THE PRESIDENT’S MALARIA INITIATIVE 

SAVING THE LIVES OF MOTHERS 

AND CHILDREN IN AFRICA 

FIRST ANNUAL REPORT 

MARCH 2007 

THE PRESIDENT'S MALARIA INITIATIVE 

SAVING THE LIVES OF MOTHERS 

AND CHILDREN IN AFRICA 

FIRST ANNUAL REPORT 

MARCH 2007 
Cover photo:
 


A mother and her two children, one of whom has a fever she suspects is due to malaria, sit in front of a
 


health clinic in Rufiji district, Tanzania. PMI is providing lifesaving artemisinin-combination drugs to
 


clinics in this district to treat malaria cases promptly and effectively. 
 


Credit: USAID / Karie Atkinson
 


ii  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
TABLE OF CONTENTS
 


Abbreviations and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
 


Executive Summary and Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
 


Chapter 1: The Global Challenge of Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
 


Chapter 2: Malaria Control Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
 


Chapter 3: Angola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
 


Chapter 4: Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
 


Chapter 5: Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
 


Chapter 6: Partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
 


Chapter 7: Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
 


Chapter 8: Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
 


Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
 


Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
 


SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  iii
iv  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
ABBREVIATIONS AND ACRONYMS
 


ACT Artemisinin-based combination therapy 

ADDO Accredited drug dispensing outlet 

CDC Centers for Disease Control and Prevention 

CHW Community health worker 

DHS Demographic and Health Survey 

DSS Demographic Surveillance System 

FANC Focused antenatal care 

FY Fiscal year 

GFATM The Global Fund to Fight AIDS, Tuberculosis, and Malaria 

HHS United States Department of Health and Human Services 

HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome 

IDP Internally-displaced persons 

IPTp Intermittent preventive treatment for pregnant women 

IRS Indoor residual spraying 

ITN Insecticide-treated mosquito net 

MCP Malaria Communities Program 

MEDA Mennonite Economic Development Associates 

MoH Ministry of Health 

NGO Non-governmental organization 

NMCP National malaria control program 

PEPFAR President’s Emergency Plan for AIDS Relief 

PMI President’s Malaria Initiative 

RDT Rapid diagnostic test 

SP Sulfadoxine-pyrimethamine 

UNHCR United Nations High Commissioner for Refugees 

UNICEF United Nations Children’s Fund 

USAID United States Agency for International Development 

WHO World Health Organization 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  v
’

THE PRESIDENT’S MALARIA INITIATIVE 

“The toll of malaria is even more tragic because the disease itself is highly treatable and preventable. Yet this is 

also our opportunity because we know that large-scale action can defeat this disease in whole regions. And the 

world must take action.” – President George W. Bush, June 30, 2005 

1  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

Nineteen-year-old Sikiri Mchotike with her sixteen-month-old daughter, in Tanzanias Rufiji district. Pregnant USAID / KARIE ATKINSON 

mothers and children are the groups most vulnerable to malaria. The PMI focuses on reaching these two target 

groups with lifesaving drugs and insecticide-treated mosquito nets. 
’

EXECUTIVE SUMMARY AND BACKGROUND
 


THE PRESIDENT’S MALARIA INITIATIVE 

AT A GLANCE 

Goal 

• Reduce the number of deaths caused by malaria 

by 50 percent in 15 African countries by 2010. 

Four Key Interventions 

• Insecticide-treated mosquito nets 

• Indoor residual spraying with insecticides 

• Intermittent preventive treatment for pregnant women 

• Artemisinin-based combination therapies 

Timeline and Budget 

• Year 1: $30 million in funding for 3 countries 

• Year 2: $135 million in funding for 7 countries 

• Year 3: $300 million in funding for 15 countries 

• Year 4: $300 million in funding for 15 countries 

• Year 5: $500 million in funding for 15 countries 

Accelerating the Fight Against Malaria 

Each year, an estimated 300 to 500 million people 

become ill with malaria worldwide and more than one 

million die. Of these deaths, 85 percent occur in subSaharan Africa. For children in Africa, malaria is a 

leading cause of death. It also accounts for approximately 40 percent of public health expenditures in Africa and 

is estimated to cause an annual loss of $12 billion from 

the continent’s gross domestic product. 

In spite of these grim statistics, malaria is a preventable 

and treatable disease. At a meeting in Abuja, Nigeria, in 

2000, African heads of state made a pledge to significantly scale up malaria control efforts in their countries. 

Since that time, the international community has 

responded by increasing global advocacy and funding for 

malaria control in sub-Saharan Africa through the Roll 

Back Malaria Partnership, The Global Fund to Fight 

AIDS, Tuberculosis, and Malaria (GFATM), The World 

Bank Malaria Booster Program, and private donors, such 

as the Bill and Melinda Gates Foundation. In June 

2005, President George W. Bush, recognizing the critical 

need for greater international efforts to reduce the burden of malaria across Africa, announced the President’s 

Malaria Initiative (PMI). 

Goals of the Initiative 

The PMI represents an historic five-year expansion of 

U.S. Government resources to fight malaria in the region 

most affected by the disease. The President committed 

an additional $1.2 billion in malaria funding to this 

Initiative and set two ambitious goals for PMI focus 

countries: 

•	 Reduce the estimated number of deaths caused by 

malaria by 50 percent; and 

•	 Reach 85 percent of those most vulnerable to malaria 

– children under five years of age and pregnant 

women – with a package of four proven and highly 

effective prevention and treatment measures. 

Structure of PMI 

The PMI is an interagency initiative led by the 

U.S. Agency for International Development (USAID)
 


and implemented together with the Centers for 
 


Disease Control and Prevention (CDC) of the
 


Department of Health and Human Services (HHS). 
 


It is overseen by a PMI Coordinator and an Interagency
 


Steering Group made up of representatives of USAID,
 


CDC, Department of State, Department of Defense,
 


National Security Council, and Office of Management
 


and Budget. 
 


USAID / KARIE ATKINSON 

Dr. Ngajilo, a clinical officer at Kibiti Health Center in 

Tanzanias Rufiji District, explains to 17-year-old Stamili Rutta 

how to give ACTs to her ten-month-old son Moja Mohammed. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  2
PMI RESULTS AT A GLANCE 

Angola 

• 540,949 long-lasting insecticide-treated nets distributed in seven provinces at high risk of malaria. 

• 107,373 houses sprayed with insecticide, and 590,398 people protected in epidemic-prone provinces. 

• 1,450 health workers trained in intermittent preventive treatment for pregnant women. 

• 587,520 artemisinin-based combination therapy treatments procured and being distributed. 

• 129,875 rapid diagnostic tests procured for use in health facilities in nine districts. 

• 1,283 health unit staff trained on use of artemisinin-based combination therapy. 

Tanzania 

• 130,000 free long-lasting insecticide-treated nets distributed through local health clinics. 

• 13,894 of 382,900 infant vouchers distributed have been redeemed for insecticide-treated mosquito nets in just 

over one month. 

• 203,754 houses sprayed with insecticide, and 1,018,156 people protected on Zanzibar. 

• 376 health workers trained in intermittent preventive treatment for pregnant women. 

• 380,160 artemisinin-based combination therapy treatments procured and distributed to refugees in camps of 

northwestern Tanzania and residents of Rufiji District. 

• 875,000 rapid diagnostic tests procured for use on the mainland and Zanzibar. 

• 4,217 health workers trained on use of artemisinin-based combination therapy. Together with health workers trained 

by other partners, all 121 districts now have government health staff trained in the use of artemisinin-based 

combination therapy. 

• An estimated 128,000 people benefited from larviciding of mosquito breeding sites. 

Uganda 

• 305,305 free long-lasting insecticide-treated mosquito nets distributed through clinics and internally-displaced 

persons camps. 

• 505,573 nets retreated with insecticide in 29 districts. 

• 103,329 houses sprayed with insecticide, and 488,502 people protected in Kabale District. 

• 168 health workers trained in intermittent preventive treatment for pregnant women in 11 districts. 

• 261,870 artemisinin-based combination therapy treatments procured, of which 87% have been distributed to health 

facilities. 

• 2,844 health workers trained on use of artemisinin-based combination therapy in 16 out of 80 districts in the country. 

YEAR 1 BUDGET: $30 million (FY06) and $4.25 million (FY05) 

Country Selection 

Focus countries were selected and approved by the 

Interagency Steering Group using the following criteria: 

•	 High malaria disease burden; 

•	 National malaria control policies consistent with 

the internationally accepted standards of the World 

Health Organization (WHO); 

•	 Capacity to implement such policies; 

•	 Willingness to partner with the United States to 

fight malaria; and 

•	 Involvement of other international donors and partners in national malaria control efforts. 

Scaling Up PMI Activities 

The PMI began with a budget of $30 million in Fiscal 

Year (FY) 2006, which was supplemented by $4.25 million in reprogrammed FY05 funds. With Congressional 

approval, the PMI budget will grow to $500 million in 

FY2010. The PMI supports four proven and highly 

effective malaria prevention and treatment measures, 

which it tailors according to local patterns of disease, 

malaria control plans, and capacities: 

•	 Insecticide-treated mosquito nets (ITNs); 

•	 Indoor residual spraying (IRS) with insecticides; 

•	 Intermittent preventive treatment for pregnant 

women (IPTp); and 

•	 Artemisinin-based combination therapy (ACT) 

3  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
Year Fiscal 

Year 

Budget Focus Countries 

Year 1 2006 $30 million Angola,Tanzania, Uganda 

Year 2 2007 $135 million Malawi, Mozambique, Rwanda, 

Senegal (in addition to Year 1 

countries) 

Year 3 2008 $300 million Benin, Ethiopia (Oromiya), 

Ghana, Kenya, Liberia, 

Madagascar, Mali, and Zambia 

(in addition to Year 1 

and Year 2 countries) 

Year 4 2009 $300 million All 15 PMI countries 

Year 5 2010 $500 million All 15 PMI countries 

TOTAL: $1.265 billion 

Specific Targets 

The PMI has a single set of country-level targets for the 

four major control measures. These targets are the same 

for each focus country, and they apply to the populations 

most vulnerable to malaria – children under age five and 

pregnant women: 

•	 More than 90% of households with a pregnant 

woman and/or children under five will own at least 

one ITN; 

•	 85% of children under five will have slept under 

an ITN the previous night; 

•	 85% of pregnant women will have slept under an 

ITN the previous night; 

•	 85% of houses in geographic areas targeted for IRS 

will have been sprayed; 

The PMI Approach 

The PMI is organized around four operational principles 

based on lessons learned from over 50 years of U.S. 

Government efforts in fighting malaria, together with 

experience gained from implementation of the 

President’s Emergency Plan for AIDS Relief (PEPFAR), 

which began in 2003. The PMI approach involves: 

•	 Use of a comprehensive, integrated package of four 

proven prevention and treatment interventions; 

•	 Significantly-increased spending on procurement of 

lifesaving commodities, such as antimalarial drugs and 

insecticides for IRS; 

•	 Commitment to strengthen national malaria control 

programs and to build capacity for eventual country 

ownership of malaria control efforts; and 

•	 Close coordination with international and in-country 

partners. 

The PMI works within the overall strategy and plan 

of the host country’s national malaria control program 

(NMCP). Planning and implementation of PMI activities are coordinated closely with each ministry of health. 

The PMI intends to strengthen in-country capacity so 

that gains achieved with U.S. Government and other 

donor support are sustainable. 

Partnerships 

Partnerships are at the heart of PMI’s strategy. The PMI 

works closely with multilateral organizations, such as 

WHO, the Roll Back Malaria Partnership, The GFATM, 

The World Bank, the United Nations Children’s Fund 

•	 85% of pregnant women and children under five will 

have slept under an ITN the previous night or in a 

house that has been protected by IRS; 

•	 85% of women who have completed a pregnancy in 

the last two years will have received two or more doses 

of IPTp during that pregnancy; 

•	 85% of governmental health facilities will have ACTs 

available for treatment of uncomplicated malaria; and 

•	 85% of children under five with suspected malaria 

will have received treatment with ACTs within 24 

hours of onset of their symptoms. 

RESEARCH TRIANGLE INSTITUTE INTERNATIONAL 

Spraying the inside walls of homes is a highly effective method to 

prevent malaria. In Zanzibar, PMI has trained 452 spray operators, such as the one shown practicing here. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  4
(UNICEF), and with the private sector, including 

ExxonMobil, and Malaria No More. The participation 

of non-governmental, faith-based, and community-based 

organizations with their strong community ties and ability to deliver services to people in remote areas where the 

formal health system is weak is also crucial to the success 

of PMI. 

Achieving Results 

The PMI is off to a very rapid start. Within six weeks 

of the President’s announcement, PMI had fielded needs 

assessment teams to all three first-year countries. Within 

six months, high-impact activities were under way in 

Angola and Tanzania, and a month later in Uganda. 

During the first nine months of the Initiative, PMI 

supported highly-successful indoor residual spraying 

campaigns in all first-year countries. These campaigns 

protected more than two million people and were the 

first wide-scale spraying programs in these countries in 

decades. 

“We have the knowledge and the technology 

to prevent infections and to effectively treat 

people who have malaria. With this knowledge comes the obligation to act.” 

– Mrs. Laura Bush, First Lady, August 14, 2005 

In all three countries, PMI has significantly expanded 

ITN programs and is working to accelerate the transition 

from regular ITNs to long-lasting nets, which do not 

require periodic re-treatment. In both Angola and 

Uganda, private sector providers of ITNs have been supported and strengthened, contributing to sales of more 

than 600,000 ITNs to those who can afford to pay. In 

Uganda, PMI supported a campaign that resulted in free 

re-treatment with insecticide of more than 500,000 

existing nets. In total, PMI has procured and supported 

the distribution of approximately one million ITNs in 

its first year. In addition, PMI’s support for the Angola 

ITN campaign helped attract contributions of about 

400,000 additional ITNs from other donors. 

Artemisinin-based combination therapies have already 

been procured and delivered to all three countries, making this highly effective treatment available to vulnerable 

populations. The PMI is providing both microscopes 

and rapid diagnostic tests in all countries to improve the 

accuracy of malaria diagnosis. To prevent malaria in 

USAID 

Insecticide-treated nets are an essential tool to protect women 

and their children from malaria. 

pregnant women and reduce the incidence of life-threatening low birth weight among newborns, PMI has 

supported IPTp. In total, more than 10,000 health 

providers have already been trained in these critical 

interventions with PMI support. 

Highlights of the activities carried out during the first 

year of PMI in the three countries include: 

Angola: Beginning in December 2005 in Angola, the 

PMI supported a spraying campaign in epidemic-prone 

southern provinces, which included training 350 locally 

hired spray personnel and protected more than 590,000 

people. In addition, PMI provided technical assistance 

and commodity support to a complementary GFATMsupported spraying program that protected an additional 

176,000 people. In July 2006, PMI, in conjunction with 

the Government of Angola, The GFATM, the Measles 

partnership, ExxonMobil Foundation, and other donors, 

supported the free distribution of 826,000 long-lasting 

ITNs (420,000 contributed by PMI) in seven provinces 

at high risk of malaria. An additional 120,000 long-lasting nets were sold at subsidized prices to urban residents 

who had the ability to pay. With support from both 

The GFATM and PMI, ACTs are now used for the 

treatment of malaria in health facilities in two provinces. 

