Malaria Treatment & Prevention

Zanzibar is semi autonomous and has its own Ministry of Health, which was determined to control Malaria. The Minister is a former Head of the Zanzibar National Malaria Control Program (ZMCP). A brilliant public health physician, Dr. Mahdi Ramsan was ZMCP advisor. They received a substantial Global Fund to Fight AIDS, TB and Malaria grant. When the US President's Malaria Initiative (PMI) was announced in 2005, Tanzania was one of the first three countries. There was interest in having a quick win to demonstrate the effectiveness of the PMI approach, so Zanzibar was made a PMI priority and received $3 per capita per year from PMI, plus Global fund money. The ZMCP coordinated the Global Fund and PMI to: 1) introduce ACTs (2004); 2) Distribute Olyset LLINs to all pregnant women and children under five (2005), and; provide IRS to every house on the islands (2006). In Pemba a survey of elementary school children (in school, not in hospital or home sick) showed parasitemia levels of 60% falciparum malaria in 2005 and many children were dying. in 2006, after the bed net distribution,the levels were 30%, and in 2007 after IRS, to less than 1%. Zanzibar is made ...

Zanzibar is semi autonomous and has its own Ministry of Health, which was determined to control Malaria. The Minister is a former Head of the Zanzibar National Malaria Control Program (ZMCP). A brilliant public health physician, Dr. Mahdi Ramsan was ZMCP advisor. They received a substantial Global Fund to Fight AIDS, TB and Malaria grant. When the US President's Malaria Initiative (PMI) was announced in 2005, Tanzania was one of the first three countries. There was interest in having a quick win to demonstrate the effectiveness of the PMI approach, so Zanzibar was made a PMI priority and received $3 per capita per year from PMI, plus Global fund money. The ZMCP coordinated the Global Fund and PMI to: 1) introduce ACTs (2004); 2) Distribute Olyset LLINs to all pregnant women and children under five (2005), and; provide IRS to every house on the islands (2006). In Pemba a survey of elementary school children (in school, not in hospital or home sick) showed parasitemia levels of 60% falciparum malaria in 2005 and many children were dying. in 2006, after the bed net distribution,the levels were 30%, and in 2007 after IRS, to less than 1%. Zanzibar is made of islands which make it easy to control malaria, and the combination of political will, plenty of external resources and effective tools (nets, insecticides and antibiotics) made it work. But malaria has been controlled in Zanzibar at least twice before. When children stopped dying, resources and political interest went elsewhere and malaria returned, more virulent than ever, as many people lost their partial immunity and mosquitoes and parasites became resistant to DDT and Chloroquine. Will history repeat itself?

"Will history repeat itself?" That is the question.

Zanzibar in particular with its amazing success in bringing malaria to a ‘controlled low endemic state’ is now in the spotlight. Will the country be able to "maintain the gains?" An article recently published by Smith et al. in Science explains the "Sisyphean problem of malaria in Zanzibar."

Much like a vaccine program, the resources for malaria funding need to continue to keep the disease from rebounding. Much of the debate now revolves around whether to pursue an elimination strategy (ending transmission within the countries boarders) or to continue with a control strategy (keeping malaria at a level where it does not constitute a major public health burden). The Zanzibar Malaria Control Program's (ZMCP) feasibility study with the Global Health Group (http://www.malariaeliminationgroup.org/malaria-elimination-zanzibar-feasibili...) found that the long term cost of both strategies were fairly equal and tied to the fate of mainland Tanzania's malaria program.

As both the Smith et al. paper argues, and the feasibility study concludes, the debate should rather revolve around how enthusiasm for malaria funding can be sustained. This may be a formidable task considering the out of sight, out of mind paradox ...

"Will history repeat itself?" That is the question.

Zanzibar in particular with its amazing success in bringing malaria to a ‘controlled low endemic state’ is now in the spotlight. Will the country be able to "maintain the gains?" An article recently published by Smith et al. in Science explains the "Sisyphean problem of malaria in Zanzibar."

Much like a vaccine program, the resources for malaria funding need to continue to keep the disease from rebounding. Much of the debate now revolves around whether to pursue an elimination strategy (ending transmission within the countries boarders) or to continue with a control strategy (keeping malaria at a level where it does not constitute a major public health burden). The Zanzibar Malaria Control Program's (ZMCP) feasibility study with the Global Health Group (http://www.malariaeliminationgroup.org/malaria-elimination-zanzibar-feasibili...) found that the long term cost of both strategies were fairly equal and tied to the fate of mainland Tanzania's malaria program.

As both the Smith et al. paper argues, and the feasibility study concludes, the debate should rather revolve around how enthusiasm for malaria funding can be sustained. This may be a formidable task considering the out of sight, out of mind paradox the heavily donor reliant ZMCP now faces amidst the global economic downturn and expense of continuing the fight. However it is imperative that this paradox be solved not just for the health of Zanzibaris, but also for all the other countries about to reach a state of control with donor assistance.

As published in a recent set of country policy briefs (http://globalhealthsciences.ucsf.edu/GHG/e2pi-maintaining-the-gains.aspx), continuing malaria control funding in Zanzibar for the next five years (2011-2015) could have major health and economic benefits. The report models that sustaining financing for this time could avoid about 747,000 malaria cases and 13,000 malaria deaths and be highly cost-effective; costing about $49 per disability-adjusted life year (DALY ) averted and about $8 per case averted. This makes sustained malaria control financing a “best-buy” for global health.

It needn't repeat itself, but we must change the paradigm for malaria control to a more targeted and sustainable approach. (I can elaborate if people are interested)

Clive

This can come about with better surveillance, which Zanzibar has in the works with its Malaria Epidemic Early Detection System (MEEDS) program. This will allow for better targeted approaches to controlling malaria, but as I understand it, this type of surveillance needs to be accompanied by a holistic improvement of its health system.

What kind of malaria control approaches or paradigms can be developed or improved to where they can be afforded with out international assistance which is often volatile and unpredictable?

Charlie

In my Country, This program for malaria thats Ok, maybe in some part as
Atlantic cast , the cas for Malaria is very Hight

Charlie the Smith article overstates itself.

It’s great, but unsurprising, that Zanzibar has reduced malaria using drugs and vector control tools of known effectiveness. Of course, the efforts of the control program should at least be maintained or even transitioned into elimination if sustained funding is possible.

But Zanzibar’s experience is not relevant to the provinces of most other nations, let alone an entire continent. Political and administrative complexity matter and generally increase with size. Yet, somehow I’ve seen this example, of a tiny and geographically isolated sub-national area, repeatedly paraded as a broader lesson for vast, interconnected regions. Such extrapolation is unreasonable.

http://topnaman.com/policy/zanzibar-is-a-small-island-of-1-2-million-people/