National Malaria Control Programme, NMCP

English

Digital Library of the Tanzania Health Community

 
 
 
 
 
 
 
 
NATIONAL MALARIA FORUM- 25TH APRIL 2014. 
1 
 MALARIA STATUS IN TANZANIA 
MAINLAND: AN OVERVIEW Presentation Outline: 
• Overview 
• Intervention scale  up/achievements 
• Current malaria epidemiologic profile and 
the New Malaria strategy 2014-2020 
• Summary/conclusion 
 The Malaria Burden_ Introduction 
• Tanzania has the third (3rd) largest population at risk of malaria in 
Africa after Nigeria and DRC. 
• One of top 10 countries that account for 70% of the global malaria 
burden. Others include: Burkina Faso, Cameroon, Côte d’Ivoire, DR 
Congo, Ghana, Mozambique, Niger, Nigeria and Uganda (WMR) 
• Over 93% of population (40 M) live in areas where malaria 
transmission occurs. 
• Great variation in the risk of malaria transmission: Prevalence - 1% - 
33% with an average of about 10% 
• Despite a declining evidence, still is the leading cause of Outpatient, 
Hospital admissions and  deaths.  About 20 to 60% of OPD 
attendances 
• Misclassification major problem, difficult to assess trends over 
years from HF data 
•  The poorest bear the brunt of the burden 
 
 
 
 Malaria burden,… 
• Malaria is about 
people’s lives and 
livelihoods: 
Impact of malaria on 
the economy of a 
Tanzanian farmer 
• Other development 
sectors , similarly 
affected MMTSP 2002-2007, 2008 -2013 Interventions (summary): 
• Integrated Malaria Vector Control 
• Insecticide Treated Nets (ITNs/LLINs) 
• Indoor Residual Spraying (IRS) 
• Environmental management including Bio-
larviciding  in Dar es Salaam city. 
• Intermittent preventive therapy to pregnant women 
(IPTp) 
• Early Diagnosis and Effective Treatment 
• Behaviour Change and Communication (BCC) 
• Monitoring, Evaluation and Surveillance. 
• Regional and District/Councils support. 
  6 7 
                   National Coverage 
    Insecticide treated mosquito nets (ITNs) 
     Intermittent preventive treatment in Pregnancy  
     Artemisinin  Based Combination Therapy (ACTs) 
     Mass media and Community mobilization (BCC) 
     Rapid Diagnostic Tests (mRDT)  
Regional Coverage 
  
Indoor Residual Spray - Lake 
Zone 
  
Larviciding (78 
Wards) 
Interventions scale up: 
 Household with at least one ITN/LLIN by 
Residence, 2008-2012 
58.8 
31.6 
38.3 
87.2 
93  91.5 
urban rural mainland
2008 2012Use of ITN/LLIN by different groups 
20 
26  27 
69 
73 
76 
household members underfives pregnant women
2008 2012Percentage of Household with at least one 
ITN by wealth quintile 
 
 22.1  
 28.2  
 33.7  
 41.3  
 66.7  
 89.9    92.0    94.4    91.8  
 82.0  
Lowest Second Middle Fourth Highest
2008 2012Use of ITNs among all household 
members 
Percentage who slept under an ITN 
the night before the survey among 
all households 
Percentage who slept under an 
ITN the night before the survey 
among households with an ITN Proportion of women receiving SP for IPTp: 2+ 
doses in last pregnancy 
42.6 
27.5 
30.1 
40.2 
31.1 
32.7 
urban rural mainland
2008 2012IRS: Proportion (%) of household sprayed by 
residence 
1.7 
3.1 
1.2 
3.7 
11.6 
9.9 
12.2 
42.3 
mainland urban rural lake
2008 2012Proportion of children with fever who took 
anti-malarials by type of medicine 
 8  
 31  
 20  
 37  
 4  
SP
AQ
Q
ACT
Oth
4 
16 
19 
61 
3  SP
AQ
Q
ACT
Oth
2008  2012  
 Current malaria status (Malaria 
Epidemiological Profile)  Malaria Epidemiological Profile 
• Available evidence suggest  that malaria prevalence  
have dropped significantly over the last decade  
 
• National surveys conducted between 2008 and 2012 
(Tanzania HIV/AIDS and Malaria Indicator 
Survey_THMIS)- underfive children 
 
• A temporal analysis of available malaria prevalence 
surveys between 1980 and 2012- children 2 to 10 
years 
• Health Management Information system (DHIS2) Malaria Epidemiological Transition_ National 
Surveys 
• Prevalence in 
underfive children 6–
59 months old  halved  
from 18.1% to 9.5% 
between  2008 and 
2012 (THMIS 2008, 
2012) 
 
• Varies from <1% 
(Arusha, Manyara, 
Kilimanjaro, Singida 
and Iringa to 33% in 
Geita  
 Malaria prevalence by Residence 
7.1 
20.4 
18.1 
 3.4  
 10.7  
 9.5  
urban rural mainland
2008 2012Malaria prevalence by zone 
10.5 
21.6 
30 
5.2 
10 
4.3 
34.2 
 7.7  
 16.7  
 20.6  
 7.6  
 2.7  
 1.2  
 2.8  
 14.8  
east west south s high sw high central north lake
2008 2012Malaria epidemiological profile_ A temporal 
analysis of prevalence surveys between 1980 
and 2012 
• The proportion of Tanzania's population living in areas of 
intense transmission (Population Adjusted Parasite Prevalence 
( PAPfPR2-10 ≥ 50%) declined from 11.6% to 2.3% by 2010 
 
• Population living in areas where transmission is categorized as 
hypo-endemic (parasitaemia 0 - <10 %)  increases from about 
30%  in 2000 to 60% in  2010 
 
• Areas with limited/no epidemiological transition are located 
in the Southern and parts of the Northwestern regions of 
Tanzania. The malaria epidemiological transition 
Loess regression line of 2193 survey data points assembled 
between 1980 and 2012 The malaria epidemiological transition  
Percentage of Tanzania's population at various classes of P.  
falciparum endemic risk in 2000 and 2010  
2000 
2010 The malaria epidemiological transition 
endemicity classes for the year 2000 The malaria epidemiological transition 
endemicity classes for the year 2000 Declining parasite prevalence_ NIMR  Tanga 
_experience from Magoda and Mpapayu villages from 
1992 to 2012 
• Objectives: To assess the 
trend of malaria burden in 
two villages in Muheza 
district over a period of 20 
years (1992 – 2012) 
Muheza district (2 villages) 
• Study sites 
 Magoda  ---1992-2012 
  Mpapayu --1997-2012 
• Complete surveys data of 
6050 individuals available 
from 1999  
• Blood smears tests 
 
 -
 10.0
 20.0
 30.0
 40.0
 50.0
 60.0
 70.0
 80.0
 90.0
19921995199619971998199920002001200420082009201020112012
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Magoda
Mpapayu
Source, NIMR Tanga presentation 
25 Proportion of OPD malaria cases reported from 
August 2013 - March 2014 (DHIS2)  
 
 
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Proportion of Malaria cases diagnosed at OPD  
 
Major Challenges Malaria transmission risk 
• Vulnerability to malaria 
transmission remain high 
due to suitable climatic 
conditions 
• Need to sustain the low 
levels  of transmission 
with sustained vector 
control interventions 
• Challenge to everybody to 
ensure continuous and 
appropriate use of 
recommended 
interventions Proportions of cases with fever, and malaria parasites 
<5 yrs old   ≥ 5 yrs old  
Parasite positivity rates declined significantly but fevers remained high in all