Tanzania: In Tanzania, beginning in mid-December 

2005, PMI distributed 130,000 free long-lasting ITNs 

(233,000 total with contributions by the GFATM) 

through local health clinics, more than doubling existing 

ITN ownership rates among pregnant women and children under age five on Zanzibar and Pemba Islands. 

5  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
USAID / KARIE ATKINSON 

Early results of the malaria-control interventions (longlasting ITN distribution and earlier GFATM provision 

of ACTs) were dramatic. According to local health 

reports, the number of laboratory-confirmed malaria 

cases on Pemba Island dropped 87 percent (from 12,531 

to 1,570) between January and September 2006 when 

compared with the same period the preceding year. Also 

in Zanzibar, PMI supported an indoor residual spraying 

campaign that benefited more than one million people. 

On the mainland, larviciding of mosquito breeding sites 

in Dar es Salaam is benefiting an estimated 128,000 people, and more than 380,000 ACT treatments have been 

procured and have arrived in-country. 

Uganda: To address the alarming rates of malaria 

mortality in internally-displaced person (IDP) camps 

in northern Uganda, PMI distributed over 300,000 free 

long-lasting ITNs to children and pregnant women. In 

addition, PMI is helping private net producers expand 

their markets, and more than 500,000 ITNs have been 

sold to those who can afford to pay. The PMI also procured and began distributing 261,870 pediatric ACT 

treatments as part of community-based distribution in 

northern Uganda. In August 2006, PMI completed a 

spraying campaign in southwestern Uganda that benefited 

488,000 people and trained more than 400 sprayers and 

supervisors who will be capable of implementing future 

programs. Finally, PMI completed a program that 

retreated over 500,000 conventional nets with insecticide. 

Looking Forward 

The PMI’s second year of implementation has begun. 

Activities are already under way in the four new FY07 

countries, and planning missions have begun in several 

of the eight newly announced FY08 countries. During 

this year, we intend to address major existing challenges: 

•	 The need for a rapid scale-up of ACT distribution 

and appropriate use of these drugs in countries with 

historically weak national pharmaceutical management 

systems; 

•	 The need to strengthen monitoring and evaluation 

systems for malaria so that national malaria control 

programs and partners can monitor the progress of 

their activities, make adjustments, and report on their 

results; and 

•	 The need to translate high ITN ownership into 

high net usage. 

The PMI is helping to change attitudes toward malaria 

control. No more a “fact of life” or an “intractable problem” in sub-Saharan Africa, malaria can be beaten back 

with a concerted effort from all partners. 

Jennifer Naya, who is pregnant with her fourth child, receives a 

free ITN and a dose of sulfadoxine-pyrimethamine (SP) to prevent her from getting malaria, together with counseling about 

HIV/AIDS. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  6
CHAPTER 1 

“Malaria is one of the greatest threats to human health and economic welfare on earth.” 

– Ambassador Randall L. Tobias, Director of U.S. Foreign Assistance and USAID Administrator, June 8, 2006 

7  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

Children under five, such as the Angolan children pictured here, are among those most vulnerable to malaria. ORC MACRO / ALFREDO FORT 
SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  8

Malaria Transmission and Infection

Malaria is a blood-borne infection transmitted to human

beings by the bite of female Anopheles mosquitoes that

carry the malaria parasite. The initial symptoms of a

malaria infection include fever, chills, and flu-like illness.

The malaria parasite infects and destroys red blood cells,

and if left untreated can result in anemia, lung and kidney failure, coma, and death. 

Malaria is typically found in warmer regions of the world,

such as sub-Saharan Africa, because both the mosquito

and the malaria parasite it carries thrive in tropical and

subtropical climates. Four types of malaria parasites infect

humans. In sub-Saharan Africa, the majority of infections are caused by Plasmodium falciparum. This species

of parasite is responsible for the most severe form of the

disease and for the majority of deaths worldwide. While

the infection is treatable with effective antimalarial medications, the emergence of widespread parasite resistance

to traditional antimalarial drugs, such as chloroquine,

has become a global challenge to malaria control.

Social and Economic Impact 

Approximately 3.2 billion people worldwide live in areas

at risk of malaria transmission. Each year, an estimated

300 to 500 million of them become ill with malaria, and

more than one million die. More than 80 percent of

these deaths occur in sub-Saharan Africa. Figure 1.1

shows the distribution of malaria in Africa. While all

persons living in areas where malaria is transmitted are at

risk of becoming infected, three populations are particularly vulnerable – children under five years of age, 

pregnant women, and people infected with HIV/AIDS.

Malaria is one of the leading causes of death among children in Africa, accounting for approximately 18 percent

of deaths in children under five.

Malaria and poverty are closely linked. Economists estimate that malaria accounts for approximately 40 percent

of public health expenditures in Africa and causes an

annual loss of $12 billion, or 1.3 percent, of the continent’s total gross domestic product. Although malaria

eradication efforts during the 1950s and 1960s successfully eliminated or controlled the disease in many areas,

malaria remains a major killer in Africa due to a combination of biologic, economic, and political factors. The

sub-Saharan climate provides ideal conditions for the

malaria parasite and mosquito vector, while poverty and

political instability have repeatedly created obstacles to

successful malaria control in many African countries.

Prevention and Treatment Interventions

Malaria is both preventable and treatable. While a

malaria vaccine is not yet available, several proven and

cost-effective prevention and treatment measures exist.

These include insecticide-treated mosquito nets, indoor

residual spraying of insecticides in homes, intermittent

preventive treatment of pregnant women with an antiTHE GLOBAL CHALLENGE OF MALARIA

MALARIA AT A GLANCE

• Each year, an estimated 300 to 500 million 

people become ill with malaria, and more than 

one million die.

• Every 30 seconds, an African child dies of malaria.

• More than 80 percent of the world’s malaria deaths

occur in sub-Saharan Africa.

• Malaria is a leading cause of death of children in Africa.

• Malaria accounts for approximately 40 percent 

of public health expenditures in Africa.

• Malaria is a preventable, treatable disease.

Female Anopheles mosquitoes acquire and transmit the malaria

parasite when they feed on a human host.

CDC
Figure 1.1: Distribution of Endemic Malaria in Africa 

malarial drug, and prompt use of artemisinin-based 

combination therapies for those who have malaria. 

The appropriate mix of prevention and treatment interventions varies according to local conditions, including: 

•	 Pattern of malaria disease transmission; 

•	 Mosquito resistance to insecticides and parasite resistance to antimalarial drugs; 

•	 Age and pregnancy status of infected persons; and 

•	 Operational feasibility and sustainability. 

An “Urgent Calling” 

First Lady Laura Bush described the defeat of malaria as 

an “urgent calling,” made even more pressing by the fact 

that the disease can be prevented. Malaria casts a shadow not only over health, but also educational 

attainment, worker productivity, and economic investment in sub-Saharan Africa. International development 

experts agree that malaria control is critical to the continued development of this region. Recognizing the 

grave threat presented by malaria in sub-Saharan Africa, 

and in anticipation of the 2005 G8 Summit, President 

Bush announced the President’s Malaria Initiative, a 

five-year, $1.2 billion initiative to cut malaria mortality 

by 50 percent in 15 African countries with a high burden of malaria. 

9  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  10
CHAPTER 2 

“The PMI is about saving lives – the lives of pregnant women and the lives of young children. With the support 

of the American people, the PMI is reaching pregnant women with lifesaving drugs and insecticide-treated nets 

– two key interventions in our fight against malaria” – Rear Admiral R.T. Ziemer USN (ret), Coordinator, President ’s 

Malaria Initiative, December 27, 2006 

11  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

The PMI has trained hundreds of spray operators to conduct IRS campaigns, including this team in Tanzania. USAID / TANZANIA 
MALARIA CONTROL INTERVENTIONS
 


INSECTICIDE-TREATED MOSQUITO NETS 

Background 

Insecticide-treated mosquito nets (ITNs) are one of 

three proven malaria prevention measures used by PMI. 

In Africa, malaria-carrying mosquitoes typically bite late 

at night or in the early morning hours. A net hung over 

the bed prevents mosquitoes from biting. When that net 

is treated with insecticide, it provides much greater protection by repelling and killing any mosquitoes that land 

on it. ITNs come in a variety of shapes, colors, and sizes 

to suit local tastes and needs. The insecticides used to 

treat the nets have been approved for safety and efficacy 

by the World Health Organization (WHO). 

The price of a bed net in local markets of PMI countries 

varies between $4 and $7 dollars. ITNs typically require 

re-treatment with insecticide about every six months to 

maintain their effectiveness. By comparison, nets made 

with a wash-resistant insecticide preparation (long-lasting 

ITNs) are a recent and promising development in net 

technology, since they do not require owners to re-treat 

them on a regular basis. These long-lasting ITNs maintain their full protective effect through a minimum of 20 

washes, which translates into protection for three to four 

years or the lifetime of the net. Whenever possible, PMI 

purchases long-lasting ITNs rather than the conventional 

ITNs or re-treatment kits because experience has shown 

that re-treatment rates are often quite low. 

ITNs have been shown to reduce all-cause mortality in 

children under five by about 20 percent and malarial illnesses among children under five and pregnant women 

by up to 50 percent.1 When 80 percent or more of residents in a village use an ITN, even those not sleeping 

under a mosquito net benefit from the protective effect. 

A 2003 evaluation of interventions to prevent child mortality estimated that insecticide-treated materials ranked 

second, after breastfeeding, in terms of the number of 

childhood deaths they could prevent.2 

Scaling Up ITN Use 

Insecticide-treated nets represent a relatively simple and 

low-cost means of preventing malaria, and PMI has 

focused on scaling-up ITN coverage in all three countries 

(see Appendix for details). While ITN activities were 

USAID / CHRIS THOMAS 

A truckload of baled long-lasting ITNs arrives in the northern 

Ugandan district of Gulu. 

tailored to the local conditions and capacities of each 

country, the following principles and best practices were 

common to the ITN strategy employed by PMI: 

•	 Targeting children under five and pregnant women, 

the populations most vulnerable to the severe effects 

of malaria; 

•	 Supporting a market segmentation approach for 

ITN distribution, with provision of free ITNs to the 

poorest and most vulnerable groups while working to 

increase access to low-cost or subsidized nets for those 

who can afford them. The goal is to increase the availability, affordability, and demand for ITNs through 

equitable, sustainable market segmentation; 

•	 Building upon existing ITN activities of ministries 

of health, donor partners, non-governmental and 

faith-based organizations, and the commercial sector. 

In Angola, for example, PMI distributed long-lasting 

ITNs through a nationwide measles vaccination 

campaign; 

•	 Whenever possible, procuring and distributing longlasting ITNs, rather than conventional ITNs, which 

require re-treatment at periodic intervals; 

1 Lengeler C, Insecticide-treated bednets and curtains for preventing malaria (Cochrane 

Review),The Cochrane Library, Issue 2 (2002). 

2 Jones G et al. How many child deaths can we prevent this year? The Lancet (2003) 

362: 65-71. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  12
•	 Building host government and commercial sector 

capacity in ITN logistics and regional supply chain 

management, to make distribution of nets easier and 

more cost-effective; and 

•	 Educating owners of ITNs on how to use and care 

for them properly and why they are important for 

the prevention of malaria. 

INDOOR RESIDUAL SPRAYING 

Background 

Indoor residual spraying (IRS) is a proven and highly 

effective malaria control measure. During the 1950s and 

1960s, IRS, together with improved standards of living, 

helped eliminate or control malaria in many areas. IRS 

involves the coordinated, timely spraying of the interior 

walls of a home with small amounts of insecticides, 

which kill mosquitoes when they enter the home and 

rest on walls. The protection provided by spraying lasts 

from about four to ten months, depending on the insecticide used and the wall surface. 

WHO has approved 12 insecticides it considers effective 

and safe for use in IRS, including DDT (see Box 1). 

The choice of insecticide depends on whether it is registered for use in the country, the type of wall surfaces to 

be sprayed, the duration of the transmission season, and 

resistance levels of the local species of mosquitoes that 

transmit malaria. The choice of insecticide will also 

depend on whether or not the national malaria control 

program plans to apply different insecticides in a rotaBox 1: DDT 

USAID/ANGOLA 

A sprayman applies insecticide to the inside walls of a home 

in Angola. 

tion scheme to slow the emergence of resistance. For 

IRS to be effective, at least 80 percent of the homes in 

the targeted geographical area must be sprayed. 

IRS requires well-trained and supervised spray teams. 

In sub-Saharan Africa, IRS has traditionally been targeted to the following settings: (1) areas where malaria 

transmission is seasonal or epidemic and occurs at a 

relatively low levels, such that only one annual round of 

spraying is needed; (2) urban settings where local transmission is well documented and public infrastructure 

exists to accommodate the operational requirements of 

spraying; and (3) in refugee or internally-displaced persons (IDP) camps. In each of these settings, research 

USAID supports indoor residual spraying (IRS) with DDT as an effective malaria prevention strategy in tropical Africa in 

those situations where it is judged to be the best insecticide from the standpoint of local transmission of the disease and 

based on a host-country policy. Its use for IRS to prevent malaria is allowable under the Stockholm Convention – also 

known as the Persistent Organic Pollutants or POPs Treaty – when used in accordance with WHO guidelines. Some 

countries do not carry out IRS or have not registered DDT for use in their malaria control programs. The reasons may 

include insecticide resistance, the epidemiological situation of the country, the organizational capacity of the program, or 

in some cases, concerns related to their agricultural export market. 

DDT is more effective and less expensive than many other insecticides in some situations; as a result, it is a very competitive choice for IRS programs. DDT specifically has an advantage over other insecticides when long persistence is needed 

on porous surfaces, such as unpainted mud walls, which are found in many African communities, particularly in rural or 

semi-urban areas. 

In FY06, USAID allocated funds for the purchase of DDT in three countries – Ethiopia, Mozambique, and Zambia. In 

Zambia, as in the other countries receiving IRS support, USAID will provide training and materials for improving national 

capacity for the safe and judicious use of pesticides in accordance with WHO standards and as stipulated by international 

agreements, such as the Stockholm Convention. 

13  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
USAID / CHRIS THOMAS 

The PMI has trained hundreds of spray operators to conduct 

IRS campaigns, including these teams in Angola. 

INTERMITTENT PREVENTIVE 

TREATMENT IN PREGNANCY 

Background 

Malaria infection during pregnancy poses serious health 

risks for both the mother and her unborn child. Malaria 

may be transmitted from mother to fetus before or during labor and delivery. If a pregnant woman contracts 

malaria, she is at much greater risk of anemia, premature 

delivery, and death. In addition, her newborn child is at 

higher risk of low birth weight – a leading contributor to 

infant mortality in Africa. The prevention and treatment of malaria during pregnancy depends on a 

combination of malaria control measures, including the 

use of ITNs, laboratory diagnosis for prompt and effective treatment, and intermittent preventive treatment. 

shows that IRS can provide a rapid, short-term reduction 

in malaria infection rates. More recent evidence from 

southern Africa and Equatorial Guinea has demonstrated 

that IRS can also be an extremely effective control measure in areas with higher levels of transmission. 

