Mosquito Net Coverage and Utilisation for Malaria\ud Control in Tanzania\ud

\ud In recent years malaria parasites have developed resistance to the most commonly used antimalarial drugs in Tanzania, posing a major challenge for its control. This has led to frequent changes of malaria treatment guidelines, more recently to expensive, yet more effective arthemether/lumefantrine. The use of insecticide treated mosquito nets (ITNs) and long lasting nets (LLINs) in Tanzania has increased slowly over the past few years. Despite the introduction of a voucher scheme to the vulnerable groups, the proportion of households with at least an ITN/LLIN in the country has not been able to achieve the Abuja Declaration of 60% net coverage. Statistics available on the utilisation of nets do not provide a good estimate of the coverage, because of the different study design used to collect the information. This survey was carried out in 21 districts of Tanzania to determine the coverage and utilisation of insecticide treated nets to provide baseline information of the net requirement to cover every sleeping bed in the country. Specifically, this study aimed to (i) determine the ITN coverage by and its distribution in the country; and (ii) determine knowledge, attitudes and practice of the householders as regards to malaria prevention and control Twenty one districts (one from each region) of Mainland Tanzania were selected for the survey. Selection of the district was random. In each district, two wards were selected, one urban (within the district capital) and one rural or sub‐urban. Households were selected randomly using a table of random numbers. At household level, the head or any adult who represented the head of household was interviewed. A structured pre‐tested questionnaire was used to collect information on knowledge, attitude and practices in malaria control, with emphasis on mosquito net ownership and utilisation. Of the 9549 targeted households, 9166 (96%) participated in the survey. Majority of the respondents (76.8%) were from rural district.The mean household size was 3.9 persons. On average, children <5 years old accounted for 39.3% of the members of the households. Respondents with no formal education accounted for 15.8‐37.4% of the interviewees. Most of them were from Mkuranga (55%), Kigoma‐Ujiji (44.2%) and Newala (37.9%). High literate rates were observed in Arumeru and Moshi districts. The majority of the respondents knew that the mosquito is the vector of the malaria parasite (92.6‐99.4%) and infection is through a mosquito bite (92.7‐99.8%). The knowledge of respondents on malaria transmission was generally high (94.0‐99.0%). The majority of the respondents (95.2%) considered the use of mosquito nets as the most effective way of malaria prevention. However, of these, only 66.7% said to have actually used nets in their life time. Knowledge on the use of mosquito nets in the control of malaria was highest and lowest in Eastern and Central zones, respectively.\ud Seventy‐seven percent (4457/8933) agreed to have the investigator entry into their houses and verify the\ud number of nets owned. On average, 62.9% (5,785/8933) of the households had at least a mosquito net. Majority of the respondents in Northern (76.5%) and Southern (76.5%) zones owned at least a mosquito net. The lowest mosquito net ownership was observed among respondents in Western Zone (39.6%). District‐wise, net ownership was highest in Lindi (94.5%), Kyela (91.3%) Arumeru (86.1%), Ilala (83.1%)\ud and Nyamagana (80.0%). Ownership of net was very low in Kilolo (34.8%), Kigoma (36.5%) and Musoma Rural (41.3%). Of the households with nets, 74.4% were using nets all year round. A larger proportion of respondents in Kilolo (68.5%), Mpwapwa (51.9%), Songea Rural (49.2%) and Shinyanga Rural (46.3%) were only using the nets during the rainy season. Out of 9,166 households visited, 3,610 (39.3%) had at least one under five child. Of these, in 1,939 (53.7%) of the households the child slept under a mosquito net during the previous night. Use of nets in children <5 years was most common in northern zone (74%); followed by eastern (66.9%) and southern zone (61.1%). Districts with the largest proportion of <5 year children sleeping under a mosquito nets were Lindi (90.0%), Kyela (85.2%), Ilala (83.2%) and Arumeru (78.2%). Only about a quarter (27%) of the children <5% in western zone were sleeping under a mosquito net. Lowest net coverage for <5 year was in Kigoma (22.7%), Kilolo (25%) and Bukoba Rural (31.2%). A total of 5,785 (62.9%) owned at least a mosquito net. Of these, 4,219 and 1,566 were from the rural and urban districts, respectively. More households in the urban districts (73.4%) than rural districts (59.7%) owned at least a mosquito net. Likewise, there were more households (64.9%) in the urban districts with <5years children sleeping under mosquito nets than in the rural districts (50.4%). More households in urban (32.8%) than in rural districts (25.1%) had at least one insecticide treated net. The number of households with mosquito nets enough for all members of the households ranged from 18.9% (in Urambo) to 37.4% (in Hanang). Households with at least 50% or more occupants using mosquito nets ranged from 16.4% (in Urambo) to 42.8% (in Arumeru). Districts with the largest proportion of ≥50% of the household members sleeping under mosquito nets were Arumeru (46.9%) and Lindi (46.7%). In Manyoni and Lindi, 3.1% and 5% of the households were found to have more nets than the number of household occupants. Only 9% (801/9196) of the households had all occupants sleeping under a mosquito net. Kyela district had about a quarter (23.9%) of the households with all occupants sleeping under nets. Only 29% of the households had at least one insecticide treated mosquito nets. All nets in 51.4% of the households surveyed were ITNs. The largest proportion of households with ITN was observed in northern zone (40.2%), with Arumeru (46%) and Hanang (44.1%) districts having the highest ITN coverage. The lowest proportion (15.5%) of households with ITN was found in the Western Zone. Districts which had the lowest ITN coverage were Musoma Rural (12.6%), Kigoma‐Ujiji (13.2%), and Shinyanga Rural (14.4%). On average, 90.7% (8,123/8,953) of the respondents would prefer using ITN than having their house sprayed with long lasting residual insecticide. More households in urban (32.8%) than in rural districts (25.1%) had at least an ITN> A total of 1939 children underfives were sleeping under mosquito net (any type). Of these, 1140 (58.8%) were using insecticide treated nets (ITN). Overall, 31.6% of the underfives slept under an insecticide treated net during the previous night. Highest coverage was reported in Kyela (47.7%), Nyamagana (47.7%) and Arumeru (46.4%). Lowest ITN in underfives was reported in Kigoma‐Ujiji (16.0%), Musoma (17.2%) and Urambo (17.7%). In Songea more underfives children were sleeping under ITN (43.6%) than in untreated nets (40.9%). Control of bedbugs, lice, fleas, mites and cockroaches was the major added advantage of using insecticide treated nets. On average, 30.8% and 19.6% of the respondents mentioned cockroach and bedbug control as the main advantage of using ITN, respectively. The majority (52.9%) preferred blue coloured net (Northern=45.6%; Central=59.2%; Eastern=56.4%; Lake= 54.4%; Southern= 60.3%, Western= 58.5%) and Southern Highlands= 49.1%). Other colour preferences were white (29.6%), green (14.1%), black (2.1%) and pink (1.2%). A strong preference for blue mosquito nets was observed among respondents in Musoma (77.3%) and Newala (75.5%) districts. On the other hand, the weakest preference (24.7%) for blue nets was observed among respondents in Arumeru district. The majority of the respondents (82%) preferred rectangular shaped net. A larger percent (61.8%) the respondents preferred to have the map of Tanzania as a national logo to identify nets distributed in the country. On average, 62.7% and 28.8% of the households in Tanzania own at least one mosquito net (any type) and insecticide treated net, respectively. Tanzania expects that ITN coverage of under fives in 2009, after the Under Five Catch‐up Campaign is complete, to be at least 80%. If this is to be achieved, there is a need for concerted effort in scaling up the distribution and demand for long lasting nets throughout the country. Moreover, the planned use of IRS in malaria control, currently considered unpopular should be accompanied by rigorous community health education to avoid resistance from household members.\u

Supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in Tanzania

Background: Reliable supply of laboratory supportive services contributes significantly to the quality of HIV diagnostic services. This study assessed the status of supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in selected districts of Tanzania.Methods: The study was conducted in 39 health facilities (HFs) from eight districts in four regions of Tanzania, namely Iringa, Mtwara, Tabora and Tanga. Facilities with care and treatment centres for HIV/AIDS patients were purposively selected for the study. The study utilized a quantitative method of data collection. A questionnaire was administered to heads of laboratories to obtain information on laboratory supply chain management.Results:  A total of 39 health facilities (HF) were included in the study. This included 23 public and 16 private facilities. In 82% of the HFs, ordering of supplies was performed by the laboratory departments. The information commonly used to forecast requirements of the laboratories included the number of tests done (74.4%; n=29), current stock levels (69.2%; n=27), average monthly consumption (64.1%, n=25) and minimum and maximum stock levels (10.2%, n=4). Emergency orders were significantly common in public than private facilities (73.9% vs. 56.3%, p=0.004).  Delivery of ordered supplies took 1 to 180 days with a significantly longer period for public than private facilities (32.5 vs. 13.1 days, p=0.044). Most of the public HFs ordered supplies from diverse sources compared to private facilities (68.2% vs. 31.8%).Conclusion: There was a weak inventory management system and delays in delivery of supplies in the majority of HFs, which are likely to impede quality of HIV care and treatment. Strengthening capacity for data management and ensure constant supply will potentially improve the quality of HIV diagnostic services

