Malaria in Tanzania
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| Dr. Bernard Nahlen, Deputy Malaria Coordinator, President’s Malaria Initiative (PMI), reviews mosquito larval-control activities with Ms. Khadija Kannady, Urban Malaria Control Programme (UMCP) Project Coordinator, and two staff from UMCP in Dar es Salaam, Tanzania. The UMCP benefits 614,000 people in Dar es Salaam through the regular monitoring of malaria vector mosquito breeding sites and application of the biological pesticide BTi, which kills the mosquito larvae before they can become adults and transmit malaria. Begun in 2002 as a small indigenous project by one of Dar es Salaam’s three municipal councils, the UMCP is an example of a local initiative supported with targeted PMI funding that has reaped exponential benefits with malaria risk in these neighborhoods cut by half in just the past two years. Source: Dr. Rene Salgado |
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Overview
"The majority of Tanzanians suffer from malaria, a preventable disease that can have a serious negative impact on pregnant women and young children. Malaria is the number one killer among children in Tanzania, and mothers who contract malaria during pregnancy run the risk of having low birth weight babies, maternal anemia, impaired fetal growth, spontaneous abortions, stillbirths, and premature babies."a The U.S. Agency for International Development (USAID) through the President's Malaria Initiative is committed to reducing the burden of malaria by helping Tanzania develop the capacity to more effectively prevent and appropriately treat malaria.b In the past, these activities included providing technical assistance and collaboration with the Ministry of Health to revise the national guidelines for treating malaria during pregnancy and to strengthen health services for pregnant women. USAID has provided support in other areas of malaria prevention and control, including the use of insecticide treated nets (ITN) and collaborates with the National Malaria Control Program and several local and global partners including the Roll Back Malaria Partnership (RBM), The Global Fund for AIDS, TB and Malaria (GFATM), and The World Bank.c
Malaria in Tanzania
"Malaria accounts for 30 percent1 of the national burden of disease and loss of productivity in Tanzania, where the disease is endemic throughout much of the country. Growing resistance to first-line antimalarial drugs in re cent years has greatly diminished the government's ability to treat the disease."d "Children are the common victims of malaria, with mortality rates being highest among those five years and younger."e The majority of malaria in Tanzania is caused by the malaria parasite Plasmodium falciparum and the principal vector is gambiae s.s. Tanzania, like many countries in the region, has reported Chloroquine and some Sulfadoxine-pyrimethamine (SP) resistance to Plasmodium falciparum and artemisinin-based combination therapy (ACT) is currently recommended as the first line drug in their national antimalarial treatment policy for uncomplicated malaria.f
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Tanzania Assessment Results
Tanzania's malaria control program is comprehensive and in line with the RBM program. Tanzania is an RBM signatory and has four key strategies: 1) improved malaria case management, 2) vector control through the use of ITNs, 3) prevention of malaria in pregnancy, and 4) epidemic preparedness and containment. Key achievements include:
- USAID has worked closely with the Tanzania Ministry of Health (MOH) and the National Malaria Control Program (NMCP) on developing national policies and standards for intermittent preventive treatment (IPT) for pregnant women;
- USAID has collaborated with the MOH to develop IPT training materials and scale up IPT activities.
The President's Malaria Initiative
In June 2005, President Bush announced a significant increase in resources from the US Government in order to fight Malaria. This new groundbreaking initiative challenges other countries, partners, donors and foundations to also commit to combating this disease significantly in sub-Saharan Africa each year over the next five years. To launch this initiative, the United States will significantly expand resources for malaria in Angola, Tanzania and Uganda beginning in 2006, and will expand to at least four more highly endemic African countries in 2007, and at least five more in 2008. By 2010, the U.S. Government will provide an additional $500 million per year for malaria prevention and treatment. The goal of the President's Malaria Initiative is to reduce malaria deaths by 50 percent in each of the target countries after three years of full implementation. This effort will eventually cover more than 175 million people in 15 or more of the most affected African countries.b
Country Status (annual figures)
| Total Populationg | 34,763,000 |
| Population growth rateg | 1.95 |
| Life expectancy at birthg | 46 years |
| Per capita GDP in international $h | $630 |
| Total expenditure on health as % of GDPh | 4.9% |
| Per capita total expenditure on health (US$)h | $13 |
| Per capita government expenditure on health (US$)h | $7 |
Population at Risk for Malaria
Endemic Risk: 93%
Epidemic Risk: 3%
Negligible Risk: 4%
Tanzanian Districts Most Affected1
All districts of Tanzania are affected by malaria.
US Government Support for Malaria
USG support for the malaria response in Tanzania is estimated to be: TBD
USAID Implementing Partners in the President's Malaria Initiative
TBD
General Health and Development Indicators (DHS Data; 2004 Preliminary Report)
| Indicator | 1996 | 1999 | 2004 |
| Infant mortality rate (per 1,000 live births) | 87.5 | 99.1 | 68 |
| Under-five mortality rate (per 1,000 live births) | 136.5 | 146.6 | 112 |
| Percentage of women with no education | 28.5% | 27.1% | 24.2% |
| Total fertility rate (children per women) | 5.8 | 5.6 | 5.7 |
| Percentage of women who received antenatal care from a trained health professional prior to most recent live birth | 89.3% | 92.5% | 94.3% |
| Percentage of children fully immunized | 70.5% | 68.3% | 71.1% |
| Percentage of children with acute respiratory infection or fever taken to a health facility | 69.6% | 67.5% | -- |
| Percentage of children underweight (-2 SD) | 30.6% | 28.9% | 21.8% |
| Percent pregnant women attending an ANC at least once during pregnancy | 93.5% | 96% | 94.3% |
Indicators for the President's Malaria Initiative
The indicators listed below will be collected by the US President's Malaria Initiative and have been agreed upon by the RBM Partnership, of which the USG is a partner.
