Tanzania Malaria Indicator Surveys 2001 - 2008:\ud Morbidity Indicators and Coverage of Major\ud Malaria Prevention and Control Interventions

Background\ud \ud Malaria continues to be a major public health problem in Africa. In Tanzania alone, thereare an estimated 17 to 20 million malaria cases per year resulting in approximately100,000 deaths. The main strategies to control malaria are vector control through insecticide treated nets (ITNs) and idoor residual spraying (IRS), intermittent preventive treatment during pregnancy (IPTp) and early diagnosis and prompt and effective treatment of cases. In 2001, the first Malaria Mid-Term Strategic Plan (MMTSP) was launched in Tanzania followed by the second MMTSP implemented in 2008. In order to evaluate the MMTSP, the NMCP conducted 4 cross-sectional community-based surveys in the years 2001, 2003, 2005 and 2008, as well as one survey collecting only malaria biomarkers in 2006. The findings of the latest survey are presented and analyzed in the present work.\ud \ud Methods\ud The NMCP 2008 malaria indicator survey was carried out in 21 malaria sentinel districts, one per region, in Mainland Tanzania. Demographic data of all household members and information on mosquito net availability and use was collected, as well as data on use of IPTp and prompt and effective treatment of fever in children. Further, malaria prevalence and haemoglobin levels were tested in children under the age of five years and in currently pregnant women. In the analysis, logistic regressions with the outcome variables net use, prevalence of malaria and anaemia, and linear regressions with the outcome haemoglobin level were conducted, using location, altitude, distance to health facility, sex and age group as explanatories.\ud \ud Data found in this work was compared with both, the Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS) and the Tanzania National Insecticide Treated Nets Programme (NATNETS) survey (both conducted in 2008). Principle findings 8377 households were interviewed with a total population of 40,135. 65% of the households owned at least one mosquito net and 40% owned at least one ITN. Household net ownership was associated with location, altitude and distance to health facility. 42% of the population slept under a net the night before the survey and 27% under an ITN.\ud \ud Location, distance to health facility, sex and age group were significant determinants for net use. Among children under the age of five years, net use was found to be 49% for any net and 33% for ITN, while among pregnant women it was 47% for any net and 31% for ITN. Overall, household net ownership and personal net use increased over the survey years.\ud \ud Malaria and anaemia prevalence among children was 16.1% and 5.6%, respectively. Malaria prevalence was associated with location, altitude, age group and use of ITN, while anaemia prevalence was associated with altitude and age group. Both, prevalence of anaemia and malaria among children under five decreased between 2006 and 2008. 26% of the children reported to have had a fever during the past two weeks. 15% of these children received the first line antimalarial drug within 24 hours from onset. 76% of the women who had delivered during the two years prior to the survey used IPTp and 44% took at least two doses of SP as IPTp.\ud \ud Discussion\ud It was shown that increasing coverage of malaria prevention and control interventions is negatively correlated with malaria and anaemia prevalences, hence lower prevalences for both conditions. The results of the NMCP survey were similar to those of the THMIS and the NATNETS survey and were as well externally confirmed by other studies.\ud \u

Targeted Subsidy for Malaria Control With Treated Nets Using a Discount Voucher System in Tanzania.

During the last decade insecticide-treated nets have become a key strategy for malaria control. Social marketing is an appealing tool for getting such nets to poor rural African communities who are most afflicted by malaria. This approach usually involves subsidized prices to make nets and insecticide more affordable and help establish a commercial market. We evaluated a voucher system for targeted subsidy of treated nets in young children and pregnant women in two rural districts of southern Tanzania. Qualitative work involved focus group discussions with community leaders, male and female parents of children under 5 years. In-depth interviews were held with maternal and child health clinic staff and retail agents. Quantitative data were collected through interviewing more than 750 mothers of children under 5 years during a cluster sample survey of child health. The voucher return rate was extremely high at 97% (7720/8000). However, 2 years after the start of the scheme awareness among target groups was only 43% (45/104), and only 12% of women (12/103; 95% CI 4-48%) had used a voucher towards the cost of a net. We found some evidence of increased voucher use among least poor households, compared with the poorest households. On the basis of these results we renewed our information, education and communication (IEC) campaign about vouchers. Discount vouchers are a feasible system for targeted subsidies, although a substantial amount of time and effort may be needed to achieve high awareness and uptake - by which we mean the proportion of eligible women who used the vouchers - among those targeted. Within a poor society, vouchers may not necessarily increase health equity unless they cover a high proportion of the total cost: since some cash is needed when using a voucher as part-payment, poorer women among the target group are likely to have lower uptake than richer women. The vouchers have two important additional functions: strengthening the role of public health services in the context of a social marketing programme and forming an IEC tool to demonstrate the group at most risk of severe malaria

Mur contre la malaria : entretien avec le docteur Christian Lengeler

Version anglaise disponible dans la Bibliothèque numérique du CRDI: Controlling malaria : a conversation with Dr. Christian Lengele

Controlling malaria : a conversation with Dr. Christian Lengeler

French version available in IDRC Digital Library: Mur contre la malaria : entretien avec le docteur Christian Lengele

Using questionnaires through an existing administrative system: a new approach to health interview surveys

This paper reviews recent developments in the field of health interview procedures, and their contribution to decentralized health planning. Their importance is reflected in the growing awareness that the perception of health problems by the beneficiaries is an important element in the success or failure of a primary health care (PHC) strategy for disease control and health improvement. The ‘indirect' health interview procedure represents a methodological evolution of the traditional interview approach, by the fact that questionnaires are not administered directly by the investigators or their field staff to the chosen key informants. They are distributed through an existing administrative system and self-administered by the recipients. This reduces the costs of such surveys, and allows large areas to be screened rapidly. The paper describes ongoing research designed to test this approach in seven African countries. Methodological problems and limitations, the most important of which is that it is not appropriate for individual diagnosis, are also discussed. This approach is best used as a screening strategy to identify high risk communities, on which health resources can then be concentrate

Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies

Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at schoolchildren and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero Distric

Field evaluation of a recombinant glutathione S-transferase-based pyrethroid quantification assay

A recombinant glutathione S-transferase (GST)-based pyrethroid quantification assay was field-tested in Ifakara, Tanzania. Initial laboratory tests suggested that all reagents used in the assay should be sufficiently stable for field use, provided that domestic refrigeration facilities were available. Insecticide-impregnated bednets were collected from a region where a social marketing programme was in progress. A total of 100 bednets were collected and the assay plus standard HPLC analysis was performed on the residues extracted from four replicate areas of each net. Insecticide residue estimations for assays performed on white and pale green bednet samples were accurate when compared with residue analysis by HPLC. However, for dark green or blue bednets, there was no correlation between the GST-based assay and HPLC pyrethroid quantification results. The assay failure with the dark coloured nets was caused by the extraction of the dyes along with the insecticide, which subsequently interfered with the GST assay. When the same samples were analysed by HPLC, the dyes were separated from the insecticide by reverse phase column chromatography and hence did not affect the result