Expanding IRS Activities 

Before PMI began, only a few countries in Africa were 

carrying out large-scale IRS campaigns, most of these in 

the southern African region. In Year 1, PMI launched 

spraying activities in all three countries (see Appendix for 

details). While IRS activities were tailored to the local 

conditions and capacities of each country, the following 

principles and best practices were common to the IRS 

strategy employed in each country: 

•	 Completion of environmental assessments and plans 

for the appropriate handling and safe use of insecticides prior to spraying; 

•	 Recruiting and training local residents and provincial 

health staff to carry out and supervise IRS and build 

in-country capacity for future spraying activities; and 

•	 House-to-house visits in communities prior to spray 

campaigns to educate homeowners about IRS and 

improve acceptance of spray teams. 

3 Kayentao K et al. Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. J Infect Dis (2005), 

191: 109-116. 

4	 Steketee RW et al.The burden of malaria in pregnancy in malaria endemic areas.Am J 

Trop Med Hyg (2001), 64: 28-35. 

Intermittent preventive treatment of pregnant women 

(IPTp) is a highly effective means of reducing the risk 

of malaria in both the pregnant woman and her unborn 

child. It involves the administration of at least two doses 

of an antimalarial drug, sulfadoxine-pyrimethamine (SP), 

to the woman during the second and third trimesters of 

her pregnancy with at least a one-month interval 

between doses. IPTp reduces the frequency of maternal 

anemia, malaria infection of the placenta, and the delivery of low birth weight babies.3 Because in most African 

countries more than 70 percent of pregnant women 

attend antenatal clinics, these clinics serve as an attractive 

platform for delivering preventive treatments. The appropriate use of IPTp could prevent 75,000 to 200,000 

infant deaths each year in Africa.4 

IPTp is only recommended in areas with moderate to 

high levels of malaria transmission. At present, SP is the 

USAID / CHRIS THOMAS 

Pregnant women must receive three tablets of sulfadoxinepyrimethamine (SP) at least twice during their pregnancy to 

reduce their risk of the complications of malaria. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  14
USAID / JIMMY NYAMBOK 

A head nurse at the antenatal clinic of Gulu Regional Referral 

Hospital in northern Uganda leads a health education session 

with pregnant women. The talk includes information about how 

to prevent malaria during pregnancy with IPTp and the regular 

use of ITNs. 

only drug recommended by WHO for IPTp, but 

studies are under way to determine the safety and efficacy of alternatives, since resistance to SP is spreading in 

eastern and southern Africa. SP costs just 10-12 cents 

per treatment. IPTp is particularly important in pregnant women with HIV/AIDS because HIV infection 

increases a woman’s susceptibility to malaria and 

reduces her ability to control the infection. 

The Centers for Disease Control and Prevention (CDC), 

with USAID support, is responsible for much of the 

original research documenting the efficacy of IPTp in 

reducing malaria-related illness among pregnant women 

and the risk of death in their children in sub-Saharan 

Africa, and for the studies of the feasibility of implementing IPTp during routine antenatal clinic visits. 

Follow-up studies provided evidence on the proper dosing schedules for IPTp with SP in both HIV-positive 

and HIV-negative pregnant women.5 

Expanding IPTp Use 

In each of the three Year 1 countries, sufficient resources 

were already available from the Ministries of Health and 

other partners for the procurement of SP. Consequently, 

PMI focused its efforts on (1) training health care workers in the use of IPTp and provision of high-quality 

antenatal services, and (2) creating demand for antenatal 

care through health promotion and education activities 

(see Appendix for details). 

DIAGNOSIS AND TREATMENT 

Background 

Artemisinin is an antimalarial drug derived from a plant, 

Artemisia annua, or sweet wormwood, that has been 

used as a fever remedy in China for more than 1,000 

years. The artemisinin family of drugs are the most 

rapidly-acting and effective antimalarial drugs currently 

available. Combined with a second effective antimalarial, they have become the standard of care for malaria in 

most parts of the world where resistance to traditional 

single drug therapies, such as chloroquine, has become 

common. This is termed artemisinin-based combination 

therapy, or ACT. The rationale for using combination 

therapy for malaria is similar to that for the treatment of 

tuberculosis and HIV infections. The combination of 

two or more effective antimalarial drugs greatly reduces 

the probability of the emergence of malaria parasites that 

are drug-resistant, and thus prolongs the effective lifetimes of both drugs. 

Since ACTs cost 10-20 times more than chloroquine and 

have a shelf life of just 18-24 months, good pharmaceutical management is critical to their effective use. 

Unfortunately, many Ministries of Health in Africa have 

weak drug management and logistics systems. In addition, ACTs are relatively new to most African countries, 

Mrs. Kidja Monde holds her 18-month-old son Alfred and a 

packet of ACT she received at Kibiti Health Center in Rufiji 

district, Tanzania. 

5 Sirima SB et al. Malaria prevention during pregnancy: Assessing the disease burden 

one year after implementing a program of intermittent preventive treatment in 

Koupela District, Burkina Faso.Am J Trop Med Hyg (2006), 75(2): 205-211 ;Van Eijk 

AM et al. Effectiveness of intermittent preventive treatment with sulphadoxinepyrimethamine for the control of malaria in western Kenya: A hospital based study, 

Trop Med Intl Health (2004), 9(3): 351-360 

CDC / PATRICK KACHUR 

15  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
’

so large-scale in-service training of health workers 

and education of patients will be needed. 

The high cost of ACTs heightens the need for accurate 

diagnosis of malaria, which, because of its nonspecific 

symptoms, may be quite difficult to distinguish from 

other causes of fever. Microscopic examination of blood 

smears from patients with suspected malaria is considered the gold standard for diagnosis, but it requires 

considerable supervisory and logistic support to sustain 

high quality performance. In recent years, the development and refinement of rapid diagnostic tests (RDTs) 

for malaria has offered a potentially simpler solution to 

malaria diagnosis in settings where microscopy is not feasible or sustainable. RDTs are simple to use; however, 

they do have limitations, including problems with quality control during production and sensitivity to high 

temperature and humidity. In addition, health care 

workers may not accept negative test results when those 

results do not agree with their clinical impression of the 

cause of a patient’s illness. 

Expanding Malaria Diagnosis and Treatment 

with ACTs 

During Year 1, PMI has procured and is distributing 

ACTs in all three countries, making these highly effective 

treatments available to vulnerable populations. Because 

of the importance of accurate diagnosis for the rational 

use of ACTs, PMI is also supporting national malaria 

control programs to improve the quality of laboratory 

diagnosis of malaria (see Appendix for details). 

USAID / KARIE ATKINSON 

A health worker at a clinic in Tanzanias Rufiji District awaits the 

results of several rapid diagnostic tests (RDTs), which will tell her 

which patients have malaria parasites in their blood. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  16
CHAPTER 3 

“Malaria is the main killer in Angola. It has had a devastating impact on our population ... if we fight malaria 

and other diseases effectively, then we can succeed in our reconstruction process.” – Aguinaldo Jaime, Deputy Prime 

Minister of Angola, June 8, 2006 

17  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

USAID/ANGOLA

The PMI seeks to prevent and treat malaria among children under five, such as this Angolan girl. 
ANGOLA
 


Malaria in Angola 

Angola recently emerged from almost three decades of 

civil war that severely affected its development. The total 

population of Angola is about 15 million, of which 68 

percent live in poverty. The existing health system covers only about 30 percent of the population. 

According to the Ministry of Health (MoH), malaria is 

Angola’s leading cause of illness and death. An estimated 85 percent of the population is at risk of malaria and 

only the highly urbanized center of the capital, Luanda, 

is malaria free. The central and northern provinces have 

malaria transmission that peaks between March and 

May, and again in October and November. 

Transmission in the south is highly seasonal with 

periodic outbreaks. 

ANGOLA AT A GLANCE 

Indicator Baseline Coverage PMI Accomplishments to Date1 

Pregnant women who slept under an ITN 

the previous night 9.5% 2 

540,949 long-lasting ITNs distributed 

Children under five who slept under an 

ITN the previous night 9.4% 2 

Houses in geographic areas targeted for 

IRS which were sprayed 0 3 107,373 houses sprayed and 590,398 people protected 

Pregnant women who received IPTp 

according to national policy 0.9% 2 1,450 health workers trained in IPTp 

Children under five with suspected malaria 

who received treatment with ACTs within 

24 hours of onset of their symptoms 

0.7% 2 

587,520 ACT treatments procured 

and being distributed 

129,875 RDTs procured 

Government health facilities with ACTs 

available for treatment of uncomplicated 

malaria 

3.8% 4 1,283 health unit staff trained on ACTs 

YEAR 1 BUDGET: $7.5 million (FY06) and $1.74 million (FY05) 

1) The PMI measured Year 1 results in terms of process indicators, rather than outcome indicators. Because of cost considerations, coverage of each intervention will only be measured every two years and its impact on malaria-related illness and death only evaluated at the beginning and end of the Initiative. Results 

reported in this chapter are up-to-date as of January 1, 2007. 2) Preliminary data as of January 1, 2007, based on 52 percent of interviews completed in nationwide Malaria Indicator Survey. 3) No areas were targeted for spraying by the National Malaria Control Program. 4) Best estimate based on available 

information as of January 1, 2007. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  18
Figure 3.1:Allocation of $7.5 million 

PMI Budget in Angola, FY2006 

(Proportion of budget spent on commodities: 62%) 

Note: $1.74 million of FY05 funds were also used: $1.41 million 

for IRS; $250,000 for ITNs; and $80,000 for ACTs and IPTp. 

Scaling Up Interventions inYear 1 

President’s Malaria Initiative staff worked closely with 

the National Malaria Control Program (NMCP) and 

other national and international partners to identify 

gaps in malaria funding and coordinate plans with the 

National Malaria Control Strategy. Angola’s PMI budget 

for FY 2006 was $7.5 million (Figure 3.1). An additional $1.74 million in FY05 funds were used mostly to 

jumpstart IRS activities. Almost half of the FY06 budget 

was allocated to long-lasting ITN procurement and distribution. Twenty percent was allocated to indoor 

residual spraying (IRS), and another 21 percent to diagnosis and treatment activities. Since The Global Fund to 

Fight AIDS, Tuberculosis, and Malaria (GFATM) and 

the MoH provided sufficient SP supplies for intermittent 

preventive treatment for pregnant women (IPTp) in 

Table 3.1: ITN Activities in Angola 

Angola, PMI focused its efforts on supporting the 

roll out of IPTp through health worker training. The 

ExxonMobil Foundation, a long-term supporter of 

malaria control efforts in several African countries, 

donated an additional $1 million to USAID in Angola 

to further the PMI’s goals in both FY06 and FY07. 

Insecticide-Treated Nets (ITNs) 

Angola’s NMCP supports a market segmentation 

approach to ITN distribution. This consists of free distribution of 70 percent of nets to pregnant women and 

children under five in more rural areas, subsidized distribution of 20 percent of nets to those same groups in 

Luanda, and social marketing with cost recovery of the 

remaining 10 percent of nets in urban areas. The PMI’s 

activities are closely coordinated with The GFATM’s 

Round 3 grant to Angola, which is also procuring large 

quantities of long-lasting ITNs. 

Activities related to ITNs supported by PMI during Year 

1 included (see Table 3.1): 

USAID / ALONZO WIND 

Cynthia G. Efird, U.S. Ambassador to Angola, distributes free 

long-lasting ITNs during the launch of an integrated measlesITN campaign called “Viva a Vida com Saúde” (Live a Life with 

Health) in Zaire Province in northern Angola. 

Activity Location ITNs Distributed 

Distribution of free long-lasting ITNs 

through joint MoH-led ITN-measles 

vaccination campaign 

7 of the most highly 

endemic provinces 

826,000 long-lasting ITNs (of which 

420,000 were procured by PMI) 

Distribution of subsidized and cost-recovery 

long-lasting ITNs 

Urban and peri-urban areas 120,949 long-lasting ITNs 

Note: It is estimated that one mosquito net will protect about 1.6 people because, on average, two people will sleep under a net 80% of the time. 

19  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
Table 3.2: IRS Activities in Angola 

Activity Location Houses Sprayed People Protected People Trained 

IRS campaign Cunene and Huila 

Provinces 

107,373 houses 590,398 residents of sprayed 

houses and 100,000 residents 

living within IRS cordon 

350 spraymen and women, 

supervisors, and clinicians 

Assistance to 

GFATM-supported 

campaign 

Namibe Province 25,329 houses 176,155 residents 

of sprayed houses 

•	 Procurement and distribution of 420,000 free longlasting ITNs in seven of the most malarious provinces 

as part of a nationwide MoH-led measles vaccination 

campaign in collaboration with UNICEF and other 

partners. The GFATM and the ExxonMobil 

Foundation contributed an additional 406,000 nets. 

A post-campaign survey in the seven provinces where 

ITNs had been targeted showed a dramatic increase 

from estimated baseline levels of net ownership (less 

than 10 percent) and usage (less than 5 percent). 

Following the campaign, 94 percent of families surveyed owned a net, and 69 percent of children under 

five had slept under a net the previous night; 

•	 Procurement and distribution of 120,949 subsidized 

and cost-recovery long-lasting ITNs through antenatal 

clinics and commercial outlets in metropolitan 

Luanda; and 

•	 Demand creation and health education related to 

ITNs through house-to-house visits, radio spots, 

drama shows, and discussions with village chiefs in 

the seven provinces involved in the measles-ITN 

campaign and in Luanda. 

Indoor Residual Spraying (IRS) 

As no large-scale IRS program had been carried out in 

Angola for more than 10 years, PMI worked closely with 

RESEARCH TRIANGLE INSTITUTE INTERNATIONAL 

In preparation for the IRS campaign in southern Angola, 350 

locally-hired personnel were trained in spraying operations. 

the NMCP and provincial health departments to train 

staff and conduct spraying in two epidemic-prone 

provinces in the south of the country. 

Key IRS activities supported by PMI during Year 1 

included: (see Table 3.2) 

•	 Training of 350 local personnel to conduct and 

supervise IRS operations; 

•	 House-to-house visits and distribution of leaflets in 

all communities scheduled for spraying to educate 

residents about the risks of malaria and increase 

acceptance of IRS and cooperation with the spray 

teams; 

•	 An IRS campaign in Cunene and Huila Provinces, 

during which 107,373 houses were sprayed; this represents 90 percent of the houses targeted for spraying. 

The campaign protected at least 590,398 people and 

was estimated to benefit an additional 100,000 residents whose homes were not sprayed but who lived 

within a cordon of sprayed houses around the provincial capital; and 

•	 Provision of spray pumps, insecticide, and educational 

leaflets to allow a GFATM-supported spraying campaign in Namibe Province to start while their 

equipment and supplies were clearing customs. 

This campaign covered 25,329 households. 

