Executive Summary

Thanks for your generosity. The Power of Love team along with the beneficiary families, would like to say a “big thank you” for your continued support for “Project Mosquito Nets.” Your support has resulted in lowering the incidence of malaria, improved health, higher school attendance, and economic stability in communities highly vulnerable to malaria in Zambia.

Need for malaria control: Malaria continues to be the leading cause of child mortality globally; and deaths due to malaria continue to be unacceptably high. As per the World malaria report, progress towards the 2020 milestones was off track by 40%. However, the emergence of several modern technologies such as a malaria vaccine, antimalaria drugs, intermittent preventive therapy, and genetically modified mosquitoes can provide an opportunity to control malaria substantially. Implementing  these innovative technologies, increased funding, and more collaboration between multilateral organizations such as the WHO, GAVI, and the Global Fund can lead to the eradication of malaria in the next two years.

Impact of COVID: According to the World Malaria report, disruptions in the delivery of malaria services contributed to a considerable increase in malaria cases (14 million) and deaths (69,000) between 2019 and 2020. Developing countries continue to face challenges.

Malaria in Africa: Since 2000, malaria cases and deaths have been declining in Africa due to the provision of insecticide-treated nets (ITNs) and antimalarial drugs. A decrease in access in either or both would lead to potentially catastrophic increases in malaria morbidity and, mortality within Africa. In 2019, only 52% of the people within a household in sub-Saharan Africa had access to an ITN and this number fell during COVID. Hence, there is a continuing need to escalate malaria prevention measures to prevent the resurgence of this disease and consequent loss of productivity and life.

Why Zambia? Zambia continues to be a highly endemic malaria country, with the entire population of about 20 million considered to be at risk of contracting malaria due to high co-infection rates between HIV, malaria and TB, poor sanitation etc. It is among the 20 countries with the highest malaria incidence and mortality globally. Pregnant women living with HIV, and children under five are highly vulnerable to malaria infection and death. However, only 52% of pregnant women and children under five use a net.

Our response: There were an estimated 247 million malaria cases and 619,000 malaria deaths worldwide in 2021. To keep families and children healthy and malaria free, 22,000 long lasting insecticide treated nets and education were provided last year.

Our plan is to expand the provision of nets till the new vaccine is approved by WHO and available widely. Our hope is for Zambia to be malaria free in the next 2-3 years.

Benefits of Eradicating Malaria: Ending infectious diseases like malaria is vital if we are to meet the UN’s Sustainable Development Goals. Preventing malaria, in addition to saving precious lives, stabilizes household incomes, keeps children in school and provides huge economic benefits globally.

Project Mosquito Nets Program Activities in 2022 

The Power of Love team has the knowhow to administer the vaccine to young children and we are anxiously awaiting its arrival in Zambia. Till then, we will continue to keep children and families safe from malaria via the provision of education and long-lasting insecticide treated nets.

Provision of Nets: In 2022, 22,000 long lasting insecticide treated nets and education on malaria prevention was provided benefitting more than 40,000 adults or 75,000 children as each net can sleep up to four young children or two adults. For 2023, our plan is to provide 25,000 nets and education. Over the past five years we have been able to provide 68,000 nets. See table below:

 Year   2010   2011  2012   2013   2014   2015   2016   2017  2018   2019     2020     2021    2022

 Qtty 500  1000   1000   1000    2000  2000    2000    2500   8500   11500  11000 15000    22000

Education on Prevention of Malaria: Trained health care professionals provided health education and information about malaria prevention. Topics discussed during the education session included:

• hygiene, drainage maintenance, filling and/or removal of mosquito breeding sites,
• proper use and maintenance of nets (cleaning and storage) to prevent damage,
• impact of malaria (low birth weight) in pregnancy,
• information regarding malaria prevention for children living with HIV,
• identification of signs and symptoms of malaria, and
• information regarding regular re-treatment of nets, cost, and location.

Finally, families were informed about the importance of preventing malaria as it can be fatal for HIV+ pregnant women and young children. This is followed by a demonstration on the proper use and storage of nets.

Profile of Beneficiaries: Direct beneficiaries are children living with HIV, young children, pregnant women, breast feeding moms, older adults, and adults who are infected with TB and/or HIV.

Beneficiary communities: several urban (located in and around Lusaka) and rural communities were selected based on need and high malaria transmission rates due to poor sanitation. Some of the beneficiary rural communities are Ndola, Mansa, Kafue, Mupanshya, Chongwe, Chisamaba, Lufusa, Chikankata, Chinyunyu, and Njolwe. Many rural communities are located by a river/swamp (good breeding grounds for mosquitoes) with the nearest clinic 15-20 miles away. Beneficiary communities were selected with the help of community organizations such as churches, and government health clinics. 

