In November 2007, Africa Fighting Malaria (AFM) visited Zanzibar to document the islands' progress in controlling malaria. In this report, we briefly describe the history of malaria control on Zanzibar and track the progression of the current program, which has successfully managed to bring the disease under control. The lessons learned and challenges ahead for Zanzibar provide an excellent case study of the appropriate policies for other island nations and countries seeking to control and eliminate malaria.
Zanzibar has a long history of malaria control and benefited from a highly effective control program in the 1960s. Unfortunately this program was abandoned in 1968. The disease subsequently returned to the islands, and by the 1980s was once again the number one killer of children. In 2003, the Government of Zanzibar changed treatment policies from chloroquine, which was failing in 60 percent of cases, to artemisinin-based combination therapies (ACTs). It also initiated indoor residual spraying programs (IRS) and distributed insecticide-treated nets (ITNs) to pregnant women and children under 5 years of age. These interventions dramatically reduced the burden of malaria - parasite prevalence on the islands is now below 1 percent.
Zanzibar's success in controlling malaria presents some new challenges. For example, presumptive treatment of fever with anti-malarials, a strategy broadly applied in endemic settings, must be revised in Zanzibar's case. Fever cases among both adults and children are no longer likely to be caused by malaria. Malaria scientists now must decide how best to take the malaria control program forward, how to detect malaria epidemics and respond to them. Perhaps most important of all, scientists, malaria control program officers and donors need to find the most appropriate way to sustain the program and keep Zanzibar malaria-free. The island should be able to eliminate malaria with the existing set of vector control tools and treatments. However, in order to achieve elimination, it is incumbent on Zanzibar's political leaders to prioritize malaria control and to work constructively with malaria scientists to implement the best possible range of strategies. Malaria could return to these islands via trade routes and claim the lives of people who have lost natural immunity to the disease. If history is any guide, the long-term success of malaria control depends on Zanzibar's capacity to grow economically and create wealth for its inhabitants. The full report is available at: http://www.fightingmalaria.org/pdfs/AFM_Zanzibar_March08.pdf