Innovative malaria training strengthens healthcare delivery in Zambia

During the last week of September 2004, a major educational programme was rolled out in Lusaka, Zambia, designed to familiarise health workers from around the country on the correct use of Coartem as first-line therapy for falciparum malaria and its effective integration into the countries’ malaria control policy, and to show them how to cascade this information down to health workers and the general public.

The Malaria Case Management Educational Programme, or MCMEP, was devised to help Zambian healthcare professionals to sharpen skills in everything from prevention and distribution logistics, to diagnosis, early referral and effective treatment of falciparum malaria. Assisted by the Zambian National Malaria Control Centre, a group of international malaria experts helped more than 300 Zambian colleagues to enhance their knowledge base with a combination of lecturesand hands-on workshops. This innovatory programme was organised and sponsored by Novartis in collaboration with the Zambian National Malaria Control Centre, and similar training sessions on both diagnosis and treatment of malaria will be held around the country during the remainder of the year. Coartem will be available in many remote rural areas of Zambia in time for the approaching high-transmission season which begins in November.

It is hoped that Zambia’s innovative malaria policy will become a model for African neighbours. Observers from Kenya and Ethiopia attended the MCMEP training session and Coartem will soon be introduced in several other African countries.

The African malaria problem

Over the past 30 years, the incidence of malaria has tripled across Africa due to the emergence of parasites resistant to standard treatments such as chloroquine. Sulfadoxine / pyrimethamine and amodiaquine. These drugs have been mainstays of malaria treatment for many years, because they are inexpensive, well tolerated, and until recently, quite effective. However, in much of Africa, 60 % of cases are resistant to chloroquine.

In Zambia last year, there were more than 4 million cases of malaria, and more than 50,000 people died form the disease, making it the leading cause of morbidity and mortality.

Introducing the MCMEP Dr. Brian Chituwo, Zambia’s Minister of Health, stated that malaria accounts for up to 20% of maternal deaths – and 40% of illness among under-fives. “Sadly, a large proportion of these cases represent the fertile segment of our population – pregnant women and children under five,” said Dr. Chituwo. “This is totally unacceptable, considering that malaria is completely preventable and curable.”

Why Coartem?

Alarmed by the rising malaria burden, and following WHO recommendations to use artemisinin-based combination therapies (ACTs) where conventional antimalarials no longer work, Zambia has adopted Coartem as first-line therapy, to replace chloroquine.

In 2001, Novartis and the World Health Organization formed a ten-year partnership to distribute Coartem at not-for-profit prices in the world’s most malaria-endemic countries. The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria provided financial grants to procure Coartem at the preferential prices offered by Novartis and distributed through the WHO.

After the success of the South African KwaZulu pilot study, where an integrated control programme of insecticide-treated bed nets, insecticide spraying and treatment with Coartem reduced malaria deaths by 95%, Zambia became one of the first countries in Africa to endorse WHO recommendations and adopt ACTs as first-line therapy. To help ensure the continuing success of the new treatment policy, Novartis has gone beyond the usual role of drug supplier and is supporting a range of capacity building programs in collaboration with Zambia’s Ministry of Health and the National Malaria Control Centre.