Innovation yields success

In 2006, Zambia completed the first-ever nationally representative household survey assessing coverage of the key malaria interventions and measuring malaria-related burden among children under age five. This effort was led by the Ministry of Health, through the National Malaria Control Centre and in collaboration with MACEPA and several other Zambia Roll Back Malaria partners, to support its ambitious plan to scale up malaria control interventions throughout Zambia.

While the questionnaire and many of the survey methods have been used previously in Demographic and Health Surveys, the Zambia National Malaria Indicator Survey (MIS) was unique for several reasons. The survey represents the first time a stand-alone MIS had been carried out focusing on anemia assessment, malaria parasite testing, and intervention coverage using these methods. The innovative use of hand-held computers (personal digital assistants, or PDAs) also set this study apart. The PDAs had pre-programmed questionnaires for efficient data entry and cleaning. The devices were equipped with global positioning system units to allow household listing, second-stage sample selection, and interviewing in a single field visit.

The main purpose of the study was to measure the Zambia National Malaria Control Centre’s progress toward achieving the goals and targets set forth in the National Malaria Strategic Plan for 2006 to 2011. The objectives of the study were to:

• Obtain a nationally representative estimate of the coverage achieved by malaria control interventions and progress toward achieving goals and targets in the National Malaria Strategic Plan.
• Assess subnational variations in coverage of insecticide-treated mosquito nets, indoor residual spraying, prevention during pregnancy, and prompt, effective case management.
• Assess anemia and malaria parasite prevalence in children under age five.
• Strengthen the national system for the monitoring and evaluation of malaria program scale-up in Zambia.

The MIS findings suggest that good progress is being made in some areas, but much work remains. In 2006, nearly half of households in Zambia have an insecticide-treated net (double from three years prior). However, only one quarter of Zambian children under age five are sleeping under nets. In addition, while more than sixty percent of pregnant women took at least two of the recommended three doses of preventive medicine, Fansidar, during their last pregnancy, broad access to medicines (and to most other interventions) is low, particularly among the rural poor. 

The 2006 Zambia MIS provides an important benchmark for successfully measuring progress in scaling up malaria interventions. Additional surveys to be conducted periodically will continue to inform planning and provide evidence of impact.

Access the Zambia National Malaria Indicator Survey report here.

A summary of the report is also available.