Intermittent PreventiveTreatment for 

Pregnant Women (IPTp) 

Since the MoH and The GFATM were already procuring sufficient sulfadoxine-pyrimethamine (SP) to meet 

all needs, PMI focused its Year 1 efforts on training 

health workers in the correct use of IPTp. A total of 

1,450 health unit workers were trained in five provinces 

being supported by PMI during Year 1. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  20
USAID / ANGUS SPIERS 

Diagnosis and Treatment 

Although the MoH approved artemisinin-based combination therapies (ACTs) as the treatment of choice for 

uncomplicated malaria in late 2004, single-drug therapy 

continues to be used in many rural areas. The GFATM is 

supporting the procurement and distribution of ACTs in 

59 of the country’s most populous districts. With PMI 

and ExxonMobil funding, PMI provided technical assistance to strengthen overall MoH capabilities in the 

storage, distribution, and appropriate use of antimalarial 

drugs. In addition, a PMI-supported non-governmental 

organization (NGO) is facilitating ACT implementation 

in MoH hospitals and health centers. 

Diagnosis and treatment activities supported by the PMI 

during Year 1 included: 

•	 Procurement of 587,520 ACT treatments, which 

arrived in-country in January 2007 and are being distributed through MoH facilities in nine districts with 

the assistance of NGOs; 

•	 Provision of expert technical assistance to strengthen 

the MoH’s antimalarial drug management system and 

development of provincial- and district-level guides for 

pharmaceutical management; 

•	 Training of 1,283 health unit staff in the use of ACTs; 

•	 Procurement and arrival in-country of 129,875 rapid 

diagnostic tests for malaria to be used in the same districts as those targeted for ACT distribution; and 

In Angola, PMI is supporting the training of antenatal clinic 

workers to ensure that women receive a complete package of 

antenatal care that includes SP as well as an ITN. 

The PMI is working with partners to provide technical assistance 

to the Angolan MoH in pharmaceutical management to ensure 

safe and effective use of ACTs. Dr. Diabanza, Provincial Malaria 

Coordinator for Zaire Province and new ACT supplies that were 

procured by The GFATM in Kuimba Municipal Hospital. 

•	 Completion of a needs assessment for malaria laboratory diagnosis. 

Monitoring and Evaluation 

Monitoring and evaluation activities supported by PMI 

during Year 1 included: 

•	 A nationwide Malaria Indicator Survey to measure 

coverage of the four major interventions as well as allcause and malaria-specific mortality in children under 

five through mothers’ reported birth histories and verbal autopsies. As of January 1, 2007, 52 percent of 

the 3,000 planned households had been visited. The 

results of this survey will be used as baseline data for 

PMI in Angola. Preliminary analysis of these interviews showed that prior to the large-scale measles 

immunization-ITN campaign, 19.7 percent of households owned at least one ITN, but only 9.4 percent 

of children under five and 9.5 percent of pregnant 

women had slept under the net the night before. 

Only 0.9 percent of pregnant women had received 

IPTp during their pregnancy, and only 0.7 percent of 

children under five had received an ACT for malaria 

treatment within 24 hours of the onset of their illnesses; 

•	 A year-long epidemiologic and entomologic assessment of malaria risk in the capital, Luanda, and the 

southern provinces to provide reliable and up-to-date 

information on malaria transmission in Angola. The 

findings from this assessment will help target future 

ITN and IRS activities; and 

USAID / ANGUS SPIERS 

21  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
MELANIA’S STORY: 

IRS PROTECTS A MOTHER AND HER CHILDREN 

IN ANGOLA 

Melania is 28 years old and lives with her husband and children, aged two and four, in their modest one-bedroom 

house in Forte Santa Rita, Namibe Province. She sells fruit 

and vegetables at the local market, but when her children 

are ill, she must stop working to care for them, and she 

struggles to put food on the table for her family. After 27 

years of conflict, the vast majority of Angola’s citizens, such 

as Melania, continue to live in poverty. 

“Since my home was sprayed, my children 

haven’t had malaria.” – Melania, Angola. 

Melania lives in southern Angola, an area prone to malaria 

outbreaks. In Angola, as in most of Africa, malaria is a leading cause of illness and death. Between December 2005 

and March 2006, PMI,The GFATM, and WHO assisted the 

MoH and provincial health authorities to carry out the first 

large-scale IRS campaign in Angola in more than a decade. 

This campaign covered more than 130,000 houses in the 

three southern provinces of Huila, Cunene, and Namibe, 

where Melania lives. 

Before homes were sprayed, an NGO, Christian Children’s 

Fund, trained and mobilized local “activistas” who carried 

out a health education campaign to ensure that residents 

understood the purpose and importance of supporting this 

effort. Melania and her husband were dubious initially.“At first I didn’t believe that the spray on the walls would kill the 

mosquitoes, and I felt it was a waste of time. The truth is that since my home was sprayed, my children haven’t had 

malaria, and I haven’t had to take them to the hospital!” observes Melania with a shy smile and a sense of relief. “I am 

grateful that ‘activitistas’ took the time to visit our homes before the spraying began. Now I am more informed on practical steps I can take to prevent my children from getting malaria and will gladly welcome another campaign.” The next 

round of spraying began in December 2006. 

Melania outside her home with her two sons in Forte Santa 

Rita, Namibe. 

O OMULO PEIXOT USAID / R

• 	A house-to-house survey in seven provinces 	 • Strengthening the MoH pharmaceutical management 

following the measles-ITN distribution campaign, system to support increased coverage of ACTs and 

which showed a striking increase in net ownership IPTp throughout the country; 

and usage among children under five (from 10% to 

69%). The opportunity presented by these house-to­ • Strengthening the capabilities of the NMCP to monihouse visits was used to further promote correct use tor and evaluate malaria prevention and treatment 

and care of ITNs. activities; and 

Challenges and Future Directions • Promoting partnerships between NGOs and the MoH 

Scaling-up of malaria control activities in Angola will to extend ACTs and IPTp coverage to the large rural 

face three major challenges during the coming year: population who do not have access to government 

health facilities. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  22
CHAPTER 4

“I have visited some of the public health centers in Unguja and Pemba [the two main islands of the Zanzibar

Archipelago]; I visited some wards without malaria patients. Before the campaign, such a situation would not

be common. [In the past], we were not serious and committed, that is why malaria came back, but this time

we are committed and so are the majority of Zanzibaris.” – Sultani Mohammed Mugheiry, Zanzibar Minister for

Health and Social Welfare, October 10, 2006 

23  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA

Mr. Aseidi is the sheha, or community leader, of Kianga village in Zanzibar. Together with other shehas, Mr. Aseidi

received training from PMI to inform and educate fellow community members about IRS. 

USAID/JOHN RIBER
TANZANIA
 


Malaria in Tanzania 

The United Republic of Tanzania consists of mainland 

Tanzania and the islands of Zanzibar (Unguja, Pemba, and 

several other islets), which operate under separate Ministries 

of Health (MoH). Thirty-six million Tanzanians live on 

the mainland, and about one million live on the Zanzibar 

Archipelago. The current life expectancy at birth is 45 

years, and about 36 percent of the population lives below 

the poverty line. Eleven percent of all Tanzanian children 

die before they reach the age of five years. 

Ninety-three percent of the population lives in areas 

where malaria is transmitted. The remaining population 

lives in Tanzania’s highlands and is generally not considered at risk. In addition, more than 290,000 refugees 

live in five camps run by the United Nations High 

Commissioner for Refugees (UNHCR) in northwestern 

Tanzania and are at an especially high risk of contracting 

TANZANIA AT A GLANCE 

Indicator Baseline Coverage PMI Accomplishments to Date1 

Mainland Zanzibar

Pregnant women who slept under an ITN 

the previous night 

16% 2 26% 2 

130,000 long-lasting ITNs distributed and 

13,894 infant net vouchers redeemed Children under five who slept under an 

ITN the previous night 

16% 2 22% 2 

Houses in geographic areas targeted for 

IRS which were sprayed 

0 3 0 3 203,754 houses sprayed and 1,018,156 

people protected 

Pregnant women who received IPTp 

according to national policy 

22% 2 14% 2 376 health workers trained in IPTp 

Children under five with suspected malaria 

who received treatment with ACTs within 

24 hours of onset of their symptoms 2% 2 36% 2 

380,160 ACT treatments procured and 

distributed 

875,000 RDTs procured 

Government health facilities with ACTs available for treatment of uncomplicated malaria <1% 4 86% 5 4,217 health workers trained on ACTs 

YEAR 1 BUDGET: $11.5 million (FY06) and $2 million (FY05) 

1) The PMI measured Year 1 results in terms of process indicators, rather than outcome indicators. Because of cost considerations, coverage of each intervention will only be measured every two years and its impact on malaria-related illness and death only evaluated at the beginning and end of the Initiative. Results 

reported in this chapter are up-to-date as of January 1, 2007. 2) 2004-2005 Tanzania Demographic and Health Survey. 3) No areas were targeted for spraying 

by the Zanzibar or mainland National Malaria Control Programs. 4) Best estimate based on available information as of January 1, 2007. 5) Roll Back Malaria 

Coverage Survey (2004). 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  24
Figure 4.1:Allocation of $11.5 million 

PMI Budget in Tanzania, FY2006 

(Proportion of budget spent on commodities: 60%) 

Note: $2 million of FY05 funds were also used: $500,000 for 

ITN procurement and promotion on Zanzibar; $600,000 for 

IPTp training; $300,000 for strengthening antimalarial drug management; $300,000 for training on malaria diagnosis and 

treatment; $100,000 for epidemic response; $70,000 for larval 

control; $30,000 for monitoring and evaluation; and $100,000 

for administration. 

malaria. In 2004, more than one third of all children 

under five who were admitted to a hospital suffered 

from symptoms of malaria. Although 80 percent of 

Tanzanians live within four kilometers of a public health 

facility, about 40 percent of those with fever and suspected malaria seek treatment in the private sector. 

Scaling Up Interventions inYear 1 

Through an extensive consultative process that included 

the Tanzania National Malaria Control Program, the 

Zanzibar Malaria Control Program, and other malaria partners, the PMI Tanzania team identified areas that would 

benefit most from PMI’s investments. The PMI’s FY06 

budget for the mainland and Zanzibar was $11.5 million 

(Figure 4.1). Almost half of this amount was allocated to 

Table 4.1: ITN Activities in Tanzania 

programs supporting insecticide-treated mosquito nets 

(ITNs), with a quarter to indoor residual spraying (IRS), 

and an equal amount to diagnosis and treatment activities, 

including purchasing artemisinin-based combination therapy (ACT). Additionally, PMI-supported larval control 

activities were carried out in the periurban areas of Dar es 

Salaam. For intermittent preventive treatment of pregnant 

women (IPTp), The Global Fund to Fight AIDS, 

Tuberculosis, and Malaria (GFATM) provided sufficient 

quantities of sulfadoxine-pyrimethamine (SP) to meet all 

Year 1 needs. The PMI complemented GFATM support 

by training health care providers to provide an integrated 

package of antenatal care. To accelerate the start-up of 

PMI’s activities in the country, an additional $2 million of 

FY05 malaria funds were used (see footnote in Figure 4.1 

for details). 

Zanzibar was the focus of PMI’s initial “jumpstart” activities. Working in collaboration with The GFATM during 

a December 2005 campaign, PMI distributed long-lasting 

ITNs free of charge to almost every pregnant woman and 

child under five on the islands. In the months following 

the campaign, selected health facilities reported an impressive 86 percent reduction in laboratory-confirmed malaria 

cases on Zanzibar, compared with the same period in 

2005. In July-August 2006, 96 percent of rural homes on 

Zanzibar were sprayed, with another round of spraying 

planned for early 2007. On the mainland, PMI concentrated on supporting the Tanzania National Voucher 

Scheme for ITN distribution and training health professionals to treat malaria with ACTs. The PMI also worked 

with the NMCP to provide ACTs to Rufiji District and to 

refugee camps and surrounding areas in northwestern 

Tanzania. 

Insecticide-Treated Nets (ITNs) 

The PMI has integrated well with mainland Tanzania’s 

National Voucher Scheme for ITNs. This program distributes vouchers to pregnant women through antenatal 

clinics nationwide, allowing them to purchase ITNs 

from private retailers at a 75 percent discount. With 

Activity Location ITNs Distributed 

Free long-lasting ITN distribution 

in collaboration with The GFATM 

Zanzibar 233,000 long-lasting ITNs (of which 

130,000 were procured by the PMI) 

Launch of infant voucher program as 

part of the Tanzania National Voucher Scheme 

Mainland 13,894 ITN infant vouchers redeemed 

Note: It is estimated that one mosquito net will protect about 1.6 people because, on average, two people will sleep under a net 80% of the time. 

25  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
’

USAID / KARIE ATKINSON 

A health worker in Tanzanias Morogoro district gives a mother a 

voucher that she will exchange for a discounted ITN at a retail 

shop. PMI’s support for this infant voucher program means that 

she only needs to pay the small top-up fee. 

PMI funding, a similar “infant voucher” program for 

children less than one year of age was instituted in 2006 

to increase ITN coverage among this vulnerable age 

group. The PMI is also supporting the roll-out of a 

completely new voucher program on the mainland, 

which will make long-lasting ITNs available for free to 

families who cannot afford the minimum top-up 

amount. On Zanzibar, PMI collaborated with The 

GFATM to distribute free long-lasting ITNs to pregnant 

women, children under five, and people living with 

HIV/AIDS. 

Activities related to ITNs supported by PMI during 

Year 1 included (see Table 4.1): 

•	 Distribution of 233,000 free long-lasting ITNs to 

every pregnant woman and child under five on 

Zanzibar, of which 130,000 were funded by PMI. 

The PMI also funded ten NGOs to conduct followup household visits in all districts to ensure that 

nets had been correctly hung and to provide general 

malaria education. Following this joint PMI-GFATM 

campaign, health facilities reported an 87 percent 

reduction in laboratory-confirmed malaria cases 

(compared to the same period in 2005); and 

•	 Distribution of 382,900 infant vouchers since the 

launch of the program in late November. In just over 

one month of operation, 13,894 of those vouchers have 

been redeemed for insecticide-treated mosquito nets. 

TRAINING HEALTH WORKERS TO PREVENT 

MALARIA AMONG PREGNANT WOMEN IN 

TANZANIA 

Francisca Lyoba, a health worker at an urban health center 

in Tanzania’s Morogoro District, is one of 376 health workers in Tanzania who received PMI-funded training on 

intermittent preventive treatment for pregnant women 

(IPTp). The six-day training is part of pre-service midwifery 

education. IPTp is just one component of a comprehensive 

antenatal care program recommended by the World Health 

Organization and supported by the U.S. Government, called 

Focused Antenatal Care, or FANC. 

The idea of FANC is to combine all the needs of the 

pregnant women into four antenatal clinic visits. While 95 

percent of pregnant women come for at least one antenatal 

visit, only 64 percent come for four visits. These visits are critical to the health of the mother and her infant. 

