress is attributed to improved case management, and scale-up of key vector control interventions; indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, insecticide resistance, outdoor biting and resting, and predisposing human behaviour, such as staying outdoors or sleeping outdoors without the use of protective measures, pose a challenge to the realization of the full impact of LLINs and IRS. This, together with the paucity of entomological data, inadequate resources and weak community participation for vector control programme implementation delayed attainment of Botswana’s goal of malaria elimination. Also, the Botswana National Malaria Programme (NMP) experiences the lack of intersectoral collaborations and operational research for evidence-based decision m...
American Medical Journal, 2013
Malaria remains a serious global public health problem and a leading cause of morbidity and morta... more Malaria remains a serious global public health problem and a leading cause of morbidity and mortality in sub Saharan Africa. In Zambia the disease is endemic with stable transmission, accounting for 40% of all outpatient attendances and is responsible for 20% deaths among children under five. Scaling up of scientifically proven high impact preventive, curative and supportive interventions and deploying the three-ones strategy: one coordinating mechanism; one implementation plan and one monitoring plan which is key for increased and successful publicprivate sector partner coordination, strengthening and mobilization. There has been marked impact in the reduction of the annual number of malaria deaths by over 60% and malaria cases by 66% (2000-2008), underfive malaria deaths by 41% (2006-2008), parasite prevalence among children under five from 22 to16% in 2010 and severe anemia rates in children by 56% (2006-2010). Intermittent presumptive treatment in pregnancy uptake has reached the RBM target at 86%. With these achievements, the country has surpassed targets set by: (i) the Abuja Declaration and (ii) the RBM of reducing the global malaria burden by 50% by 2010. The achievements can be attributed to increased advocacy, communication and behaviour change, efficient partnership coordination including strong community engagement, increased financial resources and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. Maintaining the momentum and the gains is critical as the programme strives to achieve universal coverage of evidence-based and proven interventions. The country offers some unique models and experiences that could really benefit other programmes in the region. Community-level integrated entomological and active case surveillance, prompt effective treatment and sustained high levels of contemporary malaria prevention tools is pivotal to the long-term success of malaria control and future malaria elimination. However, there is great need for sustained, predictable, regular resources and broadening the partnership base. To ensure sustainability, Government needs to remain on the driving seat and committed to malaria control in terms of funding.
Journal of Public Health and Epidemiology, 2012
Unprecedented increased mosquito bites were observed in urban and peri-urban areas of Lusaka Dist... more Unprecedented increased mosquito bites were observed in urban and peri-urban areas of Lusaka District and there was a perceived increase in malaria which necessitated a study in 2009 to determine the mosquito biting and malaria situation within urban and peri-urban settings. We analysed water bodies as sources of mosquito larvae (vegetable gardens, sewerage maturation ponds and foot paths) and, weather factors for possible effects on mosquito densities, species distribution and reviewed laboratory confirmed malaria cases and interventions implemented in the previous five years from 2009. We collected high densities of Culex quinquefasciatus mosquito larvae (mean; 250 per scoop) from sewerage maturation ponds overgrown with water hyacinth-an aquatic vegetation and collected large numbers of adult Cx. quinquefasciatus indoor (mean: 14.2, range: 2.8 to 34 per room) and up to 2,000 Cx. quinquefasciatus outdoor in one open structure. However, we did not find adult Anopheles in any of these collections but we found Anopheles larvae along a footpath in one peri-urban location. There was no evidence of increased malaria cases despite reported increased mosquito biting but a districtwide and nationwide decline in malaria trends. A combination of factors; human and environmental, created suitable micro-habitats that increased densities of the Culex mosquito but not malaria vector species within urban and peri-urban settings. An intensified surveillance, monitoring and evaluation measure is vital to understanding malaria situation and delivering effective malaria interventions in different epidemiological settings.
Emerging Infectious Diseases, 2016
Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their ... more Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their control is reliant mainly on the use of chemical insecticides. Only a few classes of insecticides are available for public health use, and the increased spread of insecticide resistance is a major threat to sustainable disease control. The primary strategy for mitigating the detrimental effects of insecticide resistance is the development of an insecticide resistance management plan. However, few examples exist to show how to implement such plans programmatically. We describe the formulation and implementation of a resistance management plan for mosquito vectors of human disease in Zambia. We also discuss challenges, steps taken to address the challenges, and directions for the future.
