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ODAY, we start a five-day series of articles on malaria and the clear and present danger that it continues to pose to the communities we live in. Formidable as the menace of malaria is, its prevalence can be reduced if we all work together and mount a united front against the disease. Although several strategies exist to fight malaria, their f r a g m e n t e d implementation only offers temporary respite - merely leaving the real threat subdued until another opportunity to strike presents itself. When the dreaded mosquito strikes, the familiar symptoms manifest through fever, flu, headache, body pains, nausea, dryness of lips and bitterness in the mouth. However, with strict adherence to preventive measures and sticking to treatment, the disease can be kept at bay. This is especially true if the fight against malaria uses a multipronged strategy which incorporates effective prevention, control and treatment measures. For instance, it is risky for people to shun preventive measures merely on the assumption that there are no mosquitoes in their neighbourhood. Wi t h o r w i t h o u t mosquitoes, it is always safer to sleep under treated bed nets and have the house sprayed with insectide. At the slightest onset of malaria symptoms, it is advisable to do a blood test. I n - d o o r re s i d u a l spraying is another integral component in the fight against malaria, and those who go round doing this noble work must be assisted without let or hindrance. The overall theme in the stories we have carried today is that stand-alone antimalaria measures are ineffective and need to be reinforced through a more potent multifaceted strategy. Such a strategy encourages a win-win situation because it is a convergence of efforts at the community, Government and nongovernmental levels. Small as the mosquito may be, robust efforts are required to deal with the fatal consequences of its bite.
Getting ready By CHIMWEMWE MWALE
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FTER six years of carrying o u t s e a s o n a l in-door residual spraying, Lusaka-based Maybin Munsaka says he knows the challenges of the malaria-fighting work, but he also knows the rewards. He has learned getting in to spray the home of a “witch doctor” - who requires visitors to remove their shoes - isn’t easy. Mr Munsaka wears protective gear, including shoes while spraying. Once he sprays the home of the local traditional healer, though, getting into the neighbours’ homes becomes easier. Among the other challenges, he said: people saying they have sprayed their own chemicals, people reluctant to move their furniture and put away their kitchenware to prepare for the spraying, rumours that the spraying is ineffective and that it brings bedbugs. The training he receives every year before spraying - and rainy season - begins prepares him to answer most of those objections, he said. The spraying has been proven effective, and while it doesn’t eliminate all insects other than mosquitoes, it doesn’t bring them either. And with advance notice, he can talk people into preparing their homes to rid themselves of a potentially deadly nuisance. Other challenges remain, he said: increasing numbers of people recently migrated from the countryside to Lusaka, who don’t speak Bemba, Nyanja, or E n g l i s h , m a k i n g communication difficult.
MUNSAKA. Then there was the woman who told him to avoid one room. When he bumped the door in the midst of his spraying though, it opened, confronting him with a large coiled snake and a collection of severed animal tails. He left without looking back, he said. As Munsaka awaits the arrival of protective gear to begin another season of spraying, none of these challenges have turned him away from his annual rounds, which he said give him satisfaction.
“I feel I am doing something for my country,” he added. He is part of his country’s five-year strategic plan, a multiattack approach, that from 2006 to 2011 is intended to reduce Malaria rates incidence here by 75 per cent. It is a plan that includes indoor spraying, insecticide treated net distribution and stopping mosquitoes where they breed by unblocking drains where standing water collects, said National Malaria Control Centre Chief Entomologist Emmanuel Chanda.
