Executive Summary

The Power of Love team along with the beneficiary families, would like to say a “big thank you”. Your generosity and caring are have resulted in improved health, fewer missed days at school/work and in lowering the incidence of malaria in beneficiary communities in Zambia.   

Benefits of Eradicating Malaria: 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 countries huge economic benefits by freeing up scarce resources for developmental projects, improving worker productivity, and increasing school attendance. Ending malaria will generate profound health and economic benefits globally. Studies have shown that malaria free countries have five times greater economic growth than countries with malaria. Each dollar invested in malaria control in Africa, returns $40 in economic growth, contributing to Africa’s prosperity and its prospects as a trading partner.

In 2018, malaria (which is both preventable and curable), killed more than 250,000 children in Africa. Children who contract malaria suffer from its effects over their entire lifetime. Studies in Uganda have shown that children that survive an episode of malaria in some parts of Africa can go on to be re-infected up to 13 times a year. We are winning the fight against malaria: Between 2010 and 2018, malaria incidence among populations at risk (the rate of new cases) fell by 20% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 34% among children under five. Let’s not stop now while we have momentum.  

Project Rationale: In Zambia, malaria transmission rates are high in all areas of the country, due to high co-infections rates between HIV and malaria, water logging, and poor sanitation. One-third of households do not have access to even one net and the remainder may need more than one net per household. Also, less than 50% of children under five sleep under a net, even though malaria can be fatal for them. HIV+ pregnant women are also highly vulnerable.

Our vision: Our vision is zero transmission rates of malaria in Zambia.

Zambia can be malaria free: Zambia has set a lofty goal of eliminating malaria by 2021 and is making huge strides toward this goal. According to the USAID this goal is ambitious but within reach.

Our response: To help Zambia achieve this goal, we provided 11,500 (up from 8,500 in 2018) insecticide treated nets and education to vulnerable communities in 2019. This will bring the total number of nets provided in Zambia to 22,500 in the last three years.

Plan for 2020: Our plan is to provide 12,000-15,000 nets and education in 2020.

Program activities are designed to keep families’ malaria free and children in school. As a result of our malaria prevention program, we are seeing fewer cases of malaria and fewer missed days at work/school in beneficiary families.  

About Malaria and Its Impact 

Malaria can kill: Globally malaria is still a problem. Worldwide there were an estimated 228 million cases of malaria and 405,000 deaths in 2018. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden - this region was home to 93% of malaria cases and deaths in 2018. In addition, children under five are particularly susceptible; in 2018, malaria killed an estimated 272,000 children - most in the African region. This implies that we lose a child to malaria every two minutes. Moreover, HIV+ pregnant women, people infected with TB, older people, and people living with HIV are especially vulnerable to malaria due to high co-infections rates between malaria, HIV, and TB.

Is it possible to reduce malaria deaths to zero? The answer is “yes, as malaria is both preventable and curable. Malaria has been eradicated in several countries such as the US, and it is possible to eradicate it worldwide.

Need for Nets: In 2018, only 50% of people at risk of malaria in sub-Saharan Africa slept under an ITN (insecticide treated net) compared to 30% in 2010 and a mere 2% in 2000. However, the rate of increase in ITN coverage has slowed since 2014. According to the World Health Organization, 90 percent of families with a bed net use it. However, only 43% of households had enough nets for all household members which is drastically short of the universal access of 100% to achieve the UN sustainable development goal of ending malaria by 2030. Moreover, a decline in the coverage of insecticide treated nets can lead to a major resurgence of the disease and can reverse the gains achieved over the last several years. This underscores the need to increase access to nets.    

Challenges: Malaria endemic countries are working to overcome the following challenges: (i) lack of sustainable and predictable international and domestic funding, (ii) risks posed by conflict in malaria endemic zones, (iii) anomalous climate patterns, and (iv) mosquito resistance to insecticides.

Zambian Response: Zambia is making huge strides toward its goal of eliminating malaria by 2021. Since July 2017, the Medicines for Malaria Venture and the Zambia National Malaria Elimination Centre have been working together to improve severe malaria case management. These organizations are using bicycle ambulances, an innovative approach, to ensure timely treatment for children severely ill with malaria. This new approach is saving lives. The country faces significant challenges such as poor infrastructure, weak health systems, porous borders, lack of funds, and mosquito resistance to insecticides. However, many of these challenges can be overcome with the provision of education and insecticide treated nets.

