Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008

Background: In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities. Methods. Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period. Results: In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically- confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003. Conclusions: Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015

Identifying trade-offs between adaptation, mitigation and development in community responses to climate and socio-economic stresses: Evidence from Zanzibar, Tanzania

In this paper, we examine how communities in Zanzibar cope with and adapt to multiple-stressors including climate change, and how these responses affect long-term adaptation, mitigation and development (AMD) goals. In particular, we identify the multiple-stressors that affect natural-resource dependent communities in Zanzibar. We then explore how community responses affect long-term development and mitigation goals before we examine the barriers to maximising AMD synergies in community responses. We use the DPSIR (Drivers - Pressures - States - Impacts - Response) as a tool to organise the complex information relating to both the marine and terrestrial SES in Zanzibar. Using data from household surveys and community-level focus groups, we find that responses to stressors resemble coping strategies as they provide short-term relief but in the long-term may negatively affect development goals. Furthermore, responses generate a trade-off between adaptation, mitigation and development. For example, when farmers respond to low productivity by spending longer on the farm, there is a development trade-off as time burdens are increased, and a mitigation trade-off as secondary forest cannot be established. We identify that AMD compatible responses are constrained by resource, regulatory, learning and governance barriers. We conclude that without local climate policy intervention, 'mal-adaptations', which threaten both mitigation and development goals, could occur across a range of temporal and spatial scales

Targeted elimination of species‐rich larval habitats can rapidly collapse arbovirus vector mosquito populations at hotel compounds in Zanzibar

Understanding the dynamics of larval habitat utilization by mosquito communities is crucial for the design of efficient environmental control strategies. The authors investigated the structure of mosquito communities found at hotel compounds in Zanzibar, networks of mosquito interactions with larval habitats and robustness of mosquito communities to elimination of larval habitats. A total of 23 698 mosquitoes comprising 26 species in six genera were found. Aedes aegypti (n = 16 207), Aedes bromeliae/Aedes lillie (n = 1340), Culex quinquefasciatus (n = 1300) and Eretmapodites quinquevitattus (n = 659) were the most dominant species. Ecological network analyses revealed the presence of dominant, larval habitat generalist species (e.g., A. aegypti), exploiting virtually all types of water holding containers and few larval habitat specialist species (e.g., Aedes natalensis, Orthopodomyia spp). Simulations of mosquito community robustness to systematic elimination of larval habitats indicate that mosquito populations are highly sensitive to elimination of larval habitats sustaining higher mosquito species diversity. This study provides insights on potential foci of future mosquito-borne arboviral disease outbreaks in Zanzibar and underscores the need for detailed knowledge on the ecological function of larval habitats for effective mosquito control by larval sources management.Danida Fellowship Centrehttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2915am2022Zoology and Entomolog