Evaluation of the bio-efficacy of three brands of repellents against wild populations of anthropophilic mosquitoes

Three commercial repellents marketed in Tanzania: Zero Bite® (a blend of microcrystalline waxes, mineral oils, natural flavours, Olibanum oil, Eucalyptus oil, Geranium oil, Citronella oil and Isopropyl myristrate); X-pel® (a petroleum jelly formulation containing diethyl toluamide (DEET) and dimethyl phthalate); No Bite® (a spray formulation with diethyl toluamide, 2 methyl 2,4 pentondiol and pthalic ester acids) were tested and compared for their repellency effect against wild anthropophilic mosquito populations. Human forearms, feet and legs were treated with the repellent products. All repellents provided protection against wild populations of biting mosquitoes (mainly Culex quinquefasciatus   and Aedes scatophagoides   ) with varying levels of efficacy. No Bite® provided the best overall protection (98%) followed by X-pel® (87%). Zero Bite® gave the least protection (48%) against the two mosquito species. All products except No Bite® displayed reduced efficacy after four hours of application. The results indicate that the two best products give satisfactory levels of personal protection against biting mosquitoes at least for the first five hours, following application, thus could provide complementary protection against mosquito bites particularly during the period when most people have not retired to bed where they may be protected by treated bednets

Indoors man-biting mosquitoes and their implication on malaria transmission in Mpwapwa and Iringa Districts, Tanzania

Entomological surveys were carried out in six villages at different altitudes in Mpwapwa and Iringa Districts in central Tanzania in March 2002. A total of 1291 mosquitoes were collected. Of these, 887 mosquitoes were collected by light traps and 404 by indoor pyrethrum spray catch technique. Seventy-nine percent (1026) were Anopheles gambiae   s.l., 0.2% (N= 3) were An. funestus, and 20.3% (N= 262) were Culex quinquefasciatus   . Other species including Cx cinereus, An. coustani and Aedes   spp accounted for 0.5% of the mosquito population. In Iringa, more mosquitoes were collected by pyrethrum spray catch than light trapping technique. The light trap catch: spray catch ratio in Iringa and Mpwapwa was 1:1.15 and 2.5:1, respectively. Indoor pyrethrum spray catch gave an overall estimate of An. gambiae density of 8 and 0.6 mosquitoes per room in Iringa and Mpwapwa, respectively, whereas light trap collections gave an overall respective density of An. gambiae of 63.9 and 2.9 mosquitoes per room. The densities of house entering mosquitoes were found to range from 0 to 135 in Iringa and from 2.6 to 3.5 per room in Mpwapwa. An. funestus mosquitoes were collected in Iringa only. None of the dissected An. gambiae collected in the two districts was infected with malaria sporozoites. Despite low mosquito densities and absence of infective mosquitoes in our study, the two districts are malaria epidemic prone, thus a continuous surveillance is critical for a prompt response to any impending outbreak. Further longitudinal studies are required to determine the transmission potential of the malaria mosquitoes in the two districts

Utilisation of health management information system in disease surveillance in Tanzania

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Diversity, spatial and temporal abundance of Anopheles gambiae complex in the Rufiji River basin, south-eastern Tanzania

The Anopheles gambiae complex contains the most efficient malaria vectors in the world. Identification of the species and the concomitant distribution are vital for effective malaria control. The objective of the study was to establish the diversity, spatial and seasonal abundance of malaria vectors in the Rufiji River Basin in Tanzania and the implications on malaria vector control. Mosquitoes were collected using CDC light-traps. Anopheles mosquitoes were identified by conventional keys. Anopheles gambiae complex were speciated using standard PCR method. Of the 562 specimens analysed by PCR 69% produced fragments equivalent to An. gambiae s.s. (390 bp), 23% equivalent to An. arabiensis (315bp), and 7% as An. merus (464 bp). An. gambiae s.s. and An. merus were more abundant on the plateau than on the flood plain (Fisher's exact test, P< 0001), whereas An. arabiensis was equally abundant between the two sites (Fisher's exact test, P=1656). The density of the three sibling species of An. gambiae complex also varied with the seasons. An. gambiae s.s. and An. arabiensis were most predominant species during the start of the rainy season, but as season progresses, An. gambiae s.s. predominated. An. merus was only recorded during the short rainy season. In conclusion, both An. gambiae s.s., An. arabiensis and An.merus are malaria vectors in the Rufiji River basin and that An. merus is recorded for the first time in the south-eastern coast of Tanzania. These findings are important in the planning and implementation of malaria vector control activities in the Rufiji River basin, south-eastern Tanzania