It kills more than 650,000 people each year. It’s the leading cause of death in children under five in sub-Saharan Africa. It disproportionately kills poor women and children and traps many of its victims in a cycle of poverty.
Reducing the number of malaria cases in Uganda could help more children to regularly attend school.
Photo Credit: DDC - International
Malaria remains a tremendous burden for Africa, but there is progress to report in the battle against this disease. Abt Associates is sustaining recent successes in the fight against malaria by expanding prevention and control, helping governments make informed policy choices, and improving treatment.
Uganda has the third highest number of deaths from malaria in Africa and some of the highest recorded malaria transmission rates on the continent. Here Abt has sprayed between 95 and 99 percent of all targeted households through the
Uganda Indoor Residual Spraying (IRS) project while reducing the program’s annual operating costs by $2.4 million.
Abt is working closely with the government of Zambia to
build local capacity to carry out IRS operations, providing technical assistance to implement a spraying program that covered more than 700,000 households to protect more than 4 million people in 15 districts from the disease.
In Mali, as part of USAID’s efforts to expand the delivery of high-quality maternal and child health services, Abt has played a key role in malaria prevention and treatment through training health workers and unifying anti-malaria messaging.
Meanwhile
in Nigeria, Abt is helping millions of people gain access to the most effective, affordable drugs to treat malaria.
Successful Uganda Spraying Program to Continue
A USAID-funded program led by Abt Associates that is laying the foundation for ending malaria in Northern Uganda has been extended for five years into a second phase. The Indoor Residual Spraying program is training Ugandans to apply long-lasting insecticides on the inside walls and ceilings of houses and other residential structures to prevent malaria at its most common transmission location — indoors.
“When you spray inside the house, you are reducing the number of infected mosquitoes that are carrying the (malaria) parasite,” said Dr. J.B. Rwakimari, chief of party of the Uganda Indoor Residual Spraying (IRS) project.
Uganda has one of the highest rates of malaria in the world. The disease kills approximately 80,000 people each year here and robs the country’s economy of $200 million annually in lost productivity.
But since 2009, approximately 2.8 million people, including more than 100,000 pregnant women and half a million children under age five – the population most vulnerable to malaria – have been protected from the disease in Northern Uganda as a result of USAID’s and the President’s Malaria Initiative’s (PMI) Uganda IRS project. Abt has succeeded in treating 95% of targeted households.
The IRS project is focusing on the 10 districts at the epicenter of malaria in Northern Uganda. In the Apac District — in north-central Uganda —people get malaria an average of six times each year. Over the last three years the number of malaria cases at St. Mary’s Hospital in the Gulu District in Northern Uganda has decreased from 4,000 per month to just 400. IRS is a key contributor to this.
The IRS project has been effective in part due to its use of local labor and sustainable resources. Sprayers, in addition to their regular compensation, receive $1 a day to use their own bicycles to reach remote parts of Uganda that are inaccessible by truck. Ugandan trainers provide hands-on demonstrations of how to use the sprayers.
“I feel very good when I am doing my work. I feel like I’m helping my country,” said Lydia Akunu, a spray operator in the Apac District.
Q&A: WHO’s Dr. Shiva Murugasampillay on the Global Burden of Malaria
Dr. Shiva Murugasampillay of the World Health Organization’s Global Malaria Program said in a conversation with Abt Associates that Indoor Residual Spraying is a powerful weapon in the fight against malaria. “We have a saying in Southern Africa that IRS is the spear for attacking [malaria], bed nets are the shield, and then you follow it up with treatment.”
Read the interview
In Zambia, IRS spray operators being trained for district campaigns.
Indoor Spraying Program Reaches Across Africa
Thirteen countries are taking part in the Africa Indoor Residual Spraying (AIRS) project, USAID’s flagship anti-malaria spraying program. Abt in 2011 was awarded a contract for the project, which is funded by the President’s Malaria Initiative. AIRS emphasizes environmental compliance, including careful handling of chemicals and spraying equipment. AIRS also includes entomological monitoring with training of local staff to track insecticide resistance and to adjust spraying appropriately. AIRS currently includes Angola, Benin, Burkina Faso, Ethiopia, Ghana, Liberia, Madagascar, Mali, Mozambique, Nigeria, Rwanda, Senegal, and Zimbabwe.
Bernard Sichamba and Aron Mufukuli – data collectors for the Zambia Integrated Systems Strengthening Project – use PDAs to gather basic occupancy information for each house prior to anti-malaria spraying.
Photo Credit: Mary Maguire, Abt Associates
Zambia Tackles Malaria with Abt Support
The Zambia Integrated Systems Strengthening Project (ZISSP), led by Abt, is both spraying residences to prevent malaria and monitoring the effectiveness of the insecticides used.
Zambia’s National Malaria Control Center, with ZISSP technical assistance, sprayed more than 700,000 households in Zambia, protecting more than 4 million people from malaria. ZISSP also provided the financial and technical support needed to train nearly 1,800 spray operators in 2011.
