Access to malaria diagnosis and treatment in Zambia in the context of scaling-up community case management: Results from repeated national cross-sectional surveys
- 1Tulane University, New Orleans, Louisiana, United States of America
- 2PATH, Seattle, Washington, United States of America
- 3PATH, Lusaka, Zambia
Abstract
Community case management has been scaled up nationally in Zambia over the last decade. However, there is limited evidence on how this nationwide implementation has affected febrile patients’ access to malaria diagnosis and treatment in Zambia. This study analyzed four rounds of Malaria Indicator Survey (MIS) data (2012–2021) to evaluate: 1) proportion of all-ages individuals with fever who sought treatment from a formal provider, 2) proportion of individuals going to CHWs over time, among those who sought treatment at a formal provider, 3) time duration between fever onset and treatment seeking at a formal provider, and 4) proportion of children <5 with malaria that received Artemether-Lumefantrine (AL) treatment. Mixed-effect logit models were employed to examine determinants of treatment-seeking behavior and factors affecting AL receipt among children <5 with malaria cases. The proportion of febrile patients seeking treatment remained below 60% throughout 2012–2021, and AL receipt among children with malaria cases consistently stayed below 50%. The mean interval between fever onset and initial treatment-seeking encounter decreased from 2.42 days in 2012 to 1.71 days in 2021. Among formal care seekers, CHW utilization increased from 1.5% in 2012 to 10.0% in 2018 before declining to 3.2% in 2021. Longer walking time to the nearest health facility was associated with lower odds of treatment seeking, whereas CHW density was not associated with treatment seeking or AL receipt. Children who did not go to formal providers had lower odds of AL receipt than those who sought treatment from CHWs. Despite nationwide CCM scale-up over the last decade, significant barriers persist in malaria patients’ access to diagnosis and treatment in Zambia. Our results indicate that while CCM coverage should be maintained and further expanded, additional complementary interventions are also needed to overcome remaining access barriers.
Versions
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BibTeX
@article{mao2026access,
title = {{Access to malaria diagnosis and treatment in Zambia in the context of scaling-up community case management: Results from repeated national cross-sectional surveys}},
author = {Zhiyuan Mao and Adam Bennett and Kafula Silumbe and John Miller and Justin Millar and Hannah Slater and Josh Yukich and Ruth A. Ashton and Irene Kyomuhangi and Andrew Andrada and Refilwe Karabo and Thomas P. Eisele},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007216},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007216},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Access to malaria diagnosis and treatment in Zambia in the context of scaling-up community case management: Results from repeated national cross-sectional surveys
AU - Zhiyuan Mao
AU - Adam Bennett
AU - Kafula Silumbe
AU - John Miller
AU - Justin Millar
AU - Hannah Slater
AU - Josh Yukich
AU - Ruth A. Ashton
AU - Irene Kyomuhangi
AU - Andrew Andrada
AU - Refilwe Karabo
AU - Thomas P. Eisele
PY - 2026
DA - 2026/09/08
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007216
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007216
AB - Community case management has been scaled up nationally in Zambia over the last decade. However, there is limited evidence on how this nationwide implementation has affected febrile patients’ access to malaria diagnosis and treatment in Zambia. This study analyzed four rounds of Malaria Indicator Survey (MIS) data (2012–2021) to evaluate: 1) proportion of all-ages individuals with fever who sought treatment from a formal provider, 2) proportion of individuals going to CHWs over time, among those who sought treatment at a formal provider, 3) time duration between fever onset and treatment seeking at a formal provider, and 4) proportion of children <5 with malaria that received Artemether-Lumefantrine (AL) treatment. Mixed-effect logit models were employed to examine determinants of treatment-seeking behavior and factors affecting AL receipt among children <5 with malaria cases. The proportion of febrile patients seeking treatment remained below 60% throughout 2012–2021, and AL receipt among children with malaria cases consistently stayed below 50%. The mean interval between fever onset and initial treatment-seeking encounter decreased from 2.42 days in 2012 to 1.71 days in 2021. Among formal care seekers, CHW utilization increased from 1.5% in 2012 to 10.0% in 2018 before declining to 3.2% in 2021. Longer walking time to the nearest health facility was associated with lower odds of treatment seeking, whereas CHW density was not associated with treatment seeking or AL receipt. Children who did not go to formal providers had lower odds of AL receipt than those who sought treatment from CHWs. Despite nationwide CCM scale-up over the last decade, significant barriers persist in malaria patients’ access to diagnosis and treatment in Zambia. Our results indicate that while CCM coverage should be maintained and further expanded, additional complementary interventions are also needed to overcome remaining access barriers.
SN - 2767-3375
ER -