Malaria elimination in Zanzibar - a pilot project for sub-Saharan Africa
2010 - 2013
Plasmodium falciparum malaria remains a major cause of death among small children in sub-Saharan Africa and is therefore a key challenge to fulfill the UN Millennium Development Goals. The recent availability of efficacious combination treatments based on artemisinin-derivatives (ACTs) together with strengthened vector control measurements with long lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS) provide a promising opportunity to raise the ambition of malaria control to a new level. Zanzibar, which initiated deployment of ACT in 2003 and mass distribution of LLINs and annual IRS in 2006, has recently provided the first evidence from a previously high transmission area in Africa of marked reduction in P. falciparum parasite prevalences among children with fever from 40% to less than 1% (Bhattarai et al 2007). Based on these results the Zanzibar Ministry of Health and Social Welfare has officially decided to change their target from control to elimination of malaria on the Isles.
- To study if it is possible to eliminate malaria in Zanzibar
- To assess the public health impact of malaria elimination in Zanzibar
The first part of this project aims at assessing if the stage of elimination is achieved through the use of the above mentioned interventions. Moreover, we will study the public health impact of pre-elimination of malaria in terms of reduced child mortality. This will be done by the conduct of annual cross-sectional surveys including blood sampling (blood films for malaria microscopy) and interview questionnaires on use/uptake of malaria prevention (LLIN and IRS) together with monthly extraction of health facility records and vital statistics in two districts in Zanzibar, i.e. North A and Micheweni, respectively. To allow for comparison with previous data we will continue to use the same methodology for data collection as described by Bhattarai et al (2007).
The project is a joint venture between IHCAR and the Malaria Research Unit, Dept of Medicine Solna, Karolinska Institute and Zanzibar Malaria Control Programme.
Preliminary results indicate a further decline in community parasite prevalence as well as blood slide/rapid diagnostic test positivity rate at primary health care facilities of less than 1%, indicating that Zanzibar has reached a stage of malaria pre-elimination.