Malaria Impact Indicatorsa
| Key Impact Indicators | Baseline | Midterm | End of Initiative 2010 Target |
| Under-5 mortality rate (per 1000) (baseline 2004) | 112j | -- | -- |
| Proportion of deaths attributed to malaria -- among children under five in selected health facilities3 (baseline) | %k | -- | -- |
| Under five Malaria case fatality fate in selected health facilities (baseline) | -- | -- | -- |
| Proportion of morbidity inpatients attributed to malaria in under fives in selected health facilities. (baseline) | -- | -- | -- |
2 Select information was not available; the Tanzania DHS Final Report 2004 will be available by the end of 2005.
3 Data source for future collection of this indicator will be determined.
Malaria Outcome Indicators2
| Key Outcome Indicators | Baseline | Midterm | End of Initiative 2010 Target4 |
| Proportion of under five with fever/malaria receiving correct treatment according to national guidelines within 24 hours of onset of fever. (baseline 2001) | 11.3%1 | -- | 80% |
| Proportion of households with at least one ITN. (baseline 2004) | 14.2%j | -- | -- |
| Proportion of children under five sleeping under a mosquito net the previous night. (this baseline data includes all the children in the household who slept under a net and households that had only some children sleeping under a net) (baseline 2004). | 36.1%j | -- | -- |
| Proportion of children <5 sleeping under an ITN the previous night. (baseline 2004) | 10.3%j | -- | 80% |
| Proportion of pregnant women sleeping under a mosquito net the previous night. (baseline 2004) | 32.7% | -- | -- |
| Proportion of pregnant women sleeping under an ITN the previous night. (baseline 2004) | 10.6% | -- | 80% |
| Proportion of pregnant women receiving at least two doses of IPT (CQ). (baseline 2004) | 18.2%6 | -- | 80% |
| Proportion of health facilities surveyed with no stockout of nationally recommended antimalarial drugs continuously for one week during the last three months at the time of survey (1st line). (baseline 2001) | 28.6%1 | -- | -- |
| Proportion of children under five with uncomplicated malaria correctly managed in health facilities.5 (this baseline data includes all patients). (baseline 2001) | 54.3%1 | -- | -- |
| Proportion of houses targeted for IRS successfully sprayed. | -- | -- | -- |
1 Tanzania RBM Baseline survey 2001 in 9 districts (Chunya, Iringa, Lake Victoria, Lushoto, Magu, Morogoro, Mpwapwa, Rufiji, Tunduru) and 30 IMCI districts unless otherwise noted.a
2 Select information was not available; the Tanzania DHS Final Report 2004 will be available by the end of 2005.
4 These targets reflect the Abjua Targets to be met by 2005: http://rbm.who.int/docs/abuja_declaration_final.htm
5 Data on this indicator will be collected from sentinel sites.
6 18.2% represents IPT as preventive treatment with at least two doses of SP/Fansidar during an antenatal visit.
Tanzania: Distribution of Endemic Malaria
This map was developed using MARA data available at: http://www.mara.org.za/. Malaria distribution model: Craig, M.H. et al. 1999. Parasitology Today 15: 105-111. Boundaries distributed by ESRI.
References
a USAID website Tanzania Success Stories: Intermittent Presumptive Treatment of Malaria in Pregnancy Program Achieves National Scale in Tanzania and the USAID Tanzania Mission website.
b USAID Infectious Disease information and the President's Malaria Initiative.
c USAID Tanzania
d Wolf, Katherine, Yann Derriennic. June 2005. Costing Artemisinin-based Combination Therapy for Malaria in Tanzania [PDF, 328KB]. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.
e The Uganda Ministry of Health (MOH) website "Malaria Control and Prevention."
f The World Malaria Report 2005, Map 5. View more information on artemisinin-based combination therapy (ACT).
g United Nation Population Division - 2000 World Population Prospects: Population Database: The 2002 Revision.
h WHO Statistical Information System (WHOSIS): Country Official Health Indicators.
i The Africa Malaria Report, 2003.
j Demographic and Health Survey in Tanzania (1999) and the DHS Preliminary Report Tanzania (2004), released 2005.
k Demographic and Health Survey in Tanzania (1999): According to a survey conducted by the Ministry of Health in three districts (Morogoro Rural, Dar es Salaam, and Hai), malaria causes about 45 percent of all deaths among children under five in Morogoro, about 25 percent in Dar es Salaam, and about 20 percent in Hai.
l RBM Baseline Survey Tanzania, 2001 [PDF], in 9 districts (Chunya, Iringa, Lake Victoria, Lushoto, Magu, Morogoro,
Mpwapwa, Rufiji, Tunduru) and 30 IMCI districts.