Introduction

Why Zambia: Malaria transmission rates are high in all areas in Zambia, due to high co-infections rates between HIV and malaria, water collection, and poor sanitation. One-third of households do not have access to even one net and the rest need more than one net per household as the average household size is six or more people. Pregnant women living with HIV are highly vulnerable to malaria infection and death. Also, less than 50% of children under five sleep under a net, even though malaria can be fatal for them. Moreover, 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, provides huge economic benefits globally. 

Impact of COVID on malaria prevention: According to Bill Gates, 2020 was a year with “mutually exacerbating catastrophes” due to COVID. Public health has been setback by 25 years, as people are not seeking health care and consequently not receiving life-saving services such as vaccinations. According to WHO, malaria deaths can double due to COVID in Sub-Saharan Africa. The need to escalate preventive measures that include mosquito bed nets and spraying homes with insecticides is greater this year.

Project Mosquito Nets Program Activities in 2020

Our vision is for Zambia to be malaria free in the next three years. Zambia has set a lofty goal of eliminating malaria by 2021 and according to the USAID this goal is ambitious but within reach. We are winning the fight against malaria. Let us not stop now.

Provision of Nets and Education: In 2020, 11,000 long lasting insecticide treated nets and education on malaria and COVID were provided to eight urban and five rural communities in Zambia. All program activities were completed in a safe manner. Trained health care professionals provided health education and information about malaria in the local language.

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,
• negative impact of malaria in pregnancy,
• information about malaria for HIV+ children,
• identification of signs and symptoms of malaria, and
• information regarding regular re-treatment of nets, cost, and location.

Health care professionals explained how best to prevent malaria. Information regarding location, timing, and cost of re-treatment of nets was provided. In addition, the importance of keeping nets clean and stored properly was emphasized. Finally, families were informed about the importance of preventing malaria as it can be fatal for HIV+ pregnant women and young children. This was followed by a demonstration on the proper use of nets.

Beneficiary communities: Eight urban (located in Lusaka) and five rural communities were selected based on need and high malaria transmission rates due to poor sanitation. The rural communities are Chibombo, (65 miles north of Lusaka), Kafue (30 miles South of Lusaka), Luangwa (147 miles north-east of Lusaka), Nampundwe, and Mwambashi (about 34 miles west of Lusaka). Some rural communities are located by a river/swamp (good breeding grounds for mosquitoes) with the nearest clinic 15-20 miles away. For residents, of Nampundwe, the health clinic is in Ngoma, 30 miles away. Most residents cannot afford nets. Beneficiary communities were selected with the help of community organizations such as churches, and government health clinics.

Profile of Beneficiaries: Direct beneficiaries are children living with HIV, young children, pregnant women, breast feeding moms, and adults who are infected with TB and/or HIV. About 20,000-40,000 children and adults benefitted as each net can sleep up to four young children or two adults. 

Program Impact

A net can sleep up to four young children or two adults. This implies that one net can keep 3-4 children malaria free, healthy, and in school. Provision of 11,000 nets benefitted about 20,000-40,000 adults and children. More specifically, 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.

Here is a story of one fo the beneficiary families: Mercy (not her real name) and her grandmother, share their new insecticide treated bed net. Sleeping under the net regularly will keep her and her grandma malaria free. Mercy is not scared of falling sick with malaria anymore as she has a bed net. Since receiving the net in 2019, no one in the family has been sick from malaria. In addition, Mercy attended COVID workshops and received education on how to prevent COVID and received masks to keep her safe.

Our malaria prevention program is unique: This program is a  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 preceded by provision of education. Third, follow-up studies are conducted regularly to assess impact and gather feedback from community residents.

Follow-Up Study

To assess the impact of provision of 5,000 nets in May/June 2020, responses from more than 1,300 beneficiaries were gathered via questionnaires in September 2020. A summary of findings is as follows:

• Most beneficiaries had knowledge regarding the proper use, storage, and re-treatment of nets. Some beneficiaries commented that they do not have enough room to store the nets during the day as the same room is used as a bedroom room and living room.
• A single net is shared by 2-3 people.
• Most nets were reported to be in good condition. 
• Children are attending school as they are malaria free.
• No cases/deaths from malaria were reported.
• In most areas, especially in rural areas, the need for nets is high. Elderly and adults living with HIV are especially vulnerable to malaria.
• There is a need to provide COVID education and PPE especially in rural areas.

Plan for 2021

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 be malaria free and healthy for just a few cents per day.  

For 2021, our goal is to provide 12,000-15,000 mosquito bed nets and education. Three thousand families received nets in February 2021 ahead of the malaria season that lasts from March to June and November-January every year. This will take us closer to a malaria free world resulting in healthier, more economically stable families, and more sustainable communities. 

Thank you for keeping vulnerable children and families malaria free, healthy, and in school.