He says the in-door residual spraying and mosquito net distribution which started in 2006 is currently being implemented in 36 districts from the initial five districts. “We will next year increase to 54 districts and continue scaling up until we cover all the 72 districts in the country. In all these districts, we work with provincial and district health officers. At district level we ensure that community members are involved by engaging them as sprayers under the supervision of technologists for a working wage,” he said. He says the engagement of community members is aimed at ensuring members of a particular community take an active role in implementing and accepting the prevention programmes. Mr Chanda says the NMCC has so far distributed three insecticide treated mosquito nets per household in six provinces saying plans are under way to cover the remaining provinces - Copperbelt, Central and Lusaka. The Ministry of Health has so far distributed over six million insecticide treated mosquito nets in most parts of the country since 2005, according to NMCC spokeswoman Pauline Wamulume. In addition, Mrs Wamulume says the NMCC has involved local authorities, traditional leaders, musicians, community radio stations and the clergy, among others, in its efforts to spread malaria prevention messages and increase community involvement. “We want religious leaders to get involved and include malaria messages in their sermons. We have also oriented all the 27 chiefs from the House of Chiefs, a number of musicians have produced songs on malaria because we want malaria awareness and interventions to be part of everyday life,” said Mrs Wamulume. She says all pregnant women visiting the antenatal clinics in the country are currently being given Fansidar to prevent malaria.
She says the daily use of mosquito nets is also being encouraged despite other interventions such as spraying because sometimes mosquitoes can move from unsprayed areas to infect people in sprayed areas before contact with sprayed walls. Mrs Wamulume says the NMCC has so far received reports from members of the public that some mosquito breeding grounds are not targeted for spraying hence the need to use the insecticide treated mosquito net to effectively combat malaria.
Once ‘bitten’... Women relive malaria bouts
By PANIC CHILUFYA
Susceptible woman takes precautions
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CHANDA. “It is important to have the entire community sprayed so that mosquitoes are not harboured in unsprayed structures. We, however, also ensure that eligible structures are sprayed so that mosquitoes are not harboured in unsprayed structures. Appropriate chemicals are applied depending on the surface of the wall structure. For plastered smooth w alls we use Fendona because it lasts while DDT lasts longer on rough surfaces,” she said She says the criteria for implementation of the malaria interventions in various parts of the country is depended on the incident rate of malaria and storage facilities saying Chilubi Island in Northern Province and Katete in Eastern Province are among the highest is the country. While malaria remains a killer disease and efforts to fight it have continued, the question still remains whether the female anopheles mosquito that carries the malaria parasite remains part of our household.
It takes more than nets to beat malaria
Once she is diagnosed with the malaria parasites, she begins treatment with Coartem, which involves taking tablets over three days, as well as a painkiller like Panadol or Brufen for headache and other pains. In the past, she has been prescribed with Fansidar, another malaria treatment course, but it has not worked for her and that is the reason she prefers Coartem, she says. “I also tried Quinine once; it is a good drug, but personally, I had bad side-effects when I took it,” Mwango confides. “There was constant ringing in my ears. It affected my appetite and the taste of food in my mouth.” Once she begins the Coartem treatment, she says, she begins to feel better within two days. She said Coartem is user-friendly in that she can continue to work while taking it. With quinine, she said, she would be kept home by the side effects. She said she ensures that she and her family always sleep under insecticide-treated mosquito nets as well as having their house and its surroundings sprayed with insecticide.
if not properly managed,” Mwango says. Mwango, a married mother of three in her late 30s, says she always insists on sleeping under a mosquito net because she is “very” prone to malaria attacks - almost every month. For some reason, she is the only member of the family who is prone to malaria. As a medical worker, she says, she is able to identify the symptoms of malaria, which normally include fever, chills, joint pains, nausea, headache, backache, heaviness of the neck and bitterness in the mouth. When she notices the symptoms, she immediately goes for a malaria blood test at the clinic’s laboratory, she adds. “Sometimes the blood slide indicates the presence of malaria parasites in her blood, but other times, despite presenting symptoms, the results have been negative,” Mwango says. Sometimes a person may have the malaria parasites in the body, hence the symptoms, but the parasites will not be detected by a blood slide because they are still lodged in the liver, she explains.
BEDTIME in my home is always a challenge” says Mwango Phiri with a chuckle. Mwango, a nurse at one of the District Health Management Team clinics in Lusaka, explains that her husband does not like sleeping under a mosquito net as he finds it stifling, while she will not sleep without one because she knows her susceptibility to malaria. “I am aware that it is a killer,
JUDY Malambo (centre) with Nicholas Malawo (right) and Natasha Mwila (left). - Picture by MULENGA CHILUFYA.