“It is important to come in for the medicines, as malaria can cause anemia, stillbirth, and low 

infant birth weight.” - Francisca Lyoba,Tanzania 

Twenty-eight-year-old Halima Athmani, who is five months pregnant, came to the clinic for her first dose of IPTp. She will 

receive at least one more dose during her pregnancy. “It is important to come in for the medicines, as malaria can cause 

anemia, stillbirth, and low infant birth weight,” Francisca Lyoba communicated to the young mother. She also counseled 

Halima on the importance of sleeping under an insecticide-treated mosquito net and taking advantage of the national 

voucher program that allows pregnant mothers and infants to obtain nets at a very low price. 

Health worker Francisca Lyoba gives expectant mother Halima 

Athmani medicine to prevent her from getting malaria. 

USAID / KARIE ATKINSON 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  26
NETS AND SPRAYING HELP PREVENT MALARIA 

IN A ZANZIBARI FAMILY 

Clothes hanging to dry, chickens roaming around, a dirt 

floor kitchen with pots and pans hanging on the wall, bright 

red tomatoes soaking in a bucket. This is home to Saida Ali 

Haji and her three children who live in Paje, a dusty, coastal 

town in Zanzibar. It is a home that is no longer hospitable 

to malaria mosquitoes. In August 2006, a PMI-supported 

indoor residual spraying campaign sent teams to spray 

200,000 households with insecticide, which protected 

more than one million people from malaria. 

The 34-year-old mother of three heard about the spraying 

campaign through a village meeting called by the “sheha,” or 

community leader. She was told she had to remove their 

furniture and food and cover other belongings with woven 

mats. “The spraying has been a good thing,” said Mrs. Haji. 

“There are not only fewer mosquitoes in our home, but also less flies and cockroaches.” As she knitted, her six-monthold son, Ali, nestled in her lap. “Malaria is a chronic problem in our village as there is a large mosquito population.” Two 

years ago Saida had malaria with fever, joint pain, and vomiting. A year later her 5-year-old daughter Rahma had malaria 

and just seven months ago her 12-year-old daughter Nihifadhi came down with the disease. 

“There has been a great change in malaria here because of the availability of nets, medicines to 

treat malaria, and now the recent spraying effort. Five years ago we had quite a few malaria 

cases in children, but now we have few cases.” - Saida Ali Haji, Zanzibar 

The family has one long-lasting ITN that they were given free at the health clinic and one conventional net they bought 

five years ago at a local shop for about two U.S. dollars. A health worker at the clinic gave her instructions on how to 

use the nets. 

“There has been a great change in malaria here because of the availability of nets, medicines to treat malaria, and now the 

recent spraying effort. Five years ago we had quite a few malaria cases in children, but now we have few cases”, Saida said. 

Preliminary results are indeed encouraging: Following the PMI and GFATM-supported net distribution campaign, health facilities reported an 87 percent reduction in laboratory-confirmed malaria cases when compared to the same period in 2005. 

Saida Ali Haji and her three children at their home in Zanzibar, 

which was sprayed with PMI support in August 2006. 

USAID / KARIE ATKINSON 

Indoor Residual Spraying (IRS) • Training of 536 local personnel to conduct IRS 

In partnership with the Zanzibar Malaria Control and supervise operations; 

Program, PMI completed a highly successful round of 

spraying in September 2006 that protected more than • A large-scale IRS campaign on Zanzibar, during which 

one million people. Prior to this campaign, no large­ 203,754 houses were sprayed. This figure represents 

scale spraying had been conducted on Zanzibar since 96 percent of all houses that had been targeted for 

1986. The PMI funded the purchase of insecticide and spraying; and 

equipment, training of spray teams, logistics, and houseto-house visits in all communities before the campaign to • Prior to spraying, house-to-house visits in all ten 

educate residents about IRS and ensure their cooperation. sprayed districts to educate and inform families about 

IRS. The PMI also engaged community leaders, 

Key IRS activities supported by PMI during Year 1 including Muslim clerics, known as shehas, to dissemincluded (see Table 4.2): inate information about IRS at the village level. 

27  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
Table 4.2: IRS Activities in Tanzania 

Activity Location Houses Sprayed People Protected People Trained 

IRS Zanzibar 203,754 houses 1,018,156 residents 

of sprayed houses 

536 (including 452 spray 

operators, 56 team leaders, 10 site 

managers, and18 supervisors) 

Table 4.3: Diagnosis and Treatment Activities in Tanzania 

Activity Location Commodities Distributed People Trained 

Distribution 

of ACTs 

Mainland 380,160 ACT treatments procured and distributed to health facilities (299,520 for 

refugee camps; 80,640 for Rufiji District) 

Training of 4,217 health workers 

on proper ACT use 

Distribution of RDTs 

to health facilities 

Mainland 775,000 RDTs procured Training needs are being met 

by other partners Zanzibar 100,000 RDTs procured and 

distributed to health facilities 

Larval Control 

Control of the immature or larval stages of the mosquito 

can be a highly effective malaria control measure when 

their breeding sites are limited in size and number. This 

approach to malaria control has infrequently been used 

in Africa but has proven to be successful in other locations. During FY06, PMI funded a larval control 

program in the periurban areas of Dar es Salaam. 

Each week, more than 26,000 potential breeding sites 

are monitored, and sites with mosquito larvae are treated 

with insecticides. As a result of this program, an estimated 128,000 residents of these areas are benefiting from 

improved malaria protection. 

Intermittent Preventive Treatment for 

Pregnant Women (IPTp) 

Using FY05 funds, PMI focused its support on curriculum development for pre- and in-service training of health 

workers in IPTp. The PMI also supported the development of an IPTp health education strategy on the 

mainland. Since The GFATM provided sufficient quantities of SP for Year 1 needs, PMI complemented GFATM 

support by training 376 health care workers on IPTp. 

Diagnosis and Treatment 

Zanzibar introduced ACTs as the treatment of choice 

for uncomplicated malaria in 2003, and these drugs are 

now being used in all health facilities. On the mainland, 

PMI supported the purchase and distribution of ACTs in 

Rufiji District and in five refugee camps in northwestern 

Tanzania. In collaboration with other partners, including the World Health Organization (WHO), Italian 

Cooperation, the NMCP, and The GFATM, PMI 

funded the training of health workers in the new ACT 

treatment guidelines, and procured rapid diagnostic tests 

(RDTs) to improve the quality of malaria diagnosis for 

both the mainland and Zanzibar. 

Diagnosis and treatment activities supported by PMI 

during Year 1 included (see Table 4.3): 

•	 Assistance to the NMCP to develop an ACT 

distribution plan dealing with procurement, storage, 

inventory management, and other supply chain issues. 

This included a training of trainers for 32 regional 

pharmacists and 150 district-level pharmaceutical personnel. With resources from the PMI, a commodity 

tracking system is also being put into place; 

•	 Procurement of 380,160 ACT treatments for refugees 

in UNHCR refugee camps of northwestern Tanzania 

and residents of Rufiji District. In both areas, distribution of PMI-procured ACTs has already begun; 

•	 Training of 4,217 health workers on ACT use on the 

mainland. With support from PMI, The GFATM, 

WHO/Italian Cooperation, and the NMCP, all 121 

districts now have government health staff trained in 

ACT use. With The GFATM and PMI’s support, 

more than 4,500 health facilities now have ACTs in 

stock; this represents almost 100 percent of all health 

facilities on the mainland; and 

•	 Procurement of 875,000 RDTs for use on the mainland and Zanzibar. Of these, 100,000 have already 

been distributed to health facilities on Zanzibar. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  28
WORKING WITH THE PRIVATE SECTOR 

IN TANZANIA 

Tucked in a bustling market place in Morogoro Town, there is 

a shop that stands out among the vegetable and fruit stalls, 

tables piled with dried fish, and tailors going about their work 

on old-fashioned sewing machines. Posters of different kinds 

of mosquito nets cover the front doors and the interior of 

the shop. Mr. Herman Kimambo, the owner, is dedicated to 

one business – selling mosquito nets – and he has been in 

that business since 1996. 

The wholesaler is a participant in the Hati Pugunzo program, 

the kiSwahili name for the Tanzanian National Voucher 

Scheme, a nationwide ITN distribution program implemented 

by the faith-based organization Mennonite Economic 

Development Associates (MEDA). Retailers and wholesalers 

are selected for the program after signing a contract in which 

they agree to track and report information on the vouchers 

and show that they have enough capital to start a business. 

Mr. Kimambo participates in this program by selling bed nets directly to individual pregnant women and indirectly to retailers 

at the wholesale price. His role is to ensure sufficient stocks of nets for retailers. He also collects vouchers and returns 

them to the bed net manufacturers in a timely manner so that the voucher cycle runs smoothly. Pregnant women receive a 

voucher during their antenatal visits. They then take the voucher to participating retailers, select a net that suits their taste 

and needs, and pay the small “top-up” amount for that net. The redeemed voucher is then sent back to the MEDA office 

where each one is reviewed to make sure it has been used properly. 

“As a result of this voucher program, my monthly sales have increased by seventy-five to one 

hundred percent.” - Herman Kimambo,Tanzania 

The wholesaler sells both traditional ITNs and long-lasting ITNs. Traditional ITNs have to be re-treated with insecticide 

about every six months and come with a net re-treatment tablet in a small packet. The nets he sells come in dark blue, 

white, green, light blue, round and square shapes and range in size from 4x6x5 feet to 9x6x7 feet.The top-up fee depends 

on the size and type of net and ranges from $0.25 to about $2 per net. His average profit margin on a bed net is between 

$0.08 and $0.16, which he earns from setting the wholesale price slightly higher than the actual price of the net. 

“As a result of this voucher program, my monthly sales have increased by seventy-five to one hundred percent,” the businessman says as he holds up a hand-written chart with different columns tracking his sales. On average, he sells two thousand 

nets per month. He also explains that new retailers, who had never bought nets from him before, are now buying from him. 

With the addition of the infant voucher program funded through the PMI and implemented by MEDA, Mr. Kimambo expects 

his sales will increase even more as demand for the nets grows. “Sales could shoot up over one hundred percent,” he 

asserts, his stock of nets neatly displayed around him. 

Approximately 36 percent of all deaths in children under five in Tanzania are due to malaria.“Efforts like Hati Pugunzo have 

reduced the burden of malaria in the district,” says Dr. Mtey, District Health Officer for Morogoro District.“Families and communities must understand the importance of using bed nets – for the program to be sustainable, the demand for nets has to 

come from them.” 

Mr. Herman Kimambo in his wholesale shop in Morogoro 

Town, Tanzania. 

USAID / KARIE ATKINSON 

Monitoring and Evaluation 

Baseline data on mortality of children under five 

and coverage of the four major control measures were 

obtained from the 2005/2006 Demographic and Health 

Survey (DHS). This survey was conducted between 

October 2004 and February 2005 with a nationally-representative sample of more than 10,000 households. The 

all-cause mortality rate for children under age five was 

estimated at 112 per 1,000 live births for the period 

from 2000-2004. In other words, during this period, 

11.2 percent of children died before their fifth birthday. 

Compared to previous mortality rates, this survey already 

indicated a substantial decline in under-five mortality 

29  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
’

USAID / KARIE ATKINSON 

Akidas mother cashes in her voucher at a retail shop for a net 

after paying a small top-up fee. She chooses a 6x6 foot ITN ­

the most popular net among women because of its large size. 

from 147 per 1,000 live births for the period 1995­

1999, probably due to general improvements in health 

care and the standard of living. In Tanzania, with support from the PMI, births and deaths are being tracked 

within defined populations at two demographic surveillance system (DSS) sites; all deaths are then followed up 

with an interview (sometimes called a verbal autopsy) 

with the parents of the deceased child. While these sites 

do not provide nationally-representative data, the estimated proportion of deaths attributed to malaria for 

children under age five at these sites will be used together with information on all-cause under-five mortality 

obtained from nationally-representative surveys to 

assess reductions in malaria mortality for children at 

the national level at the end of the PMI. 

Among all households surveyed during the Demographic 

and Health Survey, 23 percent owned at least one ITN. 

This proportion varied across urban and rural areas, with 

25 percent ownership in urban areas and only 7 percent 

ownership in rural areas of the mainland. Sixteen percent of children under five and 16 percent of pregnant 

women had slept under an ITN the night before the survey. These figures may underestimate true bednet usage, 

as the survey was not conducted during peak malaria 

transmission season. Among women who gave birth in 

the five years prior to the survey, 22 percent had received 

IPTp during their last pregnancy. 

Challenges and Future Directions 

Following the highly successful ITN campaign on 

Zanzibar during Year 1, PMI will work with the 

Zanzibar Malaria Control Program to determine how 

best to sustain high levels of coverage with long-lasting 

ITNs among pregnant women and children under five. 

Additionally, PMI will consult with Malaria Control 

Program staff to decide how much longer regular IRS 

should be continued on Zanzibar, given the striking 

reductions in reported malaria cases and the already 

high levels of ITN coverage in the population. 

On the mainland, PMI will support nationwide expansion of the infant voucher scheme of the Tanzania 

National Voucher Scheme. The voucher program to 

provide free long-lasting ITNs to the poorest families 

will also be expanded. Since nets currently offered 

through the voucher scheme require periodic re-treatment with insecticide, PMI will support Tanzanian net 

manufacturers to adopt new technology to produce 

longer-lasting ITNs. To close the gap between net ownership and net use, PMI will promote regular use of 

ITNs through mass media, rural road shows, and other 

community-based approaches. IRS will be expanded to 

cover an estimated 40,000 houses in two rounds of 

spraying in Muleba District, which recently had a malaria outbreak. The PMI will continue to provide support 

for the nationwide scale-up of IPTp. 

Beginning in early 2007, PMI will provide subsidized 

ACTs to Accredited Drug Dispensing Outlets (ADDOs). 

ADDOs are part of an innovative program that trains 

private drug sellers to correctly diagnose and treat illnesses, such as malaria. These outlets are then accredited by 

the Tanzanian government. By providing ACTs to these 

ADDOs, PMI will reach the large proportion of malaria 

patients who are treated outside the formal government 

health system. The PMI will also provide assistance to 

strengthen the Tanzanian Government Medical Stores 

Department to improve pharmaceutical management 

throughout the country. 

Children receive a net at the dual launch of PMI and the Kataa 

Malaria campaign, on December 19, 2005, which was attended 

by at least 10,000 Zanzibaris, including the President of Zanzibar, 

the First Lady, and the Minister of Health and Social Welfare. 

USAID / KIM WYLIE 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  30
CHAPTER 5 

“Following the spraying [in Kabale District], the number of malaria cases in health facilities has dropped so 

much that people will tell you malaria is no longer a big threat.” – Patrick Tusiime, Director of Health Services, 

Kabale District, Uganda, October 2006 

31  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

USAID / KARIE ATKINSON 

PMI has distributed insecticide-treated nets to people in refugee camps, such as this mother, in Northern Uganda. 
UGANDA
 


Malaria in Uganda 

Uganda has a population of 28.2 million people, with 

35 percent living in poverty. Two decades of civil war 

and unrest in northern Uganda have displaced 1.6 

million people, resulting in large populations living 

in camps. A recent survey by the World Health 

Organization (WHO) and other partners indicates 

that the northern districts of Uganda have the highest 

per capita death rate in the country. 

