Malaria in Mozambique

Situation analysis

Malaria is endemic throughout the country in areas where the climate favours year-long transmission, with peak transmission observed after the rainy season (from December to April). Transmission intensity varies from year to year and region to region, depending on rainfall, altitude and weather. Plasmodium falciparum is the most common parasite, and is responsible for approximately 90% of all malaria infections, while P. malariae and P. ovale are respectively responsible for 9.1 and 0.9% of malaria infections.

According to the situational analysis carried out in Mozambique in 2000 malaria is the major cause of health problems, being responsible for 40% of all outpatients. Up to 60% of paediatric inpatients are suffering from severe malaria. Malaria is also the major cause of mortality in hospitals in Mozambique, i.e. approximately 30% of all hospital deaths. The estimated prevalence rates in the 2 to 9 year-old age group varies from 40 to 80%, with 90% of children under five years old infected by malaria parasites in some areas.

WHO/Stephenie Hollyman

Main malaria control strategies in Mozambique are as follows:

1. Diagnosis, case management and drug supply.
2. Integrated vector management and personal protection.
3. Health promotion and community mobilization.
4. Emergency response.
5. Programme management and systems development.
6. Monitoring and Evaluation (surveillance, information and research).

Challenges

• Shortage of human resources to implement activities;
• Weak supervision of the implementation activities;
• Need for training of health workers on malaria case management and vector control, at all levels;
• Need for adequate storage and distribution of artemisin-based combination therapy (ACTs) and rapid diagnostic tests (RDT);
• Weak monitoring and evaluation system.

Achievements

• Development of the strategic plan 2006-2009 including gap analysis;
• Approval of the Global Fund proposal for malaria (Round 6);
• Adoption of the Intermittent Preventive treatment (IPT) strategy for pregnant women in 2006;
• Introduction of 1st line treatment (AS+SP) at community level;
• Production and distribution nationwide of a training manual for community health workers (CHWs) and their training on the use of ACTs;
• Elaboration and distribution of guidelines on indoor residual spraying (IRS) and use of DDT as well as training of trainers of IRS supervisors conducted in the three regions of the country;
• Updating of laboratory guidelines for the diagnosis of malaria (microscopy and RDTs), including quality control (QC);
• Introduction of RDTs for malaria diagnosis, and elaboration and approval of criteria for their use. The standard operational procedures on RDTs was produced and distributed to all provinces and health units. The training of health workers on use of RTDs was carried out in 2007;
• The Malaria Indicator Survey was carried out June-August 2007 by the National Malaria Control Programme and the National Institutes of Health and Statistics (INS and INE) nationwide, and included the involvement of several malaria implementation partners such as the President's Malaria Initiative (PMI), Malaria Consortium, WHO and others;
• Comprehensive needs assessment including malaria program review and malaria business plan initiated recently in collaboration with partners.

Next steps

• Technical support for the elaboration of policies and guidelines;
• Strengthening human resources capacity at all levels;
• Strengthen monitoring and evaluation and information system;
• Improvement of the coordination with partners and information share;
• Scaling up all malaria intervention towards universal access.