Project Mosquito Nets Program Activities in 2019

Beneficiary communities: Several urban and rural communities were selected based on need and malaria transmission rates. The urban communities are Matero, Garden, Lusaka West, and Mother of Mercy Hospice in Lusaka. The rural communities are Kafue (30 miles south of Lusaka), and Lwashimba (125 miles north of Lusaka). Many areas in these communities are breeding grounds for mosquitoes, due to water logging and poor sanitation leading to a high incidence of malaria. Second, these communities have a high incidence of malaria as co-infection rates between HIV, malaria, and TB are high. Most residents cannot afford nets as they live on less than $2 per day, defined as extreme poverty by the UN.

In Matero, one of the largest and poorest compounds in Lusaka and one of our distribution sites, the following activities were organized. A typical distribution event starts with a traditional prayer led by beneficiaries. The attendees include local leaders, health care professionals, and representatives from churches, community organizations, health clinics, and beneficiary families from the community.

Education on Prevention of Malaria: 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 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 that the best way to prevent malaria was to sleep under a net regularly during malaria season. Information regarding location, timing, and cost of re-treatment 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 could be fatal for HIV+ pregnant women and young children. This was followed by a demonstration on the proper use of nets by health care professionals from government clinics, and a question answer session.

Provision of Nets: In 2019, 11,500 long lasting insecticide treated nets were provided in urban and rural communities in Zambia. Many areas in these communities are breeding grounds for mosquitoes, due to water logging and poor sanitation. In rural areas such as Lwashimba and Kapiri, the need for nets is especially huge due to the high level of poverty and lack of education regarding malaria; Kapiri-Mposhi saw an increase in malaria cases in 2018. Most rural areas are visited by medical staff to administer vaccinations, anti-natal services, and weigh babies just twice a month. Our nets provision activities coincided with these bi-monthly visits to maximize access to vulnerable populations. 

Profile of Beneficiaries: Identification of beneficiaries was done with the help of community organizations, churches, and government health clinics. Most beneficiaries are children living with HIV, young children, pregnant women, breast feeding moms, and adults who are infected with TB and/or HIV. These populations are most vulnerable to malaria due to weak immune systems and a high co-infection rates between malaria, HIV and TB. They cannot afford to purchase nets for their families. Stories of two typical beneficiaries are given on page 9.

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, education is provided prior to the provision of nets. Third, follow-up studies are conducted regularly to assess impact and to gather feedback from community members.

Lives can be saved for just a few pennies: A net that costs a mere $5, can sleep up to four young children or two adults. This implies that a single net can keep 3-4 children malaria free, healthy and in school. Since malaria can be fatal for young children and HIV+ children, and assuming the life of a net is two years, a single net can save lives for just a few pennies a day.

Impact Studies: To assess impact of 5000 nets provided in May/June 2019, a study was conducted in September 2019. Information was collected from 1,500 beneficiaries via questionnaires and focus group discussions. Study findings based on 1,465 usable responses were as follows:

• 1423 beneficiaries had information regarding proper use, maintenance, and storage of nets.
• There was no case of malaria infections or death amongst the study participants.
• On average more than 2 people were using one net.
• 42 beneficiaries did not have information regarding re-treatment. They have been provided with this information.
• 100% of study participants requested more nets as they did not have enough for all members of their household.
• With better health, school attendance has improved, and we expect higher school performance.
• The nets are kept clean and are in good condition (not torn).
• All families would like this program to continue in 2020 and beyond.

Challenges: In rural areas such as Lwashimba and Kapiri-Mposhi, a few beneficiaries complained that the nets were being eaten by rats, and that the rural health center did not have enough medicine to re-treat the nets.

Program Impact

Provision of mosquito bed nets and education has gone a long way in reducing the incidence of malaria. More specifically, beneficiaries have an improved quality of life due to:

• better knowledge about proper use and storage and re-treatment of nets,
• have fewer infections and deaths due to malaria,
• need fewer visits to hospitals/clinics due to better health,
• with better health, there is an increase in school attendance, and fewer missed work days.

A malaria-free world: We believe that together we can end malaria in the next few years. A malaria free world will result in healthier, more economically stable families, and more sustainable communities.