The Role of Rural Health Centres in the Detection and Management of Malaria Outbreaks in a Low Transmission Setting of Choma District, Zambia
Main Article Content
Abstract
The Southern Province of Zambia has been afflicted with malaria for many years, but in recent times, with the success of the national malaria control programme, malaria transmission has declined significantly and is now at low ebb. This success has been attributed to the effective use of indoor residual spraying, proper use of insecticide-treated mosquito nets provided to the people, as well as the use of artemisinin combination therapies in all rural health centres (RHCs) to treat clinical malaria cases at health facilities as well as in the communities by trained community health workers (CHWs). Despite this success and in trying to understand the epidemiology and control of malaria in rural areas of sub-Saharan Africa, it has been clear that local elimination is most unlikely due many challenges such as lack of incentives for CHWs who are the first link of the community to the health care system, inability of the officially approved rapid diagnostic tests to detect low level parasitemia in asymptomatic individuals, and anti-malaria stock-outs in RHCs, especially during the rainy season when most areas are unreachable due to impassable roads. This paper discusses the role of RHCs in the detection and management of malaria outbreaks in low transmission settings and the challenges of achieving elimination in Choma District, Southern Province, Zambia. These challenges could adversely impact malaria elimination if they remain unanswered.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Kobayashi T, Kanyangarara M, Laban NM, et al. Characteristics of Subpatent Malaria in a Pre-Elimination Setting in Southern Zambia. Am J Trop Med Hyg. 2019;100(2):280-286. doi:10.4269/ajtmh.18-0399
3. Ippolito MM, Gebhardt ME, Ferriss E, et al. Scientific Findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe. Am J Trop Med Hyg. 2022;107(4_Suppl):55-67. doi:10.4269/ajtmh.21-1287
4. Ministry of Health. National Malari Elimination Strategic Plan 2017 - 2021: Moving from accelerated burden reduction to malaria elimination in Zambia. Published 2017. Accessed September 10, 2021. https://www.nmec.org.zm/malaria-elimination-strategic-plan
5. Gebhardt ME, Searle KM, Kobayashi T, et al. Understudied Anophelines Contribute to Malaria Transmission in a Low-Transmission Setting in the Choma District, Southern Province, Zambia. Am J Trop Med Hyg. 2022;106(5):1406-1413. doi:10.4269/ajtmh.21-0989
6. Cotter C, Sturrock HJ, Hsiang MS, et al. The changing epidemiology of malaria elimination: new strategies for new challenges. The Lancet. 2013;382(9895):900-911. doi:10.1016/S0140-6736(13)60310-4
7. Stresman GH, Kamanga A, Moono P, et al. A method of active case detection to target reservoirs of asymptomatic malaria and gametocyte carriers in a rural area in Southern Province, Zambia. Malar J. 2010;9(1):265. doi:10.1186/1475-2875-9-265
8. Kamanga A, Moono P, Stresman G, Mharakurwa S, Shiff C. Rural health centres, communities and malaria case detection in Zambia using mobile telephones: a means to detect potential reservoirs of infection in unstable transmission conditions. Malar J. 2010;9(1):96. doi:10.1186/1475-2875-9-96
9. Chipukuma HM, Halwiindi H, Zulu JM, Azizi SC, Jacobs C. Evaluating fidelity of community health worker roles in malaria prevention and control programs in Livingstone District, Zambia-A bottleneck analysis. BMC Health Serv Res. 2020;20(1):612. doi:10.1186/s12913-020-05458-1
10. Larsen DA, Chisha Z, Winters B, et al. Malaria surveillance in low-transmission areas of Zambia using reactive case detection. Malar J. 2015;14(1):465. doi:10.1186/s12936-015-0895-9
11. Hemingway J, Shretta R, Wells TNC, et al. Tools and Strategies for Malaria Control and Elimination: What Do We Need to Achieve a Grand Convergence in Malaria? PLOS Biol. 2016;14(3):e1002380. doi:10.1371/journal.pbio.1002380
12. Rosenthal PJ, John CC, Rabinovich NR. Malaria: How Are We Doing and How Can We Do Better? Am J Trop Med Hyg. 2019;100(2):239. doi:10.4269/ajtmh.18-0997
13. Searle KM, Katowa B, Musonda M, et al. Sustained Malaria Transmission despite Reactive Screen-and-Treat in a Low-Transmission Area of Southern Zambia. Am J Trop Med Hyg. 2021;104(2):671-679. doi:10.4269/ajtmh.20-0947
14. World Health Organisation. World malaria report 2020: 20 years of global progress and challenges. Published online 2020:151.
15. Lubinda J. The spatio-temporal impact of climate change on malaria transmission, control and elimination in Southern Africa: The case of Zambia. Published online 2020:271.
16. Biemba G, Chiluba B, Yeboah-Antwi K, et al. A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia. Glob Health Sci Pract. 2017;5(3):486-494. doi:10.9745/GHSP-D-16-00275
17. Chipukuma HM, Halwiindi H, Zulu JM, Azizi SC, Jacobs C. Evaluating fidelity of community health worker roles in malaria prevention and control programs in Livingstone District, Zambia-A bottleneck analysis. BMC Health Serv Res. 2020;20(1):612. doi:10.1186/s12913-020-05458-1
18. Lourenço C, Tatem AJ, Atkinson PM, et al. Strengthening surveillance systems for malaria elimination: a global landscaping of system performance, 2015–2017. Malar J. 2019;18(1):315. doi:10.1186/s12936-019-2960-2
19. Lubinda J, Bi Y, Haque U, Lubinda M, Hamainza B, Moore AJ. Spatio-temporal monitoring of health facility-level malaria trends in Zambia and adaptive scaling for operational intervention. Commun Med. 2022;2(1):1-12. doi:10.1038/s43856-022-00144-1
20. Zambia Statistics Agency. 2022 Census of Population and Housing: Preliminary Report. Published 2022. Accessed April 17, 2023. https://www.google.com/search?q=2022-Census-of-Population-and-Housing-Preliminary&oq=2022-Census-of-Population-and-Housing-Preliminary&aqs=chrome..69i57j0i546l2j0i546i649l2j69i60l2.1315j0j7&sourceid=chrome&ie=UTF-8
21. Das S, Henning TC, Simubali L, et al. Underestimation of foraging behaviour by standard field methods in malaria vector mosquitoes in southern Africa. Malar J. 2015;14(1):12. doi:10.1186/s12936-014-0527-9
22. Fornadel CM, Norris LC, Franco V, Norris DE. Unexpected anthropophily in the potential secondary malaria vectors Anopheles coustani s.l. and Anopheles squamosus in Macha, Zambia. Vector Borne Zoonotic Dis Larchmt N. 2011;11(8):1173-1179. doi:10.1089/vbz.2010.0082
23. Stevenson JC, Simubali L, Mbambara S, et al. Detection of Plasmodium falciparum Infection in Anopheles squamosus (Diptera: Culicidae) in an Area Targeted for Malaria Elimination, Southern Zambia. J Med Entomol. 2016;53(6):1482-1487. doi:10.1093/jme/tjw091