R 020817Z APR 09
FM AMEMBASSY LUSAKA
TO SECSTATE WASHDC 6875
SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
NSC WASHDC
WHITE HOUSE WASHINGTON DC

UNCLAS LUSAKA 000226 
 
 
AIDAC 
 
AID/W FOR AFR/SA MAJORIE COPSON, GH ADMIRAL ZEIMER, RENE SALGADO, 
RICHARD GREENE; AF/S FOR MATT SHIELDS; PASS TO CDC FOR KATHERINE 
TAN, BOB WIRTZ 
 
E.O. 12958: N/A 
TAGS: EAID SOCI TBIO PREL ZA
SUBJECT: ZAMBIA'S SIGNIFICANT PROGRESS FIGHTING MALARIA THROUGH THE 
PRESIDENT'S MALARIA INITIATIVE 
 
1.Summary:  The success of Zambia's scaled up malaria control 
efforts, together with their accurately measured impact, has drawn 
international attention. Since 2006, malaria parasitic prevalence in 
children dropped 54% and anemia in children under five, a common 
indicator of malaria, dropped 62%. While the attention is welcome, 
it also raises the bar as Zambia and its partners work to continue 
to roll out interventions to more of the country. Long-term funding 
by the government and donors and sustained political will must 
continue if the goals of malaria control and eventual elimination 
are to be achieved.  End Summary. 
 
¶2.  Zambia became a focus country under the President's Malaria 
Initiative (PMI) in December 2006.  In Zambia, USAID has provided 
over $38 million in malaria funding since FY 2007, including $14.9 
million for FY 2008. PMI funding for FY 2009 is approximately $14.7 
million.  The country has a very strong National Malaria Control 
Program and an effective in-country partnership upon which PMI 
builds.  Other important partners include the Global Fund, World 
Bank, the Gates-funded Malaria Control and Evaluation Partnership in 
Africa (MACEPA), WHO, Clinton Foundation, faith-based organizations 
and UNICEF. 
 
¶3. Most of Zambia's 12 million people are at risk for malaria.  The 
risk is higher during the rainy season (Nov-Mar) in many parts of 
the country.  The number of malaria cases reported declined in 2008. 
 However, malaria still accounts for 45% of outpatient visits, 45% 
of hospital admissions, 47% of overall disease burden among pregnant 
women, and 50% of disease burden among children under-five years of 
age. Malaria also has a serious economic impact on Zambia, 
accounting for 6.8 million Disability Adjusted Life Years, or DALYS, 
lost. This is higher than the losses due to acute respiratory 
infections (5.4 million) or HIV/AIDS (3.2 million). The high 
morbidity levels contribute to decreased productivity through 
absenteeism and lowered output. 
 
Recent results 
 
¶4.  Zambia uses four core proven prevention and treatment measures 
to achieve the PMI planned goals of 85% coverage in these measures 
and a 50% decrease in mortality due to malaria.  These approaches 
are: indoor residual spraying (IRS), distribution of insecticide 
treated bed nets, provision of rapid diagnostic testing, and 
effective therapy and preventive treatment of pregnant women. 
 
¶5. Indoor residual spraying: The Government of Zambia reestablished 
its IRS program in 2003 after a hiatus of thirty years. The IRS 
program builds on the successful intervention by Konkola Copper 
Mines (KCM), which began in 2001. The KCM program significantly 
reduced morbidity and mortality in mining towns in the Copperbelt 
Province, providing much of the evidence for the MOH and the NMCC to 
reinstate a broader IRS program in Zambia. Currently Zambia uses the 
highly effective insecticides DDT and pyrethroids. Strict human 
health and environmental safeguards are in place to comply with the 
Environmental Council of Zambia, WHO and USAID regulations and 
guidelines.  With PMI support, in 2008 the Government of Zambia 
(GRZ) sprayed over 760,000 homes, representing 95% of targeted homes 
and protecting approximately 4.2 million people in 15 districts 
across Zambia. 
 
¶6.  Since PMI's inception in Zambia the program has purchased and 
distributed nearly one million insecticide treated bednets (ITN) to 
protect Zambians while they sleep. PMI, working through partner 
organizations, distributes ITNs nationwide through antenatal 
clinics, and in the Northwestern Province through a mass 
distribution campaign. 
 
¶7.  In support of the diagnosis and effective treatment of malaria 
patients, since 2008 PMI has purchased and distributed 253,000 
courses of Coartem (artemether-lumefantrine combination therapy), a 
highly effective malaria treatment, and over 1.6 million rapid 
diagnostic kits to assure that patients are properly diagnosed. 
 
¶8.  PMI funds have trained health care workers and raised public 
awareness on the importance of prenatal care and intermittent 
preventive therapy with Fansidar (sulfadoxine-pyrimethamine) during 
pregnancy to prevent malaria's negative impacts on both the mother 
and her baby. These impacts include maternal anemia, spontaneous 
abortion, low birth weight (a major risk factor for death during the 
first month of life) and still birth. More than 60% of pregnant 
women throughout Zambia have received two or more doses of the 
preventive medicine. 
 
¶9.  In addition to these malaria control measures, PMI uses a 
nationwide information education campaign with community components 
to engage the public on the importance of utilizing Zambia's malaria 
control interventions. PMI also supports the government's malaria 
monitoring and evaluation program which provides data on malaria 
rates. 
 
¶10.  These scaled-up malaria control measures have had a dramatic 
impact on malaria in Zambia.  The Zambia Malaria Indicator Survey 
(MIS) was conducted in 2006 and 2008. The PMI-supported 2008 MIS 
surveyed over 4,400 homes and tested children under five years for 
malaria and anemia.  The changes between the two surveys indicate 
remarkable progress in the past two years:  1) parasite prevalence 
in under fives, measured by a rapid diagnostic test, decreased by 
54% from 22% to 10%; 2) severe anemia in under fives decreased by 
62% from 13% to 5%; 3) the proportion of under fives who slept under 
an insecticide treated net increased by 66% from 23% to 38%, among 
pregnant women the proportion increased by 69% from 24% to 40%; and 
4) the number of houses sprayed with IRS in past 12 months increased 
58% from 27% to 43%. 
 
¶11.  Zambia's scaled-up malaria control efforts and their accurately 
measured impact have drawn international attention. While this 
attention has been welcome, it also raises the bar as Zambia and its 
partners work to continue to roll out interventions including IRS 
and ITNs to more remote parts of the country. The GRZ continues to 
prioritize malaria and is in the process of preparing a Round Nine 
Global Fund proposal for malaria.  The World Bank continues to fund 
malaria programs in Zambia and plans to do so through at least 2011. 
Long-term funding by the government and donors and sustained 
political will must continue if the goal of eliminating malaria as a 
public health threat is  to be achieved. 
 
BOOTH