Last week, Zambia’s national football team won the Africa Cup of Nations for the first time in history, an extraordinary triumph that is still being celebrated across the nation.  A quintessential underdog story, the team’s dedication and relentless hard work led to the victory that in many ways mirrors another major battle taking place in Zambia – the fight to stop malaria.

In the global spotlight over the past decade for its unprecedented efforts to prevent and control the disease, the country’s most recent national survey showed it is continuing to make progress against the disease, but also that the country’s malaria map is uneven – ranging from high disease burden (Luapula and Northern Provinces) to low (Southern and Western Provinces) and even very low (Lusaka City). 

Zambia is displaying true leadership by responding with a new strategy that mirrors this range of malaria profiles within the country.   High burden areas need to reach and maintain high coverage of treated mosquito nets, sprayed walls, rapid tests and lifesaving treatment.  But what about places with low burden?

Zambia’s latest strategic plan calls for establishing five malaria-free zones by 2015.  To achieve that ambitious goal, a new three-step approach was developed that directly targets the malaria-causing parasite: 

• Step (1) Establish an information system:  As malaria is reduced it becomes more focal and therefore it’s critical to have timely local information. 
• Step (2) Conduct Test and Treat campaigns:  Trained community health workers going door-to-door to test, and treat as needed, everyone in target areas.
• Step (3) Introduce Surveillance:  Follow up on each individual confirmed case of malaria by testing others in that house, plus those in neighboring houses. 

Last year, Zambia’s malaria control program began Step 1, arming clinic workers across the country with mobile phones to report weekly the malaria situation in their communities.  With 400 clinics reporting, Zambia had reliable, real-time information to design and drive Step 2, its inaugural Test and Treat campaign.

After training community health workers and data collectors, the national program launched its effort with handheld computers, consent forms, testing kits and treatment.  In two districts, people were tested, regardless of whether or not they showed symptoms, and those testing positive for the parasite were given treatment on the spot.  In all, some 59,000 people in 12,000 households were screened for malaria in one month, reaching an estimated 95 percent of the target population.

The aim of Test and Treat is to test as many people as possible.  As early results show, most of those who tested positive were asymptomatic—feeling fine, but with malaria parasites in their blood.  Identifying and treating these people prevents them from infecting others through the next bite of a mosquito.  Expansion of this campaign is planned for the coming dry season and could begin, in one small pocket in Zambia, to model what it will take to eliminate transmission. Expansion of Step 3, Surveillance, will be critical in monitoring progress toward elimination nationally.

“All eyes are on us,” declared the District Medical Officer at the opening of this historic event, “When Zambia is free of malaria, people will remember that the effort began here.”   Let’s hope the country, newly crowned football champions of Africa, can soon declare another historic triumph – a malaria-free Zambia.