Malaria remains one of the leading causes of death in several countries around the world, with most malaria cases and deaths occurring in sub-Saharan Africa. The disease took the lives of 435 000 people in 2017, the year in which there were an estimated 219 million cases across 90 countries.
Although Zambia is actively working towards eliminating the disease, there is still a long road ahead. According to the World Health Organisation (WHO)’s World Malaria Report 2018, the reported number of deaths attributed to malaria in Zambia is on the decline, with 1,425 reported fatalities last year.
But one particular strip of Zambia’s Copperbelt Province has managed to completely turn statistics on their head. When Mopani Copper Mines commenced operations in 2000, the region’s malaria control activities had completely come to a halt, and the disease’s incidence rate had risen to 216 people in a population of 1000. Mopani devised a strategy to revitalise the control activities, face the malaria challenge head-on, and gradually stamp out the disease. Mopani’s medical department approaches malaria reduction from all angles and, in less than two decades, the results have been astounding.
An Integrated Vector Management (IVM) approach for maximum efficacy
Mopani’s malaria elimination programme is active throughout their catchment areas in Kitwe and Mufulira, where it tackles disease prevention using integrated interventions. Mulenga Mbita, Chief Health Officer at Mopani’s Medical Department, explains how these interventions work and describes the accompanying challenges.
One particular strip of Zambia’s Copperbelt Province has managed to completely turn statistics on their head.
“Under the malaria control program, we’re using an Integrated Vector Management approach. That system involves a combination of different control measures to prevent the transmission of vector-borne diseases. A vector is a carrier of disease. So in this case, we’re talking about mosquitoes.”
Indoor Residual Spraying keeps the mosquitoes away
“One of the examples of different control measures is Indoor Residual Spraying, or IRS. That involves spraying of houses precisely indoor surfaces with a chemical that has a residual effect for about four to six months,” explains Mbita.
The technique was designed with mosquitoes’ particular behaviour in mind. After feeding, the parasites tend to settle on surfaces like walls, ceilings and furniture, which is where spraying is concentrated.
“This is a community programme and it’s done for free. As Mopani, we don’t charge anything. We go out into the community and identify clients. A day before, we notify clients that we’ll be coming so that they can prepare their houses based on information that we share with them,” says Mbita.
It’s proved to be an effective method for keeping the number of mosquitoes under control, and Mopani sets ambitious targets for the number of homes it sprays. “We’ve got about 30 permanent Mopani employees and about 20 on contract who are in the field implementing this program every year during the high-risk period.”
The Copperbelt’s rainy season brings with it the highest risk of malaria, and the spraying begins in November, along with the first rains. “The target is to cover people especially during December, January, February, March; this is a high-risk period.”
Over 20,000 homes were sprayed in 2006, and the numbers have been steadily climbing every year.
Mopani’s target in 2018 was to spray approximately 40,000 homes although households can, of course, choose not to avail of the service. “Some refuse the services for personal reasons. They need to move furniture away from the surfaces so the workers can get access, so some people find it to be very inconvenient.”
Approximately 83% (33,200) of homes targeted were sprayed in 2018, says Mbita. The programme is ongoing.
Stop the breeding before it starts
Mosquitoes love stagnant water because it provides ideal breeding conditions. Mopani identifies potential mosquito breeding sites so it can stop breeding before it starts. Swampy areas called “dambos” are potential high-risk areas, and dambo canalisation has become part of the malaria control programme.
“We start dambo canalisation after the rainy season. It’s a program where we try to create canals, so as to avoid stagnant water.”
Disused swimming pools are another potential hazard, and Mopani’s team regularly pumps the remaining water from pools in properties that have fallen into disrepair.
“Apart from that we’re also doing larviciding, which involves application of a chemical on mosquito breeding sites to kill off mosquito larva. Although it’s based on WHO recommendations, it’s considered to be the last option if you’re unable to manipulate breeding sites.”
Lending a helping hand
Growing up in a malaria zone generally encourages a certain level of awareness of the disease. A large proportion of people know that covering up exposed body parts at sunset and sunrise is wise, and that mosquito repellents can keep the bugs at bay. But Mopani’s malaria control team wants to make sure that its bases are covered. All Mopani employees who work night shifts are provided with a tried and tested DEET-based mosquito repellent, with approximately 5,000 tubes of repellent distributed in 2018. Insecticide-treated nets are another tried and tested of avoiding bites from malaria vectors.
“There are challenges,” explains Mbita. “As much as we are using an integrated vector management approach as Mopani, the government doesn’t have enough resources to undertake different control methods. Their prime focus is indoor residual spraying and insecticide-treated nets. We don’t buy nets, we get them from the government and assist with the distribution, usually to expectant mothers and children under the age of five.”
Free testing and treatment
Thanks to rapid diagnostic testing (RDT), malaria is increasingly easy to identify, says Mbita. “Before you send a blood sample to the lab, you’re able to get a preliminary diagnosis within 15 minutes. RDT is 98% sensitive.”
When treatment is required, it is provided free of charge, whether you’re a Mopani employee or an employee’s dependent. Treatment programmes are run from Mufulira’s Malcolm Watson Hospital, Kitwe’s Wusakile Hospital, and a number of satellite clinics across Mufulira and Kitwe that are managed by Mopani. These same satellite clinics have HIV and AIDS treatment and prevention programs, and also provide care for other serious health disorders such as tuberculosis.
“We treat malaria using Coartem-Artemether Lumefantrine, based on the Ministry of Health recommendation as the first line drug. Then for severe malaria, we use quinine – except in pregnant women,” explains Mbita. “We’ve got a few staff members who are stationed at the satellite clinics to help us sensitize the clients that access those services. They provide health education on quite a range of topics, and one of them is malaria.”
When Mopani’s malaria control programme started in 2000, the incidence rate was 216 cases of malaria in the Kitwe and Mufulira area per 1,000 people. By the end of 2017 – less than two decades after the program began – the incidence rate had been reduced to 9.77 cases per 1,000 people. The figures for 2018 are still being compiled, but were looking extremely positive in October 2018, with just 4.1 cases identified in a population of 1,000.
As for Mopani employees, factors including awareness about malaria control have helped to drastically reduce the number of cases.
“At the time we started the program, the incidence rate was 15 employees per thousand. Last year, we were at 1.56 per thousand. From the overall analysis of the performance of the programme, there’s been a tremendous reduction in cases,” Mbita says, smiling.
He should be smiling. He and his team have come a long way, and Mopani’s malaria control programme won’t stop until it has reached its destination.
See also: Working together to fight malaria