Gatherings lead to illness... Quick action leads to recovery
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UDY Malambo, a 40-yearold businesswoman of Libala Township, who was just recuperating from a malaria bout, said she initially thought she had flu. Then, a cough, fever, chest pains and headache followed. Her daughter, S i n d y, a l s o s t a r t e d complaining of feeling unwell at the same time. The following day, Judy decided to go to St George’s Clinic, a private healthcare facility in Lusaka, where she had malaria parasite tests using blood and urine. The urine test was negative, but the presence of the malaria parasites in her blood was detected, and her temperature was about 38.5
degrees Celsius. She was immediately given an antibiotic, Brufen, and Arinate, an anti-malaria drug. “The following day, I started feeling better. Although I still have no appetite, I force myself
cannot take medicines on an empty stomach. On preventive measures, Judy said although her home does not have mosquitoes, she now sleeps under a mosquito net and will ensure that she takes anti-malaria tablets as well as having her home sprayed with insecticide. She believes she could have contracted the malaria from church because on Thursday and Sunday evenings, she attends church activities where she often gets bitten by mosquitoes, but adds she may have gotten it attending other public gatherings – including funerals.
She believes she could have contracted the malaria from church.
COMBINED efforts to distribute insecticide treated nets have led to much of the country having from 60 to at least 81 per cent of households in most districts with three nets each. This map, however, does not reflect coordination of other efforts: including in-door residual spraying and accessible treatment.
How much do you know about the mosquito?
By CHARLES CHISALA
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ANY of you must have had an encounter with this tiny but formidable foe. An average mosquito weighs between 2 and 2.5 milligrammes, but its persistence is phenomenal, and its capacity to annoy unmatched. A bite, or the mere buzz of
WHILE the country has seen significant declines in deaths of children aged under five, not all of those declines depended on nets alone. At the same time, some areas where net distribution has been successful have not seen corresponding declines in child deaths.
its wings can trigger a furious round of selfslapping and swatting in the air, with an accompanying barrage of curses. While there are more than 2,700 known species of mosquitoes, and more are yet to be discovered, the main insect vector for malaria in sub-Saharan Africa is the Anopheles mosquito.
The mosquito is said to be responsible for one million human deaths in Africa, and 50,000 in Zambia each year A diet of blood – for females only: When the mosquito bites, it injects chemicals into your body to prevent its prize, your blood, from clotting and to reduce pain. It is these chemicals that cause the
irritation associated with the mosquito bite. Only female mosquitoes feed on blood. Male mosquitoes feed on plant juices. The female mosquito drinks about five millionths of a litre of blood in one serving. The female mosquito ingests the malaria parasite when she takes a blood meal from a person
infected at least three to ten days earlier, and transmits it to other people, after a period of development. Mosquitoes do not transmit HIV. (Sources: Abujah Declaration on roll-back malaria in Africa, April, 2000, United States Department of Agriculture, World Health Organisation)
to eat and take plenty of fluids because although the Arinate dosage was only for three days, I am still taking the antibiotic and painkiller,” a weak looking Judy explained. She added that a patient
Zambia Daily Mail
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ODAY, we publish stories on the success of the Konkola Copper Mines (KCM) malaria control programme in the Copperbelt town of Chingola, as well as a story on the benefits of public, private and nonprofit partnerships in Solwezi. The stories highlight both strategies and incentives that are part of beating this disease. After the mining company undertook a holistic approach that involved indoor residual spraying, the distribution of insecticidetreated mosquito nets, parasite control and community-based advocacy, the community surrounding the company has seen no deaths from malaria for the last five years - from 16 deaths in a population of 1,000 for Chililabombwe, and seven in a population of 1,000 for Chingola in the year 2000. This achievement should be commended, especially as malaria has been the leading cause of death and a leading contributor to economic hardship in Zambia for many years. Overall, the country has recorded notable progress towards the eradication of the tropical disease, and these strides have not gone unnoticed by the international community. It is gratifying that the private sector has been taking a keen interest in the nation’s fight against malaria, and we would like to encourage those who are still undecided to join the cause. In