MAMaZ Against Malaria

MAMaZ Against Malaria aims to address the lack of access to quality commodities for case management of severe malaria in rural Zambia.

The project aims to increase access to community-based pre-referral treatment for severe malaria (pre-referral rectal artesunate – RAS) for children from six months to under six years old, and to reduce referral delays from the community to health facilities that are equipped to treat severe malaria, ideally with injectable artesunate.

The goal of the project is to devise an evidence based and sustainable strategy for improving the access of hard-to-reach communities to effective treatment for severe malaria, including rectal artesunate (RAS) at community level in a high malaria burden setting.

The project will generate evidence to show that it is feasible to:

  1. Provide pre-referral treatment for severe malaria at community level; and
  2. Improve case management of severe malaria at lower level health facilities.

MAMaZ Against Malaria is using a health systems and operational research approach to address the constraints that limit knowledge of severe malaria at community level and access to quality medical drugs which undermine effect case management.

MAMaZ Against Malaria is a follow on pilot project after the successful implementation of the maternal health focused More MAMaZ project.

MAMaZ Against Malaria will:

  • Increase access to severe malaria commodities in remote areas.
  • Intervene at community level to reduce barriers and delays in treatment-seeking and increase patient completion of referral.
  • Intervene at facility level to optimize case management for severe malaria.

The project operates in Serenje District, Central Province, across 10 intervention health facilities and 45 intervention communities. Intervention communities are sites that have previously participated in the MAMaZ and MORE MAMaZ projects.

MAMaZ Against Malaria is funded by the Medicines for Malaria Venture. The project is implemented by Transaid, Health Partners Zambia, Development Data and Disacare in partnership with the Zambian Ministry of Health and Serenje District Health Management Team.

Background

Malaria is serious public health problem in rural Zambia particularly affecting children under five.

A variety of delays and barriers to successful treatment for severe malaria mean that incidence rates in Central Province between 2013 and 2015 were 495 per 1,000 children under 5 years (Inambao et al, 2017, in Health Press Zambia Bulletin, based on analysis of HMIS data).

Delays in seeking and reaching care at the community level include:

  • Lack of understanding of severe malaria danger signs and of the need to refer urgently;
  • Preference for local remedies based on assumptions about causes;
  • Long distances to the nearest health facility; and
  • Lack of support or resources to transfer the sick to health facilities.

At the health facility level care can be hampered by:

  • Lack of capacity and commodities to treat severe malaria;
  • Inconsistent outreach services; and
  • Delays in onwards referral to district hospital.