What the Beginning of the End of Malaria Looks Like

Malaria affects 97 countries around the world, but Zambia is leading the way to end the disease for good.

April 01, 2015 Lesley Reed

The Importance of Home Treatment

In Zambia’s southernmost district, near Victoria Falls, a robust malaria control program has had a dramatic impact. Ten years ago, as much as half of the population had malaria in the hardest-hit areas. That number is down to just five cases out of 1,000 people now. In villages where there are no clinics, volunteer health workers now manage malaria from their homes—testing people who show symptoms, treating those who test positive, and tracking down anyone else who may have been infected. “Our homes are the local health post,” explains Precious Namakau. “We are always on duty.”

(Photo: Gabriel Bienczycki/PATH.org)

Teams of Two

A more intensive approach is being tried in districts to the north, where malaria has proved to be more stubborn. Teams of two—consisting of a health care worker and a data collector, both volunteers—spread out across target villages, testing and treating every member of every household. Nearly 1,000 community health workers and data collectors tested and treated more than 158,000 people in just one month.

(Photo: Gabriel Bienczycki/PATH.org)

Preventing New Infections

Phineas Chibinga—in the black striped shirt—was amazed and hopeful when we told him that the United States had eliminated malaria. He agreed to have every person in his household tested. Fortunately, his family members all tested negative, but they were still given a three-day supply of drugs to kill any malaria parasite the test may not have detected—a key step in eliminating the disease. The drug will also prevent new infections for a month. By then, at least two generations of mosquitoes will have lived and died, diminishing the possibility of mosquito-to-human transmission.

(Photo: Gabriel Bienczycki/PATH.org)

Long Day’s Work

Malaria teams spend eight to 10 hours a day walking or bicycling from homestead to homestead. Data collectors—who record and transmit information using simple mobile phones—sometimes have to climb trees to get cell reception. They send data about malaria infections, bed-net use, and other issues to district headquarters, where, for the first time ever, health officers are getting the real-time information they need to better manage the disease.

(Photo: Gabriel Bienczycki/PATH.org)

Chief of Change

“I cannot be a chief without people,” says Chief Singani of the Tonga people in the Choma District. “I saw my people were dying—that’s why I became a champion against malaria.” Chief Singani gave permission to the Zambian Ministry of Health and PATH’s malaria program to carry out the mass treatment program in his chiefdom and has helped overcome fears by leading by example. “Once I’m there also, they say, ‘Our chief is here. Let us listen carefully now.’ In that way, politely, they agree.”

(Photo: Gabriel Bienczycki/PATH.org)

The Health Committee

Members of the neighborhood health committee in the village of Nega Nega have seen a significant decline in malaria. The cases they do find are usually among migrant workers who are arriving from high malaria transmission areas to work on the local sugar cane plantations. To fight malaria, committee members work to get rid of water stagnation, distribute bed nets, and trace contacts when the increasingly rare case arises. “Our intention is to finish malaria,” says member Mwenda Machiha, center.

(Photo: Gabriel Bienczycki/PATH.org)

A Young Life Cut Short

Death from malaria is now so rare in Nega Nega that the recent loss of a two-year-old named Rogan devastated nurse Given Kasanga (shown with his son Joshua). Rogan contracted malaria while traveling with his mother. When he was brought into the health center, he was convulsing and so dehydrated that Kasanga couldn’t insert an IV. It took five hours for an ambulance to arrive. “We waited and waited,” Kasanga remembers, “but by the time the ambulance reached us, the child had died. We tried our best, but still we failed.”

(Photo: Gabriel Bienczycki/PATH.org)

Lake Kariba

Lake Kariba, in southern Zambia, is stunning at sunset—but malaria makes it hard to live in this community, which has yet to receive comprehensive testing and treatment. Malaria is so common here, residents contract it multiple times per year. The results are devastating: Mothers miscarry, fathers can’t go fishing and their families go hungry, and children miss weeks of school at a time. The local fisherman’s association has banded together to support malaria prevention efforts. For example, they levy a fine on any member found using an insecticide-treated bed net as a fishing net instead of hanging it in the home.