the case of KCM, the company has seen the benefits of its eight-year malaria control programme, as Dr Mieke Mulenga, medical services manager, has attested in one of the stories we are carrying today. KCM is not the only company to see the economic benefit to tackling a disease that undermines its workforce. Agricultural producers have long seen the benefit of making sure workers’ quarters are sprayed to kill mosquitoes. They are doing the right thing, and it also makes good business sense. But the message implied in these activities should not be lost on any of us. Creating a malaria-free Zambia is not only a right and humane goal, but one that is critical to the development of this country. Companies will have nothing to lose, but everything to gain, by investing in the protection of their workers from malaria. By protecting their workforces from this potential killer, they will be protecting their investment. By the same token, each of us w h o p l a y s a ro l e – i n c o n t ro l l i n g m o s q u i t o e s , a v o i d i n g e x p o s u re , a n d managing the disease properly and promptly when it strikes will be playing a role in contributing towards building a stronger and more prosperous nation. KCM has shown that it is possible to reduce the number of deaths in every 1,000 people to zero, and with the participation of the corporate world, households, communities and religious bodies, Zambia could be on the road to achieving the status of a malaria-free country by 2015. The benefits of that are obvious.
Monday October 19, 2009l
KCM ‘mines’malaria out of Copperbelt towns Mosquito faces extinction By CHARLES CHISALA ANY Zambians are familiar with the sight and buzz of mosquitoes, for there are swarms of them in most residential areas. However, the insect has become an endangered species in Chingola and Chililabombwe, where Konkola Copper Mines (KCM) has been carrying out intensive annual in-door residual spraying under the Malaria Control Programme to protect its employees and their families from the disease. This became clear when a team from the Ndola-based Tropical Diseases Research Centre, one of the partners in the programme, travelled to Chingola to collect mosquitoes for research, according to KCM zonal manager for public health and malaria control Benson Chingwele. “We sent out our teams of spray operators to capture mosquitoes, but each day, they came back empty-handed as they could not find any. We had to elicit the help of residents, and we only received one mosquito from the outskirts of the town, after an intense two-week hunt,” Mr Chingwele said.
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Solwezi turns heat on malaria
MALARIA cases are on the decline on the Copperbelt.
Right forces, ammo deployed against malaria By CHARLES CHISALA LAUDINA Mutuna, occupant of house number 9 Luangwa Street in Chingola’s low-cost Nchanga North Township, stands outside her home surrounded by three healthy-looking children to welcome her visitors. She is the head of a household of seven, including three children aged below 12 years. Keeping them all healthy could be a full-time job in itself, but one, she said, that has gotten easier lately. “We have not had any illness caused by malaria since November last year, when our house was sprayed by people from KCM,” she said. “This year, we have seen only three mosquitoes, outside the house.” After seeing for herself the benefits of in-door residual spraying, Ms Mutuna resolved to help other families see the importance of having their homes sprayed as well. So, she joined the KCM Malaria Control Programme by training as a community educator in 2006. “I’m one of those who have been going round, door-to-door, explaining to people why it is important to allow KCM to spray their homes. At first they used to refuse, but they are now gladly allowing spraying teams to do their
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work because they have seen the benefits,” Ms Mutuna said. Chewe Kansankala, of house number 42 Fourth Street in highcost Nchanga South Township, echoes her support. “Before they sprayed,” he said, “we used to have a lot of mosquitoes. But it takes months to see just one now.” The two families are beneficiaries of the KCM Malaria Control Programme, which has drastically reduced the cases of the disease in the company’s operation sites. KCM Malaria Control programme manager Paul Banda said as a result of the intervention, the company managed to maintain malaria deaths at zero for the last five years, from 16 deaths in a population of 1,000 for Chililabombwe, and seven in a population of 1,000 for Chingola in the year 2000. KCM has been using multiple strategies of in-door residual spraying, insecticide-treated bed nets, parasite control and grassroots advocacy. And the first step was to gather as much intelligence about the enemy as possible before striking. This operation began with a mobilisation of the community. SURVEY Mr Banda said before the actual spraying began, parasite prevalence as well as knowledge, attitudes and practices surveys
MALARIA control sprayer Mwema Kabambi.
