Assembly/AU/4(XI) Page 13 Gambia, Guinea Bissau, Sao Tome and Principe and Guinea Bissau. Use of ITNs by pregnant women is even lower at 5%. All the 35 countries where IPTp is recommended have adopted the policy but only 20 countries are implementing countrywide. Coverage with IPT is less than 10%. However, some countries like Zambia 61%, Malawi 45% and, the Gambia 33% have achieved higher IPT coverage. All countries except 2 have adopted ACTs as 1st line treatment for malaria, with 25 already implementing the policy. Across the region, 34% of children with fever received an antimalarial treatment. However, in the Gambia (52%), Tanzania (51%), Ghana (48%) and Sierra Leone (45%) received antimalarial treatment within 24 hours mostly with chloroquine which is no longer effective. Use of ACT is very low; in some 14 countries with 2005-7 data, the median proportion of children under five years with fever receiving an ACT was only 2%. By end of 2007, 25 out of the 42 malaria endemic countries in the region had included IRS in their national strategy. Of these, 17 routinely implement IRS as a major malaria control intervention while six are piloting IRS in a few districts. In the 2006-2007 malaria season a total of about 5 million units/structures were sprayed with an operational coverage in target areas of about was 83% protecting about 21 million people. Several initiatives to increase access to malaria control commodities have emerged. The Affordable Medicines facility for Malaria (AMFm) was established to bring down the cost of ACTs and help phase out the monotherapies to avoid the development of resistance. The Global RBM partnership was established in 1998. Consequently, all countries in the African region have established partnerships at the country level. Also, sub-regional RBM partnerships networks (SRNs) have been established that bring together all key partners in the sub-region to consolidate support for malaria control in the respective countries. Since 2000, 25 April has been commemorated as Africa Malaria Day. Regional events have been held across the sub-region and nationally. The commemoration of Africa Malaria day has firmly place malaria on top of the agenda in many countries. In 2007, 25 April was also declared World Malaria Day. Data from over 25 household surveys conducted in 2005-2007 has been used to compile this report. All the countries in the sub-region have functional HMIS although interpretation of the trends in malaria cases and deaths is difficult due to incomplete reports, non-standardized reporting and reliance mostly on clinical diagnosis. However, in selected countries that have scaled up interventions but also have more consistent and complete data, such as Eritrea, Kenya, Rwanda, Sao Tome and Principe, South Africa, Swaziland and Zanzibar Island in the United Republic of Tanzania, there have been reductions in malaria cases and deaths at health facility level.