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Tanzania
Malaria
Tanzania is a tropical country whose ecology and weather favour the existence of various transmittable diseases. One, malaria, remains the number one cause of morbidity and mortality. Several strategies have been employed to try to prevent and control malaria, but still the disease is rampant in all parts of the country.
Tanzania has an estimated population of 34 million (2002 census). 3.4% of GDP is used in malaria control interventions annually. A Tanzanian spends $11.37 per year on health and $2.14 is spent on malaria services only. About 75% of malaria expenditures are met by the household, with the Government contributing 20% and partners 5%. Of the household malaria expenditure, about one-third is spent on anti-malarial drugs, one-half on bed nets, insecticides and other preventive measures. This disease and economic burden is greatest on the poorest households and contributes to the continued poverty-disease cycle.
There are an estimated 16 million cases of malaria per year, resulting in about 100,000 deaths of which 39,000 occur in children under five years old. Malaria accounts for 43% of hospital admissions and 32% of in-patient deaths for children under five. It is estimated that nearly the entire population of Tanzania is at risk of malaria; children and pregnant women being most affected. It is very unfortunate that one of the preventable diseases becomes the number one cause of morbidity and mortality in a country with the necessary resources to eradicate the disease.
The Policy:
Tanzania’s policy on malaria is articulated through the National Malaria Medium Term Strategic Plan (2002-2007). The plan aims to:
- increase the proportion of children with febrile episodes that receive appropriate treatment within 24 hours of onset from 19% to 60%
- increase to 80% the proportion of clinical malaria cases that are treated appropriately
- increase to 60% the proportion of pregnant women and children sleeping under a properly treated mosquito net
- increase to 60% the proportion of pregnant women and children who are effectively protected against malaria with Intermittent Preventive Therapy
- improve the capacity of epidemic-prone districts to recognise malaria epidemics early and respond appropriately
- ensure that communities understand the dangers of malaria and what to do about it.
The Control:
The parasite Plasmodium Falciparum is responsible for over 95% of malaria infections. Over the years, chloroquine treatment responded well. However, in 2001, the policy of using this as the first line drug ceased due to high resistance and a 52% total treatment failure. The drug regime was then changed. Other preventive measures include use of insecticide-treated nets introduced in a national scale social marketing programme.
The Neglected Therapy:
According to the National Malaria Control Programme officials, malaria mosquitoes bite at midnight when it is quiet and cool. This encouraged the use of drugs for treatment and nets for preventing people from being bitten. Environmental management was neglected.
During pre-independence and the early years of independence, control of mosquito breeding sites, i.e. clearing of water ponds, cutting grass around homes, removal of cans and other water-holding devices, was a role of every household.
The system of ‘dry day’ where every home emptied water containers at a special day of the week and cleared its home surroundings, killed many mosquitoes. This is the malaria therapy which needs to be revisited. There is no single strategy, but why breed enemies and start to manufacture weapons to fight them? How effective the weapons are is questionable and that is what is facing Tanzania.
Conclusion:
Effective malaria prevention and control is useless without eradicating the vector. Residual sprays in the homes, killing the mosquito larvae and eliminating the breeding sites are necessary strategies. The fewer mosquitoes there are, the fewer cases of malaria there will be, with lower morbidity and mortality.
Those entrusted with malaria prevention need to:
- raise the profile of malaria among politicians, potential partners and community leaders
- improve the flow of information on malaria to key target audiences at national, community and household levels
- influence positive behaviour change among target audiences with great emphasis on environmental management, treatment-seeking and other critical malaria-related behaviour.
“It can be done, let every one of us join hands and play our part.”
Editorial Note
As the above article points out, in Africa malaria kills more people than HIV/AIDS. The Roll Back Malaria programme initiated by 90 organisations including WHO, the UN Children's Fund, the UN Development Programme and the World Bank, aims to halve malaria deaths in Africa by 2010. It is seeking to bring together civil society, religious groups, traditional leaders, banks and other groups in the fight against malaria. In other countries, as in Tanzania, Church leaders are involved. Bishop Dinis Singulane is chairing the Roll Back Malaria campaign in Mozambique and says the Church must get involved in basic health education to combat this preventable and curable disease which kills a child in Mozambique every 30 seconds.
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