Program Impact: Since one net can sleep up to four young children, each net can keep 3-4 children malaria free, healthy, and in school. A provision of 22,000 nets benefitted more than 40,000 adults or 80,000 children. For all beneficiaries there is an improvement in the quality of life due to:

• fewer malaria infections and deaths,
• fewer visits to hospitals/clinics due to better health,
• with better health, there is an increase in school attendance, and adults miss fewer days at work resulting in economic stability.

Lives can be saved for just a few pennies: Studies have shown that for every 1,000 children protected by a net, 5.5 lives will be saved each year. Since the cost of provision of a net is $5 (or less), a child’s life can be saved for a small investment. Additionally, since a net can sleep 3-4 young children or two adults and can be used for two years, families can stay malaria free and healthy for just a few cents per day.

Our malaria prevention program is unique: This program is part of a comprehensive program that includes pediatric HIV care and women’s empowerment programs. Many beneficiary families are enrolled in multiple programs to help achieve family sustainability. Second, nets provision is always preceded by provision of education. Third, follow-up studies are conducted regularly to assess impact and gather feedback from community residents.

A testimony: “We got soaked,” Ginny says. “I thought then that my time had come to die, but mummy said whether we are soaked or not, we are going to the clinic.” Upon seeing my condition, we went to the hospital I was given anti-malarial medication and after days of rest, I eventually recovered. “It was a day I’ll never forget,” she says. “I thought the time had come for me to die, but within the shortest period of time I was back to normal.” Ginny said her whole family suffered from malaria multiple times a year. Their home in Matero compound is close to a sewer pond and surrounded by wild grassland, a prime breeding ground for mosquitoes, especially during the wet season. There is nowhere else for the family to go; they have lived here for most of their lives. Ginny’s mom sells vegetables. During a “Safe Park” event, Ginny’s family received mosquito nets. “This was life changing,” said her mom. From the time they received the net no malaria case has been recorded in their family of four. They are so thankful and happy and consider themselves blessed. They now feel secure and safe from malaria. 

Follow-Up Study

To assess the impact of provision of 10,000 nets provided from April to June 2022, 1,200 responses were gathered (1000 via questionnaires and 225 via focus group discussions with recipients and non-recipients of nets) in July/August 2022. A summary of findings is as follows:

• Most respondents indicated that the nets are effective and easy to use.
• More nets are needed as many families do not have them. Among beneficiary families, 80% indicated that they needed more nets for their family members. The average household size is 7, so each family needs at least 2-3 nets.
• Treating malaria is expensive and results in poverty in many families.
• Malaria incidence is much lower in beneficiary families. Conversely, malaria is rampant in the homes of non-beneficiary families (it is the number one killer).
• For families who were not sleeping under a net, hospital/clinic visits were a part of daily life.
• Many respondents requested that the chemicals for re-treatment should also be provided as government clinics do not provide these. This is valuable feedback, and we are looking into it.
• Almost all beneficiaries had knowledge regarding the proper use, storage, and re-treatment of nets as demonstrated during the education session.
• On average a net is shared by 2 adults or 4 young children. Some respondents indicated that more nets were required to avoid the need for more than 2 adults using a single net especially if any of them had cough or some other infection.
• Government clinics do not provide nets.
• Beneficiaries felt cared for and loved.
• They learned that sleeping under a net is the best way to prevent malaria.
• Many people had tried using traditional ways like burning leaves on a brazier (see picture above) to get rid of the mosquitoes but once the smoke dies down, the mosquitos come back. Also, smoke generation results in serious coughs and sneezing.

Plan for 2023

Our plan is to continue to expand our malaria prevention program so that more families stay healthy, adults miss fewer days at work, and children can continue their education uninterrupted. For 2023, our goal is to provide 20,000-22,000 insecticide treated nets and education benefitting more than 75,000 children or 40,000 adults.

Malaria Can be Eradicated

Malaria continues to be the leading cause of child mortality globally; and deaths due to malaria continue to be unacceptably high. However, the emergence of several recent technologies such as a malaria vaccine, antimalaria drugs, intermittent preventive therapy, and genetically modified mosquitoes can provide an opportunity to control malaria substantially. Implementing  these modern technologies, increased funding, and more collaboration between multilateral organizations such as the WHO, GAVI, and the Global Fund can lead to the eradication of malaria in the next two years.

The new WHO approved vaccine for malaria can save the lives of more than 20,000 children if administered to all children in high incidence malaria countries in Africa. However, it will have to be used along with existing tools such as insecticide treated nets and anti-malarial drugs. In addition, ample funding and clear guidelines to ground teams will be crucial to its success.

Conclusion

The need for insecticide treated nets continues to be huge due to high transmission rates, lack of affordability by vulnerable populations, and the disruption in malaria treatment services due to COVID. The continued provision of insecticide treated nets and education will eradicate malaria resulting in healthier, more economically stable families and stronger communities.