Zambia Integrated Management of Malaria and Pneumonia Study (ZIMMAPS)

Project Description

Malaria and pneumonia are the two leading causes of death among children under age five in sub-Saharan Africa. Fever is a symptom of both conditions, making it very difficult to distinguish one disease from another, particularly for volunteer community health workers who provide primary health care in remote rural areas. All Zambian children who come to rural community health posts with a fever are treated with antimalarial drugs and those suspected of pneumonia are referred to the health center. This often leads to treatment for the wrong disease, exposure to inappropriate antimalarials, and delays in care for pneumonia.

The Zambia Integrated Management of Malaria and Pneumonia Study (ZIMMAPS) was designed to determine whether community health workers could employ a simple, rapid diagnostic test (RDT) for malaria, and, based on the results, follow strict treatment guidelines to treat accordingly. Children who tested positive were treated for malaria and those suspected of having simple pneumonia were given a course of the antibiotic amoxicillin. Severe cases of pneumonia were referred to a health center.

Findings from ZIMMAPS showed that with proper training and support, community health workers can effectively diagnose and treat malaria and pneumonia, thus improving the treatment rates for both.

As a result, Zambia’s National Malaria Control Center and the Child Health Unit are scaling up use of the antimalarial drug artemether-lumefantrine with the use of RDTs by community health workers and integrating pneumonia treatment into existing home management treatment of malaria.

The study also helps address problems associated with presumptive treatment for malaria—waste and overtreatment—as well as delays in getting treatment for pneumonia. Public health experts worry that over-prescription could lead to widespread resistance to the artemisinin-based combination therapy drugs currently used in Zambia and nearly all other African nations. In addition, the delay in starting treatment for pneumonia could lead to severe disease and death. A thorough cost analysis of the intervention versus the standard practice is also planned.

This project is one activity of the CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Kojo Yeboah-Antwi
Boston University Co-Investigators Davidson Hamer, William MacLeod, Lora Sabin
  • Child Health Unit, Ministry of Health – Zambia
  • Mazabuka District Health Management Team
  • National Malaria Control Center (NMCC)
  • Siavonga District Health Management Team
  • The Salvation Army – Chikankata Mission Hospital
Country(ies) Zambia
Dates of Research 2006–2009