Parasites & Vectors, 2016
Background: Botswana significantly reduced its malaria burden between 2000 and 2012. Incidence dr... more Background: Botswana significantly reduced its malaria burden between 2000 and 2012. Incidence dropped from 0.99 to 0.01 % and deaths attributed to malaria declined from 12 to 3. The country initiated elimination strategies in October 2012. We examine the progress and challenges during implementation and identify future needs for a successful program in Botswana. Methods: A national, rapid notification and response strategy was developed. Cases detected through the routine passive surveillance system at health facilities were intended to initiate screening of contacts around a positive case during follow up. Positive cases were reported to district health management teams to activate district rapid response teams (DRRT). The health facility and the DRRT were to investigate the cases, and screen household members within 100 m of case households within 48 h of notification using rapid diagnostic tests (RDT) and microscopy. Positive malaria cases detected in health facilities were used for spatial analysis. Results: There were 1808 malaria cases recorded in Botswana during 26 months from October, 2012 to December, 2014. Males were more frequently infected (59 %) than females. Most cases (60 %) were reported from Okavango district which experienced an outbreak in 2013 and 2014. Among the factors creating challenges for malaria eradication, only 1148 cases (63.5 %) were captured by the required standardized notification forms. In total, 1080 notified cases were diagnosed by RDT. Of the positive malaria cases, only 227 (12.6 %) were monitored at the household level. One hundred (8.7 %) cases were associated with national or transnational movement of patients. Local movements of infected individuals within Botswana accounted for 31 cases while 69 (6.01 %) cases were imported from other countries. Screening individuals in and around index households identified 37 additional, asymptomatic infections. Oscillating, sporadic and new malaria hot-spots were detected in Botswana during the study period. Conclusion: Botswana's experience shows some of the practical challenges of elimination efforts. Among them are the substantial movements of human infections within and among countries, and the persistence of asymptomatic reservoir infections. Programmatically, challenges include improving the speed of communicating and improving the thoroughness when responding to newly identified cases. The country needs further sustainable interventions to target infections if it is to successfully achieve its elimination goal.
Malaria journal, Jan 2, 2015
Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spray... more Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, malaria-endemic countries, including Eritrea, have struggled to effectively deploy these tools due technical and operational challenges, including the selection of insecticide resistance in malaria vectors. This manuscript outlines the processes undertaken in consolidating strategic planning and operational frameworks for vector control to expedite malaria elimination in Eritrea. The effort to strengthen strategic frameworks for vector control in Eritrea was the 'case' for this study. The integrated vector management (IVM) strategy was developed in 2010 but was not well executed, resulting in a rise in malaria transmission, prompting a process to redefine and relaunch the IVM strategy with integration of other vector borne diseases (VBDs) as the focus. The information sources for this study included all available data...
Malaria Journal, 2015
Background: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards ... more Background: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards malaria control with the view of transitioning from reduction of the disease burden to elimination. This paper reports on the level of achievement as highlighted by the follow-on, malaria-endemic area representative, survey that aimed to provide data and to assess progress on malaria indicators and parasite prevalence at household level across the country. Methods: In 2012, data were collected using a two-stage stratified cluster random sample of 1887 households in 96 clusters (villages in rural areas and census enumeration areas in urban centers) during a malaria indicator and prevalence survey in Eritrea. The survey determined parasite prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll-Back Malaria Monitoring and Evaluation Reference Group household and women's questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics. Results: The results of the survey showed that 90 % (95 % CI 89-91) of households owned at least one mosquito net. The proportion of the population with access to an insecticide-treated net (ITN) in their household was 55 % (95 % CI 54-56). The utilization of ITNs was 67 % (95 % CI 65-70) for children under 5 years and 60 % (95 % CI 58-63) for pregnant women (OR: 0. 73(95 % CI 0.62-0.85); P = 0.52). Only 28 % (95 % CI 26-30) of households were covered by indoor residual spraying (IRS) the previous year with significant heterogeneity by zoba (Debub 50 % (95 % CI 45-54) vs Gash Barka 32 % (95 % CI 28-36); OR = 0. 47 (95 % CI 0.36-0.61), P = 0.05). Malaria parasite prevalence was low; 1.1 % (95 % CI 0.9-1.3) in the general population and 1.4 % (95 % CI 1.0-2.0) in children under five and 0.7 % (95 % CI 0.4-1.1) among women aged 15-49 years. Only 19 % (95 % CI 15-26) of children under five had fever in the 2 weeks preceding the survey, with 61 % (95 % CI 54.1-67.1) seeking treatment from a health facility. Data on knowledge levels show that 92 % reported that malaria is transmitted by mosquitoes, 92 % mentioned that the use of mosquito nets could prevent malaria, 47 % knew malaria prevention medication, 83 % cited fever as a sign and symptom of malaria, and 35 % had heard or seen malaria awareness messages. Conclusion: Notwithstanding confounders, the observed low malaria parasite prevalence could be associated with malaria intervention coverage, access and utilization as well as high and equitable knowledge levels in the population. This indicates that Eritrea is on the right track towards pre-elimination. However, technical and infrastructure capacity should be strengthened to facilitate implementation, surveillance, monitoring, and evaluation.
