By Stacey Naggiar
Advocacy and Communications Officer, MACEPA, and Global Health Corps Fellow
“Will they bring the malaria medicine on the river?” a fisherman asked at Chalokwa Fishing Camp in Siavonga. “There is no way of protecting us fishermen when we are on the river.”
In Sinazongwe, Pastor Bwalya spoke to fellow religious leaders. “God gives us wisdom to use medicine to help ourselves in the line of biblical teachings… let us preach this truth.”
Among 420 classmates, a timid girl raised her hand and asked, “Can I take the drugs even if I’m not sick?”
It’s the season for malaria mass drug administration in Zambia and these are a handful of the questions and comments raised in communities across Southern Province. Mass drug administration (MDA for short), a strategy to accelerate malaria elimination by treating people to get rid of parasites, has been done in Zambia before with promising results. It is one part of the Ministry of Health’s strategy to eliminate malaria from Zambia, supporting interventions like bednet distribution and insecticide spraying to reduce transmission.
But asking a quarter of a million people to take a drug is no easy task. That’s why the Ministry and MACEPA have been visiting fishing camps, schools, and religious leaders1 to take questions and share information about the campaign.
Dr. John Miller, MACEPA Senior Malaria Technical Advisor, said that community engagement works by creating demand for programs like MDA. “All of the malaria interventions we use in Zambia, including MDA, are demand driven,” he said. “Without the demand, coverage suffers and we cannot achieve elimination. Community awareness raising helps provide the necessary information to create the demand to ensure these interventions are used by individuals and households.”
In rural Zambia, fishing and farming supports the livelihood of many families. But the seasonal nature of the work means many people are away from home during certain times of the year. Reaching these mobile populations who spend months at a time living in fishing camps and on islands is especially important as this group is more likely to miss the opportunity to take the drugs as part of MDA.
On Chinyuka Island, part of Mazabuka District, young farmer Brian Gwanda was quick to embrace the opportunity to avoid malaria. “Where we live there’s too much mosquitoes and it’s very far to find a clinic. I’m taking the drugs because prevention is better than cure,” Gwanda said.
A fisherman working and living on the Kafue River for 20 years, Frank Nalishebo recognized the economic benefits of preventing malaria. “Malaria comes and goes but I have had it so bad I needed to be hospitalized. It’s good to prevent illness so you don’t get sick because if you get sick it means even your income will be hurt too.”
Chilumba Sikombe, MACEPA applied behavioral communications officer, says he was blown away by the enthusiasm for the program on the islands he visited in Sinazongwe, Kazungula, and Gwembe districts. “The excitement and the receptive nature of islanders for malaria elimination is very memorable knowing that such hard-to-reach populations have all along been marginalized. It was an eye-opener for me just realizing the magnitude of work ahead of us in this malaria elimination agenda,” he said.
Studies show that school-age children are often a major source of malaria infections in their communities. Even though they may not have symptoms, children still have malaria in their blood, making it possible for the disease to continue to spread.
Howard Mukonka, an eighth grade teacher of business studies at Mboole Primary School in Choma said, “It’s a good idea [to raise awareness among pupils], especially when it comes to malaria. Malaria is a serious disease. Each time you have an absence in most cases it has to do with malaria. When these programs come we want to support it and see it is implemented successfully.”
At primary and secondary schools, drama groups play an important role by translating complicated medical information into fun and compelling skits with song and dance to help drive messages home. It became clear that the messages were understood when students told us that they would relay information about MDA to their parents and other relatives.
For many, the prospect of receiving “Malaria Ends With Me” stickers was incentive enough to raise their hand but many also had important questions. “Why can’t male mosquitoes transmit malaria as well?” one asked. “How will the babies below three months and pregnant women in their first trimester be prevented from malaria since they will be excluded from taking the drug?” another wondered.
“Does the drug treat other diseases such as AIDS?”
“Does drinking alcohol interfere with how the drug works?”
“Can the medicine be taken during the nighttime?”
School after school, I realized, perhaps we are learning more from the pupils than they are from us. Their astute observations provide a unique opportunity to reflect on how we’re communicating these messages and to design future materials that will address common questions and concerns that were raised.
With Christianity the dominant religion in Zambia, the pulpit is often an untapped resource for delivering health messages. “Once you reach out to religious leaders, you have reached out to the entire community since every member of a community belongs to a church,” said William Dennis McDonald, a pastor in Livingstone.
In some cases the church can serve not only to educate about MDA but also to challenge common misconceptions. Ouita Mulenja, an evangelist pastor at Full Gospel Church in Pemba said, “Usually there are beliefs or myths about MDA. They may think its Satanism but if the community hears about the program through the church they are assured it’s very safe for them.”
Some even went as far to say, “Church leaders who don’t allow their congregants to take part in MDA should be punished for infringing on their church members’ right to health.”
“Every moment has been memorable,” said Elizabeth Chiyende, MACEPA community engagement officer. “I have experienced a lot from seeing drama groups translate and act out key messages on MDA, children asking the most intelligent questions, fishermen expressing the need for them to be protected from malaria, and engaging the interactive and enthusiastic religious leaders. Seeing a mother trying to explain the MDA to her children and her passion towards ensuring her children are well protected left me in awe.”