Malaria is endemic in 95 percent of Uganda and represents the country’s leading cause of illness and death, 

according to the Ministry of Health (MoH). In 2003 

the MoH reported that malaria accounted for up to 40 

percent of outpatient care visits and 25 percent of hospital admissions. Nearly half of hospital inpatient deaths 

among children under five years of age are due to malaria. 

UGANDA AT A GLANCE 

Indicator Baseline Coverage PMI Accomplishments to Date1 

Pregnant women who slept under an ITN 

the previous night 10% 2 305,305 free long-lasting ITNs distributed 

through clinics and IDP camps 

505,573 nets retreated with insecticide Children under five who slept under an 

ITN the previous night 10% 2 

Houses in geographic areas targeted for 

IRS which were sprayed 0 3 103,329 houses sprayed and 488,502 people protected 

Pregnant women who received IPTp 

according to national policy 17% 2 168 health workers trained in IPTp 

Children under five with suspected malaria 

who received treatment with ACTs within 

24 hours of onset of their symptoms 

1% 2 

261,870 ACT treatments procured, of 

which 87% have been distributed to 

health facilities 

Government health facilities with ACTs 

available for treatment of uncomplicated 

malaria 

0% 4 

2,844 health workers trained on ACTs 

in 16 out of 80 districts in the country5 

YEAR 1 BUDGET: $9.5 million (FY06) and $510,775 (FY05) 

1) The PMI measured Year 1 results in terms of process indicators, rather than outcome indicators. Coverage of each intervention will only be measured every 

two years and its impact on malaria-related illness and death only evaluated at the beginning and end of the Initiative because of cost. Results reported in this 

chapter are up-to-date as of January 1, 2007. 2) Uganda 2006 Demographic and Health Survey Preliminary Report. 3) No areas were targeted for spraying by 

the National Malaria Control Program. 4) ACTs were not implemented in MoH facilities until March 2006. 5) UPHOLD, Quality Assurance Report 2006. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  32
Figure 5.1:Allocation of $9.5 million PMI 

Budget in Uganda, FY2006 

(Proportion of budget spent on commodities: 45%) 

Note: $510,775 of FY05 funds were also used for the 

procurement of ITNs. 

Scaling Up Interventions inYear 1 

The PMI worked closely with Uganda’s Inter-Agency 

Coordination Committee for Malaria, the MoH, and 

other partners to plan Year 1 activities. The PMI’s FY06 

budget for Uganda was $9.5 million (Figure 5.1). 

Almost half of this amount was allocated to programs 

Table 5.1: ITN Activities in Uganda 

supporting insecticide-treated mosquito nets (ITNs), 

and another 19 percent each to indoor residual spraying 

(IRS) and to diagnosis and treatment activities, including 

procurement of artemisinin-based combination therapy 

(ACT). Since The Global Fund to Fight AIDS, 

Tuberculosis, and Malaria (GFATM) and the MoH 

were providing sufficient quantities of sulfadoxinepyrimethamine (SP) to meet all Year 1 needs for 

intermittent preventive treatment of pregnant women 

(IPTp), PMI focused its efforts on the roll out of IPTp 

through health worker training. To accelerate the start 

up of PMI’s activities in country, an additional $510,775 

of FY05 malaria funds were used for the purchase of 

ITNs. 

The PMI began its activities in Year 1 with two 

“jump-start” activities in the high-need internally-displaced persons (IDP) camps of northern Uganda: an 

ITN distribution and promotion campaign and distribution of ACTs. These two activities were selected 

because of their potential for significant health impact. 

Subsequent activities were designed to build upon these 

initial efforts. 

Insecticide-Treated Nets (ITNs) 

As in Angola and Tanzania, Uganda uses a market segmentation approach for ITN distribution. Full-cost nets 

are sold by retailers in urban areas. In areas where no 

commercial market currently exists (or is not viable), 

subsidized nets are available to those who can afford to 

Activity Location ITNs Distributed 

Distribution of free long-lasting ITNs 

in IDP camps 

4 districts (northern Uganda) 147,318 long-lasting ITNs 

Distribution of free long-lasting ITNs 5 districts 76,865 long-lasting ITNs 

Distribution of free long-lasting ITNs 

through antenatal/child health clinics 

4 districts (northern Uganda) 76,432 long-lasting ITNs 

Distribution of subsidized and full-cost 

ITNs through the commercial sector1 

Rural and peri-urban areas 

nationwide 

414,047 ITNs 

155,237 long-lasting ITNs 

17,000 subsidized nets 

Distribution of free long-lasting ITNs 

to people living with HIV/AIDS 

15 districts 4,690 long-lasting ITNs 

Re-treatment of ITNs with insecticides 29 districts 505,573 ITNs retreated with insecticide 

1) PMI support to a non-governmental organization to develop a commercial market for ITNs led to the sale of 586,284 ITNs. 

Note: It is estimated that one mosquito net will protect about 1.6 people because, on average, two people will sleep under a net 80% of the time. 

33  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
USAID / CHRIS THOMAS 

A family receives two long-lasting ITNs in their village 

in northern Uganda. 

pay a portion of the cost of the net. Free nets are 

distributed to children under five, people living with 

HIV/AIDS, and the poorest segment of the population. 

Although 34 percent of all Ugandan households own a 

mosquito net, many of these nets are either untreated or 

no longer have active insecticide on them. 

Activities supported by PMI during Year 1 included (see 

Table 5.1): 

•	 Procurement and distribution of 147,318 free longlasting ITNs in 269 IDP camps in northern Uganda; 

•	 Procurement and distribution of 76,865 free long-lasting ITNs in five other districts with historically low 

ITN coverage rates; 

•	 Distribution of 76,432 free long-lasting ITNs to pregnant women attending antenatal/child health clinics; 

•	 A health education campaign to explain the value 

of the nets in preventing malaria and promote their 

correct use. The campaign included leaflets in local 

languages, radio shows, T-shirts with malaria slogans, 

cartoon strips, billboards, and training of 1,160 local 

council leaders in 30 districts to promote ITN use at 

the community level; 

•	 Support through a non-governmental organization 

(NGO) for development of a commercial market for 

KOMAKEC’S STORY: 

AN INSECTICIDE-TREATED NET 

BRINGS LUCK TO A BOY 

In early March 2006, 15-month-old Komakec Emanuel got 

very sick. His mother, Oroma Monica, took him to the 

health clinic near their home in the Ongako Internally 

Displaced Persons Camp (IDP) in Gulu District, northern 

Uganda. Komakec had a high fever and was vomiting and 

convulsing. When they reached the clinic, Komakec was 

immediately admitted. After Komakec was diagnosed with 

malaria, his mother expected the worst. She had already 

lost two sons to malaria before they reached the age of 

three. In fact, when he was born, she named her son 

“Komakec,” which means “I am unlucky” in Acholi. She 

feared that malaria would also take him. 

At the clinic, Komakec received lifesaving antimalarial combination drugs that had been supplied through The GFATM. Once he was well, Komakec went home with a long-lasting 

ITN provided by PMI. By using the net consistently, Komakec is significantly less likely to become ill with malaria again. 

Asked how she manages to hang the net given the limited space in her hut, Oroma explained that she ties the net up 

every evening as she spreads out the mat for sleeping and removes it in the morning. 

The PMI has distributed $1,700,000 worth of free long-lasting ITNs in nine districts in northern Uganda. Because coverage in this region is lower than the national average, PMI launched its net distribution effort in IDP camps, such as the one 

where Komakec lives. Komakec has not been sick since he started sleeping under the net, although he used to get sick 

every two months. Perhaps Komakec is not so unlucky after all. 

Komakec lives in a hut within Ongako Internally Displaced 

Persons Camp in Gulu district (northern Uganda). 

UPHOLD 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  34
’

USAID / CHRIS THOMAS 

Long-lasting ITNs provided by the PMI are distributed free to 

families in Ugandas northern district of Lira. 

ITNs, particularly in rural and peri-urban areas of 

the country, where most mosquito nets are not treated 

with insecticides. This support included demand creation through radio spots, billboards, and cartoons in 

newspapers, as well as assistance to net distributors. 

As a result of this program, a total of 586,284 nets 

were sold by private retailers over the past 12 months; 

•	 Establishment of a granting mechanism to ensure a 

reliable supply of long-lasting ITNs to NGOs for free 

distribution in the communities in which they work; 

•	 Coordination between the President’s Emergency 

Plan for AIDS Relief (PEPFAR) and PMI to distribute 4,690 free long-lasting ITNs to people living with 

HIV/AIDS; 

•	 Free re-treatment of 505,573 conventional nets with 

insecticides in 29 districts; and 

•	 A pilot program for distribution of long-lasting ITNs 

to pregnant women and children under five through 

community health workers that can serve as a model 

for other areas. 

Table 5.2: IRS Activities in Uganda 

Indoor Residual Spraying (IRS) 

The PMI worked with the National Malaria Control 

Program (NMCP) during Year 1 to introduce IRS to 

Kabale District, which is prone to malaria epidemics. 

Between March and August 2006, the PMI procured 

insecticide, spray pumps, and safety equipment, hired 

and trained spray personnel, and sprayed more than 

100,000 houses. As a result of this experience, the 

NMCP has updated and strengthened their national 

IRS policies to include spraying to control malaria in 

high transmission areas and IDP settings, in addition 

to IRS for epidemic control. The NMCP also improved 

planning, reporting, and environmental and human 

health safety requirements related to IRS. 

During Year 1, PMI supported (see Table 5.2): 

•	 Training of 450 local personnel to conduct and 

supervise IRS; 

•	 Spraying of 103,329 houses in Kabale District, which 

represents 96 percent of all houses targeted for spraying; and 

•	 Prior to the campaign, activities to promote IRS were 

carried out in all communities targeted for spraying. 

This included radio talk shows, film screenings, community meetings at the sub-county, parish, and village 

levels, and announcements through the local media. 

Intermittent Preventive Treatment for Pregnant 

Women (IPTp) 

Although Uganda’s national policy is that pregnant 

women should receive two doses of SP as part of their 

antenatal care, in practice, IPTp is not widely implemented. This is due to a variety of factors, including 

lack of access to antenatal clinics, a weak drug distribution system, and low levels of awareness about IPTp 

among pregnant women and health workers. Since The 

GFATM and the MoH procured sufficient quantities of 

drugs for IPTp in Uganda, PMI focused its efforts on (1) 

training health workers to implement IPTp as part of an 

integrated package of antenatal care services (called 

Activity Location Houses Sprayed People Protected People Trained 

IRS campaign Kabale District 103,329 houses 488,502 residents of sprayed 

houses 

450 (including 307 spray 

operators, 47 team leaders, 

28 washpersons, 20 supervisors, and 48 clinicians) 

35  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
’

UPHOLD 

Workers in the northern Ugandan district of Gulu process 

bundles of long-lasting ITNs procured by PMI. 

•	 Development of Uganda-specific IPTp training manuals for health workers together with training of 168 

health workers in 11 districts; and 

•	 Development and dissemination of health education 

materials about IPTp in collaboration with the health 

education unit of the MoH. This included wall 

charts, radio spots, dissemination of fact sheets, 

and 1,000 radio listening clubs (consisting of 10-15 

members each). 

Diagnosis and Treatment 

The MoH of Uganda approved artemether-lumefantrine, 

an ACT, as the treatment of choice for uncomplicated 

malaria in 2004 and obtained its first supplies through 

The GFATM in 2006. The major challenge to the 

Focused Antenatal Care, or FANC), and (2) promoting nationwide scale-up of ACTs is the weak pharmaceutical 

IPTp among pregnant women. management system; however, Uganda already has a very 

extensive community-based program for malaria treatKey IPTp activities supported by PMI during Year 1 ment using non-ACT drugs, which will facilitate rapid 

included: 

CARTOONS AND BILLBOARDS BOOST MOSQUITO NET SALES IN THE PRIVATE SECTOR 

An NGO supported by the U.S. Government has been working with the private sector in Uganda over the past three 

years to promote ITNs. This work, combined with marketing campaigns, such as in-store consumer promotions and 

“Squitos” cartoons strips in daily newspapers and roadside billboards, has seen the annual number of nets distributed in 

Uganda jump from 280,295 in 2002 to about 2.5 million in 2004. In 2005, 93 percent of nets distributed in Uganda came 

from the private sector, and the number of outlets selling nets has increased from just five in the capital, Kampala, to 1,164 

nationwide. 

NETMARK 

Cartoons and billboards are successfully boosting sales of mosquito nets in Ugandas retail shops. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  36
USAID / KARIE ATKINSON 

Helen Onen, a community health worker (CHW) in Ongaka 

internally-displaced persons camp in northern Uganda, is one of 

the CHWs who helped distribute long-lasting ITNs purchased 

by PMI in March 2006. 

expansion of ACTs to rural areas as this program transitions to using ACTs. 

Diagnosis and treatment activities supported by PMI 

during Year 1 included (see Table 5.3): 

•	 Procurement of 261,870 ACT treatments for northern 

Uganda, of which 87 percent have been distributed to 

health facilities or through community health workers 

who are part of the Ugandan government’s system of 

community-based treatment of malaria. Since this is 

one of the first times in Africa that ACTs have been 

administered by community health workers, PMI is 

supporting an evaluation of this approach; 

•	 Provision of technical assistance in pharmaceutical 

management and logistics for the distribution of 3.8 

million ACT treatments purchased by The GFATM; 

•	 Technical assistance to the MoH to develop a plan for 

distributing, storing, reporting, and monitoring ACTs 

at the national and district levels; 

•	 Training of 2,844 health workers in 711 health facilities in the use of ACTs as first-line treatment; and 

•	 Purchase of laboratory equipment for post-shipment 

testing and monitoring of drug quality as required by 

Ugandan law, as well as training of 15 government 

workers and 4 private sector technicians in quality 

control. 

Monitoring and Evaluation 

Baseline data for PMI on coverage with ACTs, IPTp, 

and ITNs were obtained from the 2006 Demographic 

and Health Survey (DHS), conducted between May and 

October 2006 with a nationally-representative sample of 

about 10,000 households. The results reported here are 

from the preliminary report of that survey. Among all 

households in the survey, 16 percent owned at least one 

ITN. This proportion varied across urban and rural 

areas, with 26 percent ownership in urban areas and only 

14 percent ownership in rural areas of the country. Ten 

percent of children under five and 10 percent of pregnant women had slept under an ITN the night before 

the survey. Among women who gave birth in the five 

years prior to the survey, 17 percent had received IPTp 

during their last pregnancy. 

The 2006 DHS will provide baseline data on all-cause 

mortality for children under five. In Uganda, the PMI 

is supporting the collection of malaria-specific mortality 

data for children under five in two ways: (1) with a verbal autopsy for recent deaths in children under five as a 

follow-on to the 2006 DHS; and (2) through follow-up 

of all deaths with a verbal autopsy within a defined population in Iganga District, where a demographic 

surveillance system (DSS) site already exists. At DSS 

sites, births and deaths are tracked within defined populations and all deaths are followed up with a verbal 

autopsy. Verbal autopsies have only recently been conducted in the Iganga site, and results are not yet available 

on a sufficient number of deaths to estimate malariaassociated mortality for that area. 