ZISSP, working with the Ministry of Health and funded by USAID, also is deploying doctors, entomologists, and other experts to target, track, and control mosquitoes that carry the malaria parasite.
ZISSP efforts also improved malaria treatment. Up to 80 percent of malaria deaths in children under five years of age happen in households with little to no contact with health care providers. In response ZISSP supported the Ministry of Health to train 32 trainers, 75 supervisors and 91 community health volunteers in integrated community case management. The project also trained 464 health workers in updated malaria care guidelines, including rapid diagnostic tests.
Rural Nigerians Access Affordable Malaria Treatment
Effective malaria treatment finally is affordable to approximately 37 million rural Nigerians under the Abt Associates-led Partnership for Transforming Health Systems, Phase II project (PATHS2), a contract with the U.K. Department for International Development (DFID).
The Affordable Medicines Facility for malaria (AMFm) initiative pays international manufacturers nearly 95 percent of the cost of producing Artemisinin-based Combination Therapies (ACTs), which are recommended by the World Health Organization as the most effective malaria treatment.
AMFm will distribute subsidized ACTs through primary health centers in the states of Enugu, Jigawa, Kaduna, Kano, and Lagos. AMFm is managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, with key financial support provided by DFID, the Bill & Melinda Gates Foundation, and UNITAID.
PATHS2 facilitated agreements between Nigerian pharmaceutical manufacturers and PATHS2 states to lower the prices of ACTs.
“This groundbreaking agreement between the international community, state governments and Nigerian pharmaceutical manufacturers will revolutionize the treatment of malaria in the five states,” said Mike Egboh, PATHS2 national program manager. A course of treatment costs less than US$1 most of the states in which it will be made available. The model may one day be expanded to all 36 Nigerian states.
“It will strengthen the treatment of malaria and save tens of thousands of lives,” Egboh said. “(AMFm) will also contribute to the reduction of maternal and infant mortality, as new mothers and their babies are particularly vulnerable to this dreadful disease.”
Malaria has a huge cost in Nigeria. The country had an estimated 57.5 million cases of malaria in 2006. That year approximately 225,000 Nigerians died from malaria, nearly all of whom were younger than five years old, according to the World Health Organization’s 2008 World Malaria Report.
Kadia Koulibaly, a public health nurse at the Community Health Center "Central" in Tenenkou, Mali tests blood for malaria.
Photo Credit: Ousmane Diabate, ATN Plus
Abt Project Strengthens Malaria Prevention and Treatment in Mali
Malaria prevention and treatment is improved for millions of people in Mali because of USAID’s Assistance Technique National Plus Project, carried out by Abt Associates and the Mali Ministry of Health. Although the country’s political situation is currently in transition, Abt remains ready to continue its work.
The Assistance Technique National (ATN) Plus Project trained health care providers on malaria diagnosis and treatment, increased access to malaria testing, and has standardized public health campaign messages about malaria. The malaria work is part of a larger ATN Plus effort to improve the delivery of high-quality maternal and child health care in Mali via community health centers.
“This multifaceted approach to malaria prevention and treatment is needed because of the huge impact the disease has in Mali, especially on children. Malaria is the number one reason children under five require medical care and the largest contributor to child mortality in Mali,” said Lisa Nichols, chief of party for ATN Plus in Mali.
The Abt-led ATN Plus project improved malaria prevention and care on a number of fronts. The project updated prenatal malaria case management training guidelines to be applied nationwide. Roll out of this new training began in Southern Mali’s Sikasso region, the most populated. ATN Plus also has trained more than 350 Malian regional trainers in malaria diagnostics and treatment. They in turn taught these new skills to more than 1,600 community health care providers. The project developed a standard guide for malaria intervention messages to improve the quality and consistency of behavior change messages for malaria prevention and treatment messages throughout Mali.
Abt relies on its network of local NGO district advisors to collect data on malaria control activities, such as such as the number of children diagnosed with malaria who are receiving correct treatment. ATN Plus trained these district advisors to use cell phonesto rapidly collect and submit malaria control data, which has improved the quality and availability of such information.
Removing Barriers to Care
Health Systems 20/20 Health Financing expert Yann Derriennic discusses the impact of removing user fees for malaria services for children under five in Africa.
Health Systems 20/20 is USAID’s flagship project for strengthening health systems worldwide.
Homepage Photo Credits
- Upper left: Spray operators on bicycles are able to reach the remotest parts of Uganda, inaccessible by truck, which has allowed the Indoor Residual Spraying Project to reach virtually all of its targeted households and save $2.4 million compared with using trucks. The operators also earn extra compensation for the use of their own bicycles Photo credit: DDC - International.
- Upper right: Patients and family members wait outside St. Mary’s Hospital Lacor in Northern Uganda. The region has one of the highest rates of malaria in the country. Photo credit: DDC - International.
- Lower left: Marguerite Mwale holds her granddaughter, Priska Sandonge, who had malaria at the time of this photo. The incidence of malaria in their small community of Chipulukusu is one of the highest in Ndola District in Zambia. Photo credit: DDC - International.