were to be conducted each year to determine the communities’ perception of malaria, knowledge about its transmission and use of protective measures. KCM zonal manager for public health and malaria control Benson Chingwele explained that targeted areas were staked out with a 10-kilometre radius in Chililabombwe, Chingola and Nampundwe, west of Lusaka. Nurses were trained and sent into these areas to take random blood samples from people. A total of 200 households were covered, with 106 people being tested for the malaria parasites using a rapid malaria test and blood slides. Each of these teams comprised equal numbers of nurses from KCM and the government to create harmony. “Blood specimens were collected after obtaining written consent from programme participants. If, during the survey, someone was found positive, they were immediately put on treatment or referred to hospital. This contributed to wide acceptance within the community as the treatment served as an incentive to the locals,” Mr Chingwele said. He said the Ndola-based Tropical Diseases Research Centre (TDRC) also carried out a survey on the types of malaria vector (mosquito) commonly found in the programme areas, and their susceptibility to the insecticide to be used in the spraying. IN-DOOR RESIDUAL SPRAYING After the parasite survey had been completed, the wheels of the in-door residual spraying drive were cranked into motion. Mr Chingwele recalled that the campaign started with the recruitment and training of spray operators, who would serve as the foot soldiers. “We recruited 73 spray operators from within the community to ensure acceptance, and they underwent training for 21 days,” he said. According to the latest report compiled by Mr Banda, the spraying campaign using residual insecticides was done from midOctober to December 2008, just before the peak transmission
period for malaria (JanuaryFebruary). The spraying covered the same areas where the survey had been conducted - Chingola, Chililabombwe and later extended to Nampundwe, a rural community west of Lusaka. Selected houses in Kitwe and Kalulushi were also sprayed. Mr Chingwele said months after the spraying, data revealed inspiring results. “When we later did another survey, we found that malaria cases had come down in all the areas we had sprayed,” he said. Mr Banda concurs with him. He said, “The results were quite encouraging. There was a 71 per cent decrease in malaria cases from January 2008 to December 2008 from 6,522 cases in the year 2000 to 240 in 2008.” To ensure credibility of information, KCM medical institutions – hospitals and clinics – only report proven (blood test) cases as malaria cases and the public health department follows up all the cases to establish the source of infection. LARVICIDING Another strategy was the systematic destruction of mosquito larvae, which involved the spraying of open water bodies on proven mosquito breeding sites, identified and mapped out by an entomologist from the Malaria Research Council of South Africa. This was reinforced with continuous traditional environmental control measures such as the drainage of dambos and eradication of undergrowth and reeds in the vicinity of water bodies. Mr Chingwele said after the spraying was completed, the spray operators were deployed to identify ‘hot spots’ where there were mosquito pupa and larvae. “The spray operators would, apart from killing them, ‘harvest’ (capture) the larvae and take them to the programme office, where they were hatched and sent to South Africa for identification. CANALISATION To disrupt the mosquitoes’ breeding, teams were sent to open up dambos, pools, drains and marshlands to allow the water to
COMMUNITY educator Claudina Mutuna with her family at her Chingola home.