Table 5.3: Diagnosis and Treatment Activities in Uganda 

Activity Location Commodities Distributed People Trained 

Distribution of 

ACTs to selected 

populations 

Northern Uganda 261,870 ACT treatments 

procured, of which 228,870 

(87%) have been distributed 

to health facilities and 

community-based workers 

Training of 2,844 health workers on proper 

ACT use 

37  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  38

Challenges and Future Directions

During Year 1, PMI established a strong foundation

upon which to scale up interventions over the next three

to four years. The major challenges in Uganda during

Year 2 will be to: 

• Expand ITN and IRS activities beyond the northern

and southern areas targeted during Year 1. In Year 2,

IRS will be expanded from one district to three districts, including two epidemic-prone districts and one

highly endemic district, plus selected IDP camps in

the North; 

• Assist the MoH as it introduces ACTs as the treatment

of choice for malaria; as part of this effort the PMI

will assist with the roll out of ACTs at the community

level through the well-established network of

Community Drug Distributors; and 

• Expand support for Focused Antenatal Care training

and promote early attendance at antenatal clinics to

ensure all pregnant women receive at least two doses

of IPTp. 

The PMI is also partnering with the nonprofit organization, Malaria No More, to provide 550,000 long-lasting

ITNs, which will be distributed free by community

health workers to pregnant women and children under

five in villages throughout Uganda. 

ATSA’S STORY:

A RE-TREATED NET HELPS PREVENT MALARIA 

IN ONE UGANDAN FAMILY 

Atsa Namuy Omba, mother of three, can now sleep at night

knowing that her re-treated mosquito nets are protecting

her chi ldren in the midnight hours.That’s when female

Anopheles mosquitoes feed on human blood, transmitting

the Plasmodium parasite that causes malaria.The family’s bed

nets were retreated through a PMI-funded effort that retreated more than 500,000 nets with insecticide, benefiting

about 800,000 Ugandans such as Atsa.

“Before we bought the nets, my kids were getting malaria

every two months,” said Mrs. Omba, who lives in Wakiso

District about 5 miles from Uganda’s capital Kampala.“Since

we began to use the nets, my 2-year-old son has only been

infected once in a year,” she said.

“Before we bought the nets, my kids were getting malaria every two months.” – Atsa Omba, Uganda

Before they got their mosquito nets, the family suffered financially because they were constantly at the hospital with their

children.They are farmers and earn their living selling milk from their cows and vegetables they grow. Mrs. Omba learned

about the bed nets through the advice of health workers at the hospital near her home. Following this advice, she spoke

about it with her husband, Mustafa Luvega. Next thing she knew, he had gone to the market to buy two nets for about

four U.S. dollars each.

AMBOK USAID / JIMMY NY

Atsa Omba’s mosquito net has been re-treated with support

from PMI. 
CHAPTER 6
 


“Coordinated partnerships of international donor resources are not only essential, but also the measure of our 

commitment to alleviating poverty and human suffering.” – Dr. Kent R. Hill, Assistant Administrator for Global 

Health, June 8, 2006 

USAID TANZANIA 

Zanzibari women attend a malaria-related educational session at a health facility. 

39  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
’

PARTNERSHIPS
 


Partnerships are at the heart of the President’s Malaria 

Initiative’s (PMI) strategy. Given the enormous burden 

of malaria and the ambitious target of reducing malaria 

deaths by half by 2010, effective partnerships, particularly at country level, are essential to reach the 

maximum number of people. For this reason, the 

PMI closely coordinates its activities with host country 

governments, other U.S. Government agencies, international organizations, other bilateral, multilateral, and 

private donors, and non-governmental (NGO) and 

faith-based organizations. 

Host Country Governments 

The PMI works within the overall strategy and plan 

of the host country’s national malaria control program. 

Planning and implementation of PMI activities are coordinated closely with the host government Ministry of 

Health (MoH). The PMI’s long-term goal is to 

strengthen in-country capacity so that gains achieved 

with U.S. Government and other donor support can be 

sustained. Some examples include supporting refresher 

training for laboratory workers, quality control of malaria diagnosis, training provincial and district level staff to 

plan and conduct indoor residual spraying (IRS), and 

An Angolan mother and child receive a free long-lasting ITN at 

the launch of the measles-ITN campaign in M’banza Kongo, 

Zaire province, Angola in the presence of Angolas Vice Minister 

of Health, Dr. José van Dunem (background), U.S. Ambassador 

Cynthia G. Efird and Norwegian Ambassador Arild R. Øyen. 

improving pharmaceutical supply and management 

systems for the proper distribution and use of 

artemisinin-based combination therapies (ACTs) and 

intermittent preventive treatment for pregnant women 

(IPTp). In some cases, malaria control policies were “on 

the books”, but had not yet been put into practice. 

USAID / ANGOLA 

ANGEL’S STORY: 

AN HIV-POSITIVE MOTHER RECEIVES 

A LONG-LASTING ITN 

Angel Kapiisi is a 29-year-old woman who lives with her son 

in Ibanda District in Uganda. She is one of an estimated 

520,000 adult women in Uganda who are HIV-positive. 

Angel has suffered repeatedly from malaria and was finding 

it difficult to pay for her medicines. But all that was before 

she learned about long-lasting ITNs at her psychosocial support group meetings at Ruhooko Health Centre. Angel was 

one of 4,690 HIV-positive people to receive a free net from 

UPHOLD 

Angel Kapiisi is an HIV-positive mother who has received 

a free long-lasting mosquito net through PMI. 

a non-governmental organization supported by PMI in collaboration with PEPFAR.These nets were given to mothers 

attending support group meetings or post-test HIV clubs in 

PMI-supported health facilities. Angel had never owned a net 

before and had not thought of buying one for herself. She now uses it regularly with her son and has been malaria-free 

for the past three months. Angel calls upon fellow mothers to be tested and learn their HIV status. She also encourages 

everyone living with HIV/AIDS to go to support meetings, for if she had missed such a meeting, she would have missed 

out on a mosquito net. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  40
’

With PMI support, these policies are now being implemented for the first time. As PMI enters its second year 

in the first three countries, we are focusing more on 

“We must foster an environment in which 

the right people are connected to each other, 

and to the right ideas, and at the right time, 

which is now.” 

– Stephen B. Blount, MD, Director, Coordinating Office for Global 

Health, Centers for Disease Control and Prevention, June 8, 2006 

building the capacity of MoH systems and personnel. 

This effort will include improving financial and program 

management, information, education and communication, community mobilization, demand creation, and 

monitoring and evaluation capabilities of the National 

Malaria Control Program (NMCP). 

PMI Collaboration with PEPFAR 

The PMI is also working to strengthen links with other 

U.S. Government programs in-country, especially in 

the area of HIV/AIDS. Since the President’s Emergency 

Plan for AIDS Relief (PEPFAR) and PMI both target 

pregnant women, it makes good programmatic sense to 

combine services for IPTp and the distribution of insecticide-treated mosquito nets (ITNs) with services to 

prevent mother-to-child transmission of HIV/AIDS. 

For example, in Uganda, the PMI provided 4,690 free 

long-lasting ITNs to people living with HIV/AIDS. The 

PMI is making plans to collaborate with PEPFAR in a 

range of countries to coordinate the delivery of antenatal 

services for pregnant women. 

Multilateral Organizations 

The PMI seeks to identify and fill gaps in funding from 

other global partners engaged in the fight against malaria. In each of the Year 1 PMI countries, the Initiative 

coordinated its efforts with existing grants of The Global 

Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). 

For example, in Angola, where a major portion of the 

drugs needed for the initial phase of ACT implementation are provided through a three-year $40 million 

GFATM grant, PMI has focused on training health 

workers and health education to support the scale up 

of ACTs. In Uganda, 3.8 million ACT treatments purchased by The GFATM were distributed nationwide 

with technical assistance in developing a plan for storing, 

distributing, reporting, and monitoring of ACTs at the 

national and district level from PMI. In Tanzania, PMI 

complements GFATM activities by training health care 

workers in 54 of 121 districts nationwide, while The 

GFATM trains health workers in other areas. 

The PMI also coordinates its activities with The World 

Bank’s Malaria Booster Program in countries where both 

institutions are working. At the global level, PMI partners with both the World Health Organization (WHO) 

and United Nations Children’s Fund (UNICEF) to 

ensure a steady world supply of high-quality ACTs, 

ITNs, and rapid diagnostic tests (RDTs) at reduced 

prices. The PMI and WHO are working together to 

support increased use of residual spraying with insecticides (including DDT) in Africa. The PMI also works 

with UNICEF at the country level to coordinate the 

implementation of activities, such as the joint implementation, in mid-2006, of the MoH-led ITN 

distribution-measles vaccination campaign in Angola. 

Private Sector Partners 

When PMI was launched in June 2005, President Bush 

urged other donors, including the private sector, to join 

in a broad campaign to reduce malaria mortality by 50 

percent in Africa. The President reiterated this challenge 

at the White House Summit on Malaria in December 

2006. 

Several donors in the private sector are already making 

major contributions to the fight against malaria, including the Bill and Melinda Gates Foundation, one of the 

ExxonMobil Foundation announced a grant of $1 million to support PMI in Angola at a presentation ceremony on January 30, 

2007, in Luanda, Angola. Pictured here are (from left to right): 

James R. Riley, ExxonMobil s Manager of Government Relations 

and Public Affairs Business Support, the Angolan Vice Minister 

of Health Dr. José van Dunem, USAID Mission Director Diana 

Swain, and U.S. Deputy Assistant Secretary of State Carol 

Thompson. 

USAID 

41  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
PARTNERING TO SAVE LIVES IN ANGOLA 

Getting a mosquito net into the hands of a mother in 

Angola is not a simple undertaking. It involves numerous 

steps: the net needs to be manufactured, packaged, shipped, 

cleared through customs, distributed, and then used properly. These last two steps in the process are critical if those 

nets are to reach those groups most vulnerable to malaria – 

pregnant women and children under five. In Angola, as in 

many settings in sub-Saharan Africa, net distribution is complex and costly in part because of the difficulty involved in 

reaching people in remote areas where roads are poor and 

formal health facilities are lacking. Under these conditions, 

innovative distribution mechanisms are needed. Net distribution is more cost effective when it can be “piggy backed” 

onto an existing public health intervention. In Angola, PMI 

did just that, in close collaboration with a number of other 

major partners. 

“What we are trying to do is not only help the people of Angola, but work very closely with PMI 

to develop a model of engagement where the private sector can meaningfully tie into PMI countries and PMI projects.” – Dr. Steven C. Phillips, Medical Director, Global Issues and Projects, ExxonMobil Corporation 

In July 2006, an integrated nationwide campaign reached more than 3.5 million children with measles and polio vaccinations, vitamin A, and de-worming medication. The PMI contributed more than half of the long-lasting ITNs toward the 

campaign, which distributed a total of 826,000 free long-lasting ITNs to children under five in the seven of the most 

malarious provinces of the country. The ExxonMobil Foundation contributed both financial support and 70,000 long-lasting ITNs. Early evidence about net use among children following the campaign is very encouraging. A survey conducted 

4 to 6 weeks after the campaign showed that the percentage of children under five sleeping under a bed net the previous 

night averaged 69 percent, up from an estimated 10 percent before the campaign. 

This successful campaign was the fruit of a wide-reaching partnership of organizations and donors to which the PMI 

contributed. The campaign was carried out with the support of the National Malaria Control Program of Angola and 

the Measles Initiative, a partnership formed to reduce measles deaths in sub-Saharan Africa that is led by the American 

Red Cross, the United Nations Foundation, WHO, UNICEF, and CDC. This partnership is just one example of how 

PMI is joining forces with other major global and private donors to ramp up the fight against malaria and save lives. 

USAID 

A campaign worker in Angola wears a T-shirt with the 

logos of the multiple partners involved in the measles-ITN 

campaign. 

largest funders of health activities in the world today, 

and Marathon Oil Corporation with Noble Energy, Inc., 

which are supporting a highly successful malaria control 

project in Equatorial Guinea. 

In FY06, the largest direct financial contribution to 

PMI from an external source was a $1 million donation 

from ExxonMobil Foundation for activities in Angola. 

This funding helped support the nationwide Malaria 

Indicator Survey, promotion and health education 

activities for ITNs, and strengthening of the MoH 

pharmaceutical management system. In addition, 

ExxonMobil contributed 70,000 nets to the integrated 

measles vaccination-ITN distribution campaign. In 

FY07, ExxonMobil has again donated $1 million in 

support of PMI’s activities in Angola. The nonprofit 

organization, Malaria No More, has pledged to provide 

350,000 long-lasting ITNs, which, together with 

200,000 long-lasting ITNs from PMI, will be distributed 

free to vulnerable groups in Uganda. 

The PMI also supports technology transfer to Tanzanian 

net manufacturers, together with the NMCP and 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  42
’

NGOs, to ensure in-country capacity to produce 

high-quality ITNs. 

Non-governmental and Faith-based 

Organizations 

The participation of non-governmental, faith-based, and 

community-based organizations are crucial to the success 

of PMI. These groups are well placed to deliver services 

to people in remote areas where the formal health system 

is weak. They also have access to community networks 

and benefit from a high degree of credibility at the community level. The PMI has already begun expanding its 

activities with non-governmental collaborators. To date, 

PMI has supported nearly 30 nonprofit organizations, of 

which five are faith-based. More than one-third of these 

groups are local, indigenous, nonprofit organizations. 

Non-governmental and faith-based organizations have 

contributed in major ways to PMI’s successes during 

Year 1. For example: 

•	 In Tanzania, PMI funded two faith-based organizations, Mennonite Economic Development Associates 

and World Vision, to expand the Tanzanian National 

Voucher Scheme for ITNs to include infants as well 

as people who are unable to afford full-cost or subsidized nets; 

•	 In war-torn northern Uganda, PMI has funded a 

British NGO to distribute long-lasting ITNs to 

refugees in areas where the health infrastructure has 

been shattered by years of civil unrest. With PMI 

support, the Malaria Consortium has conducted mass 

mosquito net re-treatment campaigns in which a total 

of 505,000 nets were retreated with insecticide. A local 

group, Pulse Communications, Ltd., is ensuring that 

nets are used properly through education/entertainment approaches to reach residents at the community 

level; and 

•	 In remote districts of Angola, an NGO is supplying 

lifesaving ACT drugs to those most in need, while the 

Christian Children’s Fund has carried out innovative 

promotion and education activities before and during 

indoor residual spraying. The PMI has also worked 

in partnership with the American Red Cross and 

the International Federation of Red Cross and 

Red Crescent Societies to include long-lasting ITNs 

in integrated immunization campaigns in Angola 

and Rwanda. 

USAID Mission Director Pamela White, Zanzibar s Minister of 

Health Dr. Mohammed Jiddawi, and U.S. Ambassador Michael 

L. Retzer (from left to right) attend the launch of PMI’s indoor 

residual spraying campaign in Zanzibar. 

