Abstract
BackgroundAn intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years. The successes have prompted the Zimbabwe’s National Malaria Control Programme to commit to elimination of malaria. It is critical to analyse the changes in the morbidity trends based on surveillance data, and scrutinize reorientation to strategies for elimination.MethodsThis is a retrospective study of available Ministry of Health surveillance data and programme reports, mostly from 2003 to 2015. Malaria epidemiological data were drawn from the National Health Information System database. Data on available resources, malaria control strategies, morbidity and mortality trends were analysed, and opportunities for Zimbabwe malaria elimination agenda was perused.ResultsWith strong government commitment and partner support, the financial gap for malaria programming shrank by 91.4% from about US$13 million in 2012 to US$1 million in 2015. Vector control comprises indoor residual house spraying (IRS) and long-lasting insecticidal nets, and spray coverage increased from 28% in 2003 to 95% in 2015. Population protected by IRS increased also from 20 to 96% for the same period. In 2009, diagnostics improved from clinical to parasitological confirmation either by rapid diagnostic tests or microscopy. Artemisinin-based combination therapy was used to treat malaria following chloroquine resistance in 2000, and sulfadoxine–pyrimethamine in 2004. In 2003, there were 155 malaria cases per 1000 populations reported from all health facilities throughout the country. The following decade witnessed a substantial decline in cases to only 22 per 1000 populations in 2012. A resurgence was reported in 2013 (29/1000) and 2014 (39/1000), thereafter morbidity declined to 29 cases per 1000 populations, only to the same level as in 2013. Overall, morbidity declined by 81% from 2003 to 2015. Inpatient malaria deaths per 100,000 populations doubled in 4 years, from 2/100,000 to 4/100,000 populations in 2012–2015 respectively. Twenty of the 47 moderate to high burdened districts were upgraded from control to malaria pre-elimination between 2012 and 2015.ConclusionsA significant progress to reduce malaria transmission in Zimbabwe has been made. While a great potential and opportunities to eliminate malaria in the country exist, elimination is not a business as usual approach. Instead, it needs an improved, systematic and new programmatic strategy supported strongly by political will, sustained funding, good leadership, community engagement, and a strong monitoring and evaluation system all year round until the cessation of local transmission.
Highlights
An intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years
Universal coverage by vector control interventions is required for impact and to reduce malaria cases to less than 1 per 1000 populations per annum, which is the level at which elimination should be considered [3]
This study provides some useful suggestions to sustain the current milestones in malaria control interventions, but rather to improve the control strategies for eliminating local malaria transmission in Zimbabwe
Summary
An intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years. Malaria elimination does not mean a complete absence of reported malaria cases or a total absence of disease vectors in a geographical area; instead, it refers to an interruption of local transmission (reduction to zero incidence of indigenous cases) of a specific malaria parasite species in a defined geographical area as a result of deliberate activities [3]. Vector control strategies, such as indoor residual spraying (IRS) and use of long-lasting insecticidal nets (LLINs), together with case management (prompt access to diagnosis and effective treatment) are fundamental for reducing malaria transmission [3]. Large-scale malaria control interventions including application of IRS, deployment of LLINs, intermittent preventive treatment in pregnancy (IPTp), and case management have been conducted with significant successes since the nationwide scale-up activities initiated more than a decade ago [5]
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