Malaria Journal, 2015
Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector... more Background: In the past decade, there has been rapid scale-up of insecticide-based malaria vector control in the context of integrated vector management (IVM) according to World Health Organization recommendations. Endemic countries have deployed indoor residual spraying (IRS) and long-lasting insecticidal nets as hallmark vector control interventions. This paper discusses the successes and continued challenges and the way forward for the IRS programme in Malawi. Case description: The National Malaria Control Programme in Malawi, with its efforts to implement an integrated approach to malaria vector control, was the 'case' for this study. Information sources included all available data and accessible archived documentary records on IRS in Malawi. A methodical assessment of published and unpublished documents was conducted via a literature search of online electronic databases. Discussion: Malawi has implemented IRS as the main malaria transmission-reducing intervention. However, pyrethroid and carbamate resistance in malaria vectors has been detected extensively across the country and has adversely affected the IRS programme. Additionally, IRS activities have been characterized by substantial inherent logistical and technical challenges culminating into missed targets. As a consequence, programmatic IRS operations have been scaled down from seven districts in 2010 to only one district in 2014. The future of the IRS programme in Malawi is uncertain due to limited funding, high cost of alternative insecticides and technical resource challenges being experienced in the country. Conclusions: The availability of a long-lasting formulation of the organophosphate pirimiphos-methyl makes the re-introduction of IRS a possibility and may be a useful approach for the management of pyrethroid resistance. Implementing the IVM strategy, advocating for sustainable domestic funding, including developing an insecticide resistance monitoring and management plan and vector surveillance guidelines will be pivotal in steering entomologic monitoring and future vector control activities in Malawi.
Geospatial Health, 2015
Malaria is an important health burden in Zambia with proper diagnosis remaining as one of the big... more Malaria is an important health burden in Zambia with proper diagnosis remaining as one of the biggest challenges. The need for reliable diagnostics is being addressed through the introduction of rapid diagnostic tests (RDTs). However, without sufficient laboratory amenities in many parts of the country, diagnosis often still relies on non-specific, clinical symptoms. In this study, geographical information systems were used to both visualize and analyze the spatial distribution and the risk factors related to the diagnosis of malaria. The monthly reported, district-level number of malaria cases from January 2009 to December 2014 were collected from the National Malaria Control Center (NMCC). Spatial statistics were used to reveal cluster tendencies that were subsequently linked to possible risk factors, using a non-spatial regression model. Significant, spatio-temporal clusters of malaria were spotted while the introduction of RDTs made the number of clinically diagnosed malaria cas...
Asian Pacific journal of tropical biomedicine, 2014
To establish the appropriateness of malaria case management at health facility level in four dist... more To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. Out of 4 891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI 95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI 95 21.3.1-23.7) were not subjected to any malaria test. Of the 2 247 malaria cases reported...
ISRN Preventive Medicine, 2013
The Zambian national malaria control programme has made great progress in the fight against Malar... more The Zambian national malaria control programme has made great progress in the fight against Malaria. The country has solid, consistent, and coordinated policies, strategies, and guidelines for malaria control, with government prioritizing malaria in both the National Health Strategic Plan and the National Development Plan. This has translated into high coverage of proven and effective key preventive, curative, and supportive interventions with concomitant marked reduction in both malaria cases and deaths. The achievements attained can be attributed to increased advocacy, communication and behaviour changes, efficient partnership coordination including strong community engagement, increased financial resources, and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. The three-ones strategy has been key for increased and successful public-private sector partner coordination, strengthening, a...