The Malaria Communities Program 

On December 14, 2006, First Lady Laura Bush 

announced the Malaria Communities Program (MCP) 

at the White House Summit on Malaria. The MCP is a 

$30 million program to identify and support new partner organizations, both U.S.-based and indigenous, to 

carry out sustainable malaria prevention and control 

activities under PMI. The MCP’s goal is to contribute 

to achievement of PMI targets by increasing local ownership and capacity to undertake sustainable, 

community-based malaria prevention and treatment 

activities. To accomplish this, the MCP will competitively award cooperative agreements to groups positioned 

to work at the community level in PMI countries to: 

expand and promote proper use of ITNs; support prevention and treatment of malaria in pregnant women; 

promote improved malaria case management, including 

community-based treatment efforts; and support indoor 

residual spraying and other vector control efforts through 

education and communication. All MCP partner organizations will work under the leadership of the NMCP 

and malaria control partners in the target PMI country. 

USAID / KIM WYLIE 

43  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  44
CHAPTER 7 

“PMI is a very different way of doing business than past practice. The hallmarks of the PMI are first and foremost programming based on clearly-defined numerical targets for outcomes. Second is transparency in how the 

money is being spent. Third is a robust and effective monitoring and evaluation plan. This approach provides 

assurance that taxpayers’ money is being spent effectively.” – Michael Miller, USAID Deputy Assistant Administrator, 

January 19, 2006 

45  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

USAID/JIMMY NYAMBOK 

Monitoring and evaluation is a key component of all PMI activities. Here, a community health worker 

in northern Uganda shows a record-keeping ledger. 
MONITORING AND EVALUATION
 


Monitoring progress on a routine basis and evaluating 

the outcome and impact on health or deaths in the population are essential for successful health programming. 

Routine monitoring activities allow program managers 

to identify problems in program implementation so that 

suitable modifications can be made. Evaluation activities 

enable program managers to determine whether desired 

goals and targets are being met. The PMI monitoring 

and evaluation strategy will draw on the experiences of 

both USAID and CDC in working with malaria programs over the last fifty years and build on the new 

USAID malaria data management system that was 

launched in 2005. 

Monitoring Activities 

Specific PMI-funded activities are monitored on a regular basis to allow in-country program managers to track 

progress, make adjustments, and redirect resources as 

needed. Activities within the four main intervention 

areas – insecticide-treated mosquito nets (ITNs), indoor 

residual spraying (IRS), intermittent preventive treatment of pregnant women (IPTp), and case management 

with artemisinin-based combination therapies (ACTs) – 

are tracked through reports from implementers and 

international and local partners. Types of activities that 

are monitored include procurement, distribution, and 

availability of commodities for the prevention, diagnosis, 

and treatment of malaria; training of health care workers; and health education efforts. 

Evaluation Activities 

The PMI has established a single set of targets for its 

four primary interventions: ITNs, IRS, IPTp, and ACT. 

These targets establish the levels of coverage to be 

achieved by the end of PMI and are the same for each 

focus country. The targets support the achievement of 

PMI’s goal to reduce malaria deaths by 50 percent. The 

PMI’s evaluation framework is aligned with the standard 

methodology for malaria program evaluation adopted 

and promoted by the Roll Back Malaria Partnership. 

Coverage indicators will be estimated at baseline, midpoint, and at the end of PMI. The impact of 

PMI-supported efforts on deaths in children under five 

years of age will be estimated at baseline and again at 

the end of PMI (see Box 1). 

The evaluation strategy includes: 

•	 Measurement of coverage with ITNs, IPTp, ACTs, 

and IRS at baseline, midpoint, and the end of PMI 

to see if coverage at the national level has increased 

as expected; 

•	 National estimates of deaths from all causes for children under five at baseline and at the end of PMI. 

Deaths from all causes among children under five is a 

routine health indicator collected through nationallyrepresentative surveys, such as Demographic and 

Health Surveys (DHS) and Multiple Indicator Cluster 

Surveys, in countries where routine registration of 

deaths is not available; 

ORC MACRO/ALFREDO FORT 

A mother is interviewed in Angola as part of the Malaria 

Indicator Survey in November 2006. 

CDC/BOB WIRTZ 

In a refugee camp in northwestern Tanzania, microscopists examine blood slides as patients wait for their results. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  46
’

Box 1:Timing of Mortality and Intervention Coverage Surveys 

Standard demographic surveys estimate child deaths 

through interviews with a nationally-representative sample 

of mothers who report deaths of their children in a defined 

period of time before the survey. The PMI will rely on such 

surveys for national estimates of deaths as a baseline and at 

the end of PMI. These surveys will also be used to estimate 

coverage of malaria interventions. An additional survey will 

take place at PMI’s midpoint to track intervention coverage. 

For example, in the first three PMI countries, the baseline 

survey was conducted in 2006, a midpoint survey will be 

conducted in 2008, and the final survey in 2011. * Mortality surveys also measure intervention coverage. 

USAID/KARIE ATKINSON 

•	 Collection of data on deaths attributed to malaria 	 Estimating Coverage of PMI Indicators 

from selected demographic surveillance system (DSS) Evaluation of progress toward PMI’s coverage targets will 

sites and, in some cases, national surveys (such as be collected primarily through demographic surveys of a 

DHS). This information, along with information on representative sample of national households, which will 

deaths from all causes for children under five, coverage measure: 

of malaria interventions, and other relevant factors, 

will be analyzed together to estimate reductions in • The percentage of households with a pregnant woman 

malaria- associated deaths; and/or children under five years old that own at least 

one ITN; 

•	 Collection of data on the frequency of anemia and
 


malaria infection among children under five to assess • The percentage of children under five years old 
 


impact on malaria-related morbidity; and who slept under an ITN the previous night; 
 


•	 Additional information on antimalarial drug and 	 • The percentage of pregnant women who slept under 

insecticide resistance, drug quality and safety, mosqui- an ITN the previous night; 

to populations and transmission, quality of health 

care, and service availability in health facilities will be • The percentage of pregnant women and children 

collected through special surveys and targeted studies. under five years old who slept under an ITN the 

previous night or in a house that has been protected 

by IRS; 

•	 The percentage of women who have completed a 

pregnancy in the last two years who have received two 

or more doses of IPTp during that pregnancy; and 

•	 The percentage of children under five with suspected 

malaria who have received treatment with ACTs within 24 hours of onset of their symptoms. 

The percentage of houses in geographic areas targeted 

for IRS that have been sprayed will be determined from 

routine spraying records. The percentage of government 

health facilities that have ACTs available for treatment 

of uncomplicated malaria will be obtained by health 

facility surveys. 

Health workers at Mafiga clinic in Tanzanias Morogoro District 

check vouchers redeemed for ITNs against the antenatal clinic 

register to ensure correct usage of the vouchers. 

47  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
CDC/TOM BURKOT 

Accountability and Transparency of PMI 

Providing information to the public on funding allocations, procurements, program activities, milestones, and 

results in a timely and accurate manner is a high priority 

for PMI. The PMI communication strategy calls for 

information about PMI and its operations to be made 

available through multiple communication channels, 

including PMI newsletters, public announcements, press 

releases, various international events, and the PMI Web 

site (www.fightingmalaria.gov). Latest news and updates 

on PMI activities from the field are continuously collected and shared through these channels. As of December 

31, 2006, more than 90 percent of all contracts and 

agreements related to PMI activities had been posted on 

the PMI Web site, and annual reports from implement­ A field worker examines mosquitoes from a household pyrethrum ing partners will be added in the near future. spray catch to monitor mosquito densities, particularly in areas 


where IRS is being implemented. 


Estimating Malaria-Related Deaths 

In most sub-Saharan African countries, the majority of 

deaths among children under five occur outside the formal health system. The specific cause of death is often 

unknown and is rarely recorded. Because the PMI goal 

is to halve malaria deaths and because 80-90 percent of 

malaria deaths in Africa occur in children under five, it is 

important to be able to estimate the proportion of those 

deaths associated with malaria. To do this, interviews 

(sometimes called verbal autopsies) are conducted with 

parents of deceased children. During these interviews, 

parents are asked to recall the symptoms and the duration of their child’s fatal illness. This information is then 

used to classify the cause of death. In Year 1 PMI countries, verbal autopsies are included in the 2007 Malaria 

Indicator Survey in Angola, and the Uganda 2006 DHS. 

In Tanzania, malaria-related deaths were estimated based 

on verbal autopsies carried out within the defined population of a DSS site in Rufiji District. 

As PMI countries reach their 85 percent coverage targets 

with the four major interventions, malaria-related deaths 

among children under five will decline. To determine 

whether changes in deaths at the population level are 

associated with the efforts of the national malaria control 

program, PMI, and other partners, deaths from all causes 

and malaria-related deaths in children under five will be 

interpreted together with general health data, coverage 

indicators, and climatic factors, such as rainfall, that 

influence malaria transmission. 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  48
CHAPTER 8 

“The campaign against malaria is a broad and challenging undertaking, requiring cooperation among many 

different countries, agencies, and programs.” – Mrs. Laura Bush, First Lady of the United States, June 8, 2006 

49  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

USAID TANZANIA / CHARLES LLEWELLYN 

Zanzibari girl at a health clinic. 
FUTURE DIRECTIONS
 


In its first year, the President’s Malaria Initiative (PMI), 

working with local and international partners, has made 

significant progress in scaling up malaria prevention and 

treatment activities in Angola, Tanzania, and Uganda. 

In addition, “jump-start” activities to launch PMI in 

the four Year 2 countries have already begun using 

Fiscal Year (FY) 06 and early FY07 funding: 

•	 In Malawi, 186,000 long-lasting ITNs have arrived 

and will soon be distributed free of charge to pregnant 

women attending antenatal clinics nationwide; 

•	 In Mozambique, a mass bed net re-treatment campaign took place in five provinces in November 2006, 

resulting in the re-treatment of approximately 

450,000 nets; 

•	 In Senegal, 100,000 mosquito nets were re-treated 

with insecticide; and 

•	 In Rwanda, 555,000 doses of sulfadoxinepyrimethamine have been procured for intermittent 

preventive treatment (IPTp) nationwide, and 866 

health workers have been trained on malaria in pregnancy in preparation for the official nationwide 

launch of IPTp in December 2006. 

White House Summit on Malaria 

On December 14, 2006, the President and Mrs. 

Bush hosted a White House Summit on Malaria in 

Washington, D.C., to raise awareness about malaria 

and mobilize a grassroots effort to save millions of lives 

from the disease in Africa. This event brought together 

international experts; corporations and foundations; 

African civic leaders; and voluntary, faith-based, and 

nonprofit organizations. At this Summit, the President 

and First Lady: 

•	 Launched the Malaria Communities Program – a $30 

million initiative to build new and sustainable malaria 

control projects in Africa by providing grants to 

indigenous non-governmental organizations and faithbased organizations to support malaria control work 

and help families take charge of their own health; 

WHITE HOUSE / SHEALAH CRAIGHEAD 

Mrs. Laura Bush delivers her remarks at the White House Summit 

on Malaria, on December 14, 2006, in Washington, D.C. 

WHITE HOUSE / ERIC DRAPER

President George W. Bush welcomes President Boni Yayi of Benin 

to the White House on December 14, 2006. Among other issues, 

the two leaders talked about joint efforts to combat HIV/AIDS 

and malaria in Benin. 

•	 Designated April 25, 2007, as “Malaria Awareness 

Day,” to raise awareness in the United States about 

malaria and to reaffirm U.S. commitment to overcome this disease; and 

•	 Announced the eight Year 3 PMI countries – Benin, 

Ghana, Kenya, Liberia, Madagascar, Mali, Zambia, 

and Oromiya Region in Ethiopia (see Box 1). 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  50
Box1: Map of Africa showing countries supported by PMI in Years 1, 2, and 3 

Needs assessment and planning visits to these eight new 

countries will take place between February and May 2007 

to develop operational plans for the start of activities in 

late 2007. With continued support from Congress, PMI 

expects to reach an additional 30 million beneficiaries 

with lifesaving malaria prevention or treatment measures 

during 2007 in the seven Year 1 and 2 countries, while it 

builds in-country capacity and sustainability. 

51  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  52
APPENDIX 

Summary of Results by Intervention 

1. Indoor Residual Spraying 

PMI IRS Activities by Country, FY 2006 

Country Houses Sprayed 

(percent of houses targeted) 

People Protected People Trained3 

Angola1 107,373 (90%) 590,398 2 350 

Tanzania 203,754 (96%) 1,018,156 536 

Uganda 103,329 (96%) 488,502 450 

TOTAL 414,456 2,097,056 1,336 

1) In addition to the activities reported in this table, PMI provided assistance to a GFATM supported campaign in Angola, during which 25,329 houses were 

sprayed and 176,155 residents were protected. 2) An additional 100,000 residents whose homes were not sprayed but who lived within a cordon of sprayed 

houses are estimated to have benefited from this activity. 3) Includes spray operators, supervisors, and ancillary personnel. 

2. Insecticide-Treated Mosquito Nets 

PMI ITN Activities by Country, FY 2006 

Country Free ITNs Distributed Subsidized/full cost 

ITNs Distributed1 

ITNs Re-treated 

with Insecticide 

Angola 420,000 120,949 None 

Tanzania 130,000 13,894 None 

Uganda 305,305 586,284 505,573 

TOTAL 855,305 721,127 505,573 

1) This includes ITNs distributed as well as vouchers distributed and redeemed. 

Note: It is estimated that one mosquito net will protect about 1.6 people because, on average, two people will sleep under a net 80% of the time. 

53  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 
3. Intermittent Preventive Treatment in Pregnancy 

PMI IPTp Activities by Country, FY 2006 

Country Number of Health Workers 

Trained in IPTp 

Other Accomplishments 

Angola 1,450 

Tanzania 376 IPTp has been included in the curricula of all 

nurse-midwifery certificate schools 

Uganda 168 District health education units have been supported to 

develop education materials for antenatal clinics and at 

the community level to create demand for IPTp among 

pregnant women 

TOTAL 1,994 

4. Diagnosis and Treatment 

PMI Diagnosis and Treatment Activities by Country, FY 2006 

Country Number of Rapid 

Diagnostic Tests 

Number of ACT Treatments Number of Health Workers 

Trained in ACTs 

Angola 129,875 RDTs 587,520 treatments procured and 

arrived in country 

1,283 

Tanzania 875,000 RDTs (of which 

100,000 distributed) 

380,160 treatments procured and 

distributed to health facilities 

4,217 

Uganda 0 261,870 treatments procured, of 

which 228,870 distributed 

2,844 

TOTAL 1,004,875 1,229,550 8,344 

SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA  54
ACKNOWLEDGMENTS
 


The First Annual Report of the President’s Malaria Initiative is dedicated to the staff of host governments, 

international and local partners, and all U.S. Government staff who have contributed to the achievements 

described in these pages. 

PRESIDENT’S MALARIA INITIATIVE
 


55  SAVING THE LIVES OF MOTHERS AND CHILDREN IN AFRICA 

U.S.Agency for International Development 

1300 Pennsylvania Avenue, NW 

Washington, DC 20523 

www.usaid.gov