Zambia

Severe malaria facts

Zambia is among the 20 countries with the highest malaria incidence and mortality globally.  The country carries 2% of the global malaria case burden and 5.2% of the case burden in East and Southern Africa.1

There was a 23% reduction in cases between 2015 and 2018 from 2013 to 157 per 1000 of the population at risk while mortality rates fell by 7% from 0.47 to 0.43 per 1000 of the population at risk. Severe malaria cases also decreased by 58% from 15.8 cases per 1,000 population in 2010 to 6.6 cases per 1,000 in 2015.  The country is expected to be able to reduce case burden by 40% by 2020.1

The country has put in place measures to address these issues. As of the end of 2018, at least 60% of households had one ITNs for every two people. Close to 10 million additional courses of ACTs were also delivered in 2018 versus 2017 levels.1

Additional efforts have included training of health providers in the management of severe malaria. Severe malaria in pregnant women is treated with intravenous quinine in the first trimester and injectable artesunate in the second and third trimesters.

Malaria transmission

Plasmodium falciparum is responsible for 98% of all infections although there are four main malaria parasite species are present in Zambia (Plasmodium malariae, Plasmodium ovale and Plasmodium vivax are the other three).3

Healthcare system

Ministry of health structures have been established at four levels.2

  • National Level: the MoH headquarters manage the coordination of the entire health sector.
  • Provincial Level: provincial health offices coordinate health service delivery in their provinces.
  • District Level: district health offices manage health service delivery at the district and community level.
  • Community Level: neighbourhood health committees have been put in place to ease connections between communities and the health system.

Public health facilities (including community outreach centres) provide most of the health care delivery and malaria control services in Zambia.2 Faith-based organisations (mostly under the umbrella of the Churches Health Association of Zambia) provide over 50% of formal health services in the rural areas and close to 30% of health care in the country.2

Zambia launched its National Malaria Elimination Strategic Plan (NMSP) in April 2018 to serve as a strategy towards a malaria-free Zambia.3 Key tenets of the plan are equitable access to quality-assured, cost-effective malaria prevention and control interventions.2

In 2017, the National Malaria Elimination Program of Zambia and its partners revised the Guidelines for the Diagnosis and Treatment of Malaria to include artesunate rectal capsules for pre-referral treatment of severe malaria in children less than six years, including at the community level.2  

There is renewed MoH interest in scaling up the use of artesunate rectal capsules for the management of children with severe malaria at the time of referral from community settings and health posts.4

Inpatient and mortality rates

Severe malaria distribution

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong IV artesunate
Alternative IM artesunate
Alternative IV quinine
Alternative IM quinine
Recommendation Pre-referral
Strong Injectable artesunate
Alternative Rectal artesunate
Alternative Inj quinine
Alternative Inj artemether
Severe malaria in pregnancy
Recommendation Treatment
First trimester Inj quinine
2nd and 3rd trimester Inj artesunate