(Photo: Gabriel Bienczycki/PATH.org)

A Future With No Malaria

“Here in Africa, many people were dying of malaria,” remembers midwife Fanny Sikalundu. “I saw children with high fevers and convulsions; some were unconscious. We don’t want malaria here anymore.” Sikalundu is in charge of Harmony Health Post, where she’s helping coordinate the malaria elimination strategy. “I know it’s getting better,” she says. “In the future, there will be no malaria.”

(Photo: Gabriel Bienczycki/PATH.org)

What the Beginning of the End of Malaria Looks Like — Thirteen Photos That Prove Living in a Poor, Rural Area Doesn’t Have to Be a Death Sentence for Babies

DIEN BIEN PROVINCE, Vietnam—In many regards, Vietnam is a success story. It’s graduated from low-income to lower-middle-income status over the past 25 years. Poverty rates have dropped from 58 percent to 20 percent. Its health system is expansive, with an exhaustive immunization program; coverage is in the 90th percentile for most vaccinations. (Though the country did encounter a setback last year with an unexpected measles outbreak, it was able to quickly address the issue and regain control.) Many of Vietnam’s vaccines are produced at a state-run facility, saving the country millions in hard currency. The nation has met five of the 10 Millennium Development Goals, and the World Bank says it has “one of the strongest results records of any World Bank borrower.”

Nonetheless, geographic pockets throughout Vietnam lag behind. In a country of 90 million, Dien Bien’s relatively small population of about 500,000 consists of 80 percent ethnic minorities—and a significant portion live in remote, mountainous areas that are hard to reach. Though blessed with natural beauty, the region struggles to match the health achievements of the urban center. Here, nearly 40 percent of households live in poverty, and one in three children is malnourished. The rough terrain, coupled with limited options for livelihood (most residents are farmers), make Dien Bien an ongoing challenge for the Vietnamese government’s health care system.

But midwives, local clinicians, and nonprofit organizations are tackling these inequities and making progress. The following images were taken in the provincial hospital and a remote clinic outside of Dien Bien Phu, the largest city in the province. The Ministry of Health has partnered with UNICEF to concentrate on Dien Bien and has received support from Luxembourg and Japan to carry out maternal and infant health care programs.

Lesley Reed is a senior writer and editor at PATH, an international nonprofit organization focusing on global health innovation, and was previously a development and famine relief worker in West Africa. Last December, she spent 10 days in Zambia traveling with photographer Gabriel Bienczycki to cover PATH’s malaria prevention program. Here, she shares behind-the-scenes stories from their time abroad.

SOUTHERN PROVINCE, ZAMBIA—Remember the last time you had malaria? Chances are, the answer is no. (And if you answered yes and live in the United States, you were probably born before 1951, the year the U.S. eliminated the disease, thanks mostly to the chemical DDT.)

In sub-Saharan Africa, far too many people still answer yes to that question. Malaria has yet to be eliminated, but one country has been leading the way.

When I traveled to Zambia 10 years ago, hospitals were overflowing with feverish children suffering from the disease. When I returned this past December, I found something entirely different: a country mobilized to end malaria. Over the past decade, PATH has been working with the local government to rapidly bring down malaria rates in the country. Malaria affects more than 4 million Zambians annually, and 8,000 die every year from the disease, according to UNICEF.

To end malaria for good, Zambia needs new strategies to stop the transmission of the parasite from mosquitoes to humans and back again. The vast majority of people who carry the parasite never go to a clinic; while many have no symptoms, they are still infectious. Thanks to a key partnership with the government of Zambia, we’re piloting a groundbreaking approach in Southern Province that aims to treat whole communities in one fell swoop.

Photographer Gabriel Bienczycki joined me for the 10-day trip, and the two of us met dozens of people involved in the effort. From ministers, teachers, and chiefs to the children who offered their fingers to be pricked for the malaria test, here are the stories that inspired us.

Enter Photo Gallery

The Importance of Home Treatment

Teams of Two

Preventing New Infections

Long Day’s Work

Chief of Change

The Health Committee

A Young Life Cut Short

Lake Kariba

A Future With No Malaria

Thirteen Photos That Prove Living in a Poor, Rural Area Doesn’t Have to Be a Death Sentence for Babies