flow freely. Mosquitoes breed in stagnant water. This is known as canalisation. One of the spray operators, Mwema Kabambi, said he is proud to be associated with the programme. “When I heard that KCM is looking for people to work as spray operators, I said to myself, ‘this is my chance to kill those mosquitoes for the suffering they have caused to my family’. I am satisfied now because I have killed millions of them in the 2,000 houses I have sprayed. I am happy that I have contributed to the success of the malaria programme, and I would like to see the disease completely wiped out,” he said. DIAGNOSIS Besides the above measures, Mr Banda reported that medical management has also rendered a notable push to the programme. He said patients presenting at any of the mine health facilities with symptoms suggestive of malaria have their blood tested either by
the rapid test or blood slide. TREATMENT On treatment, both Mr Banda and Dr Mulenga said malaria cases are treated according to treatment protocols developed by KCM in line with national guidelines distributed by the Ministry of Health. NETS To consolidate the gains of the in-door residual spraying campaign and the other strategies, Mr Banda reported that 8, 500 insecticide-treated mosquito nets were distributed in the programme areas. This was also meant to help those who might travel to areas not reached by the programme, where parasite-carrying mosquitoes might be present. And running across all these strategies is an on-going information, education and communication (IEC) campaign involving the distribution of literature, public address system and community drama implemented through 125 community educators.
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OMBA Munengu is one of the 13,800 people of Solwezi district, NorthWestern Province, to have enjoyed the protection of an insecticidetreated bed net in recent years. “I am sure I will not visit the clinic for malaria treatment as I used to do in the past,” she said. As in many parts of the country, malaria has been a major cause of illness and death in this booming mining town. However, in the last three to four years, Solwezi and many other districts have made significant progress in the fight against the disease thanks to the nationwide scale-up of interventions. “We have managed to bring down the disease incidence from 498 in a population of 1,000 in 2001 to only 215 in the same population in 2008,” said Dr Harrison Nguni, the District Health Director. He said his team is working with the Health Communication Partnership (HCP) Zambia to build capacities of the neighbourhood health committees. Last year, he said, the district managed to protect 66,000 people from malaria using timely in-door residual spraying. Alongside the use of treated bed nets, the other main plank of Solwezi’s battle against malaria is the use of Artemisinin-based combination therapy commonly known as Coartem. “The effective policy of antimalaria treatment to ACTs, and the improved diagnostic capabilities have helped achieve good results,” Dr Nguni said. He said malaria task forces have also helped as partners in the collaborative effort understand their respective roles in the fight against the disease. Solwezi is one of the pilot districts that have trained community-based health volunteers with the help of the Churches Health Association of Zambia (CHAZ), Dr Nguni said. He said next year, the DHMT will network with Corridors of Hope
III, World Vision and several other partners with the aim of reaching everyone in the district. World Vision is already working, he said, in the Musele development area where it has donated goods and bicycles to help implement malaria programmes at the grassroots effectively. Lumwana Mine has also helped in reducing the disease incidence in the district by setting up a workers’ malaria fund, he said. Proceeds from the fund have been used to buy mosquito nets and chlorinate drinking water in the areas surrounding the mining area. The Lumwana Workers Fund also sponsors a drama group that goes round the villages to raise awareness on malaria, according to Dr. Nguni. In addition, Kansanshi Mine has been fumigating households in the Kansanshi Golf Estate, he said. Since 2006, malaria parasite prevalence in children has been reduced by 50 per cent, while twothirds of Solwezi’s households are now covered with at least one treated net or a recent in-door spraying. More than 80 per cent of pregnant women received at least one dose of preventive medicine and any pregnant woman seeking prenatal care at a public clinic can now receive an insecticide-treated net for herself and for any child under five living with her, Dr. Nguni said. Still, recently diagnosed patients underscored the need for continuing and comprehensive efforts. “I feel pain all over my body, especially in the joints,” says Josephine Mushala, an expectant mother who has been receiving malaria treatment from Solwezi General Hospital. Josephine, a civil servant, said she does not know how she contracted malaria, but adds that she however has never used a mosquito net to protect herself against mosquito bites. She attributed the presence of mosquitoes in Solwezi to the booming construction industry in this mining town. “A lot of people are digging holes in the ground to get soils to make building blocks. They are leaving holes in the ground and these become breeding grounds for mosquitoes,” she complained. Harrison Zaza, a father of three children, says his home only has one mosquito net, which he uses. Seated on a bench waiting for his wife and his three -year -old daughter to receive treatment following a diagnosis that has confirmed they both have malaria, Mr Zaza suggests that the Ministry of Health should consider buying each member of a family a mosquito net.