Severe malaria case fatality reduced by 96% in pilot project in Zambia led by Transaid, MMV and partners

12-month MAMaZ Against Malaria pilot completed saving the lives of many children

28 Aug 2018

Transaid and Medicines for Malaria Venture (MMV), in collaboration with a consortium of partners and the Zambian National Malaria Elimination Centre (NMEC), have completed the 12-month MAMaZ Against Malaria (MAM) programme pilot with exceptional success – saving the lives of many children in Serenje district, Zambia.

During the pilot, severe malaria child case fatality was drastically reduced from 8% to 0.25%, with three recorded deaths during the 12-month study period compared to 97 deaths that would have been expected in this period.1

All suspected severe malaria cases identified in the community were given quality-assured Rectal Artesunate Suppository (RAS) (the pre-referral drug used in the community) and subsequently referred to a health facility. In addition, the project’s Emergency Transport System (ETS) supported more than 70% of all suspected severe malaria cases, with 1,066 transfers made to a health facility.

Severe malaria is highly prevalent in children under the age of five in the Serenje District and delays in receiving appropriate treatment costs lives. The MAM programme pilot set out to improve malaria case management by introducing RAS and increasing access to other key malaria medicines. To achieve this, it was also important to bolster the Emergency Transport System (ETS) by equipping communities with additional bicycle ambulances and training new riders.

Transaid and MMV worked in collaboration with the National Malaria Elimination Centre (NMEC) of Zambia to procure WHO-prequalified RAS (100mg). This drug gives children with suspected severe malaria an initial dose of artesunate, providing a 12-hour window to seek treatment at a health facility. Without RAS, children with severe malaria stand a greater risk of dying before they reach a health facility.2 Once at the health facility, children were then given injectable artesunate followed by a 3-day oral antimalarial treatment course.

Caroline Barber, CEO of Transaid, says: “The number of lives saved is a real testament to how important timely access to healthcare services is and we’re delighted to be able to share such excellent results and are now looking at how this approach can be scaled up across Zambia.”

“Malaria can become deadly all too quickly, especially for vulnerable children under 5,” said George Jagoe, Head of Access & Product Management, MMV. “This pilot project with Transaid has confirmed that we can save lives from severe malaria with appropriate interventions even in access-challenged rural settings. The incredible 96% reduction in case fatality shows the undeniable benefit of using of RAS and ETS in tandem and the importance of scaling up this work to save more lives from this disease.”

Victor Simfukwe, Transaid’s project manager in Zambia, commented; “The strong partnership with NMEC and District Health Management Team (DHMT) has really made this project so successful. We have all worked together to achieve these results. The ETS component was absolutely integral to the success and we want to thank the partners and the communities for embracing the challenge of bringing RAS to Zambia for the first time and ensuring its availability in rural areas.”

Footnotes

1 Expected deaths calculated based on the case fatality rate measured during the baseline (8%) and the elevated suspected severe malaria cases (1,215 cases) measured during the project compared to the baseline (224 cases), the project would have expected 97 deaths without any intervention.

2 World Health Organization. Rectal artesunate testing and delivery (2016)