Malaria surveillance and use of evidence in planning and decision making in Kilosa District, Tanzania

Background: Since 2001, Tanzania has been making concerted efforts to strengthen its Integrated Disease Surveillance and Response system. In this system, malaria is one of the priority diseases that are to be reported monthly. The objectives of this study were to (i) assess malaria surveillance system at facility and district levels to identify key barriers, constraints and priority actions for malaria surveillance strengthening; and (ii) to explore the use of evidence in health planning and decision making at these levels.Methods: The study was carried in Kilosa District in central Tanzania, during October 2012 and involved health facility workers and members of the district health management team. The existing information system on malaria was evaluated using a structured questionnaire and check list. Data collection also involved direct observations of reporting and processing, assessment of report forms and reports of processed data.Results: Three district officials and 17 health facility workers from both public and private health facilities were interviewed. Of the 17 informants, 15 were familiar with disease surveillance functions. A good percentage (47%, 8/17) received training on disease surveillance during the previous two years. Public transport and motorcycles were the main means of reporting epidemiological information from facility to district level. Most of the health facilities (93%, 14/15) faced difficulties in submitting reports due to lack of resources and feedback from the district authority. Analysis of malaria data was reported in 52.9% (9/17) of the facilities, but limited to malaria incidence per age groups. Challenges in data analysis included unavailability of compilation books; lack of computers; poor data storage; incomplete recording; lack of adequate skills for data analysis; and increase in workloads. Data at both facility and district levels were mainly used for quantification and forecasting of drug requirements.Conclusion: Malaria surveillance system in Kilosa district is weak and utilization of evidence for planning and decision making is poor. Capacity strengthening on data analysis and utilization should be given a priority at both facility and district levels of the health systems in Tanzania

Challenges and Opportunities for Implementing an Intersectoral Approach in Malaria Control in Tanzania

Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers’ opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania. This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development. Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister’s Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities. The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation

Challenges and opportunities for implementing an intersectoral approach in malaria control in Tanzania

Background: Malaria is a complex health problem related to socio-economic and environmental factors that cut across a number of sectors. Establishing intersectoral linkages is important to facilitate joint efforts to address the problem at all levels. The objectives of this study were to explore key sectoral engagements in malaria control policy formulation and implementation, and to determine decision and policy makers’ opinions about different sectoral activities that contribute to malaria transmission and control in Tanzania.Methods: This study included documentary review, self-administered interviews and group discussion. Interviews and group discussions involved key informants at district and national levels. The sectors involved were health, agriculture, environment, livestock, fisheries, education, works, irrigation, water resources, land development, forestry, and community development.Results: Institutions and organizations that were involved in the development of the previous and current National Malaria Strategic Plan (2007-2013 and 2013-2020) were the Ministries of Health and Social Welfare, Prime Minister’s Office of Regional Administration and Local Government, Public universities and non-governmental organizations. All the individuals involved in the development of the plans were either medical or health professionals. According to key informants, sectoral activities identified to contribute to malaria transmission included farming systems, deforestation, fishing, nomadic pastoralism, household water storage, water resource development projects, road and house construction and mining. The lack of intersectoral approaches in malaria control programme included the facts that the Health Sector does not involve other sectors during planning and development of policy guidelines, differences in sectoral mandates and management culture, lack of a national coordinating framework and lack of budget for intersectoral activities.Conclusion: The current strategies for malaria control in Tanzania need to address socio-economic and development activities across sectors and emphasise the need for intersectoral collaboration. It is recommended that the future of malaria control strategies should, therefore, be broad based and intersectoral in planning and implementation

Accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania

Research articleBackground: Universal access to and utilization of malaria prevention measures is defined as every person at malaria risk sleeping under a quality insecticide-treated mosquito net (ITN) and every pregnant woman at risk receiving at least two doses of sulfadoxine-pyrimethamine (SP). This study aimed to determine factors affecting accessibility, availability and utilisation of malaria interventions among women of reproductive age in Kilosa district in central Tanzania. Methods: Women of reproductive age with children <5 years old or those who had been pregnant during the past 5 years were included in the study. A structured questionnaire was used to seek information on malaria knowledge, accessibility and utilization of malaria interventions during pregnancy. Results: A total of 297 women (mean age=29±6.8 years) were involved. Seventy percent of the women had attained primary school education. About a quarter of women had two children of <5 years while over 58% had ≥3 children. Most (71.4%) women had medium general knowledge on malaria while only eight percent of them had good knowledge on malaria in pregnancy. A significant proportion of women were not aware of the reasons for taking SP during pregnancy (35%), timing for SP (18%), and the effect of malaria on pregnancy (45.8%). Timing for first dose of SP for intermittent preventive treatment in pregnancy (IPTp) was 1-3 months (28.4%) and 4-6 months (36.8%). Some 78.1% were provided with SP under supervision of the health provider. Knowledge on malaria in pregnancy had a significant association with levels of education (p=0.024). Ninety-eight percent had an ITN, mostly (87.1%) received free from the government. All women attended the ANC during their last pregnancy. The coverage of IPT1 was 53.5% and IPTp2 was 41.1%. The proportion of women making more ANC visits decreased with increasing parity. Conclusion: This study showed that the knowledge of the pregnant women on malaria in pregnancy and IPTp was average and is likely to have an impact on the low IPTp coverage. Campaigns that provide educational massages on the risk of malaria during pregnancy and the usefulness of IPTp need to be emphasised.National Institute for Medical Researc