Strong Partners Make Malaria an Endangered Species in Kabuyu

[This blog is part of the #DefeatMalaria World Malaria Day blog series hosted by Roll Back Malaria, to be published between April 8 and May 1, 2015]

The sun was already high in the sky on a brilliant blue morning the day before World Malaria Day. Dignitaries and public health officials gathered under tents donated by Chief Mukuni in front of Kabuyu Primary School, where an announcement about World Malaria Day commemorations was still drying on the wall. People from across the world came to hear how Kabuyu’s health professionals from Zambia’s Ministry of Health and Ministry of Community Development, Mother and Child Health have tackled malaria, bringing malaria infection rates to historic lows. They want to learn how Kabuyu did it, so that proven malaria elimination efforts can be replicated elsewhere.

Kabuyu, a health facility catchment area in Kazungula District, is 50 kilometers north of tourist magnet Livingstone, a popular gateway to Victoria Falls. A rural community of farmers and fishermen, it boasts a two-bed health facility within walking distance of the school. The nearest site for outreach health services is 26 kilometers away, a distance that can take over a day to cover during the rainy season.

Despite these distances, malaria has not been among the top ten diseases in Kabuyu since 2009, and Kazungula District has not reported a single malaria-related death since 2009. How did this happen?

The anti-malaria interventions showcased in Kabuyu included the usual set: rapid diagnostic testing for malaria and prompt treatment at the health facility, continuous bed net distribution, and indoor residual spraying. But what makes Kabuyu unique is a community surveillance and reactive case detection system established in 2012. Community health workers (CHWs) are trained to test and treat community members with malaria symptoms. If a test comes back positive, the CHW visits the person’s household, tests everyone there, plus all others within a 140-meter area of the home (roughly the size of a football field). The logic is that mosquitoes don’t travel very far after biting and feeding on someone—to prevent them from spreading the disease to a family member or neighbor, testing around the household reduces the parasite reservoir. So far this year, 221 community members have been tested in households and in clinics.  Of those only 2.2% of tested positive for malaria, a reduction of 4.6% compared to 2014.

Kabuyu’s malaria rates are low thanks to intense community action and use of the standard malaria control interventions, and from people going to their neighborhood CHW to seek testing and treatment instead of trekking to the health center. This low malaria infection rate is maintained through CHWs conducting their reactive case detection. CHWs stamp out any infections from its epicenter, thus reducing the parasites in the community at large. If there are almost no parasites, malaria infections can’t easily spread via mosquito bites. Not surprisingly, of the dozens of tested at the commemoration event, all tested negative for malaria.

To get this close to zero requires huge amounts of energy and close partnership between a diverse cast of characters: the President’s Malaria Initiative to coordinate indoor spraying; the National Malaria Control Center to dispatch entomologists who capture mosquitoes and measure type and how many are infected with malaria; the district Malaria Focal Point and colleagues who work closely with community leaders to educate and reinvigorate commitment to malaria elimination in face of falling malaria cases; MACEPA and Akros to support the local training of CHWs to deliver health services and surveillance activities closer to people’s homes; senior school staff from Kabuyu Primary School; Chief Mukuni, whose unwavering support in malaria elimination has filtered through the traditional leadership of village headmen; and partnerships with religious organizations and cross-border malaria organizations, vital since Kabuyu is less than 50 kilometers from the Zambezi River, the border with Botswana.

“The global malaria community can learn a lot from Kabuyu’s example,” Duncan Earle, Director of Country Programs, MACEPA, said. “The reality is that elimination will happen first at community level and close-knit partnerships between health workers and the communities they serve will be critical. Technical partners in government and the broader malaria control and elimination community need to prioritize their support with this in mind so that every one of the 7,000 people living in Kabuyu can be protected from malaria. Empowering communities like Kabuyu to control their own malaria destiny will be the key to achieving malaria elimination throughout Zambia—Kabuyu shows us that.”

By working shoulder-to-shoulder with the goal of eliminating malaria, more places in Zambia and the region will begin to resemble Kabuyu. Toward the end of the program, students in neatly pressed uniforms read out poems in Tonga, the local language. Malaria poetry is a common World Malaria Day commemoration activity, but unlike the usual poems, these were not about the first-hand experience of a child getting sick from malaria. These students have grown up in a community that no longer suffers from malaria, so today their poems included the statistics that reflected their ongoing victory against this preventable disease.