Description
Introduction: Malaria transmission in Zambia is heterogeneous, with health facility catchment areas classified into five epidemiological strata ranging from Level 0, with no local cases, to Level 4 with 500 or more cases per 1,000 population. The National Malaria Elimination Strategic Plan (NMESP) 2022 to 2026 has recommended the addition of single low-dose primaquine (SLDPQ) to the standard antimalarial treatment in areas with an incidence of less than 125 cases/1,000 population. Primaquine is a gametocidal drug targeting the sexual forms of the Plasmodium sp. parasites which are responsible for infection of the mosquito. Introduction of SLDPQ requires pharmacovigilance due to the risk of hemolysis, an adverse effect of primaquine in people with G6PD deficiency. The National Malaria Elimination Program (NMEP) will adopt the Primaquine Roll Out Monitoring Pharmacovigilance Tool (PROMPT) for Day 0 and Day 7 of patient monitoring.
Methods: SLDPQ introduction will be piloted in 23 Sinda District HFCAs meeting the criteria of less than 125/1,000 in the first quarter of 2024. Implementation will follow six key steps: 1. Development of training materials and reporting tools 2. Procurement of all logistics 3. Training of sub-national level staff 4. Quarterly supervision visits 5. Mid-year evaluation 6. End-of-year evaluation.
Discussion: While malaria patients in Zambia have access to antimalarial therapy, the available options do not prevent malaria transmission from persistent gametocytemia post-treatment. This particularly places other occupants within the household and nearby areas at risk of getting infected with malaria. Some low-burden districts like Sinda have made progress towards elimination, but these gains risk reversal from imported cases from neighboring districts and the rest of Zambia. By interrupting malaria transmission from patients who have taken anti-malaria therapy, SLDPQ offers a potential tool for malaria elimination.
Conclusion: SLDPQ offers an additional tool for malaria elimination in low-burden areas of Zambia, beginning with a pilot in Sinda District. After the one-year pilot, the program will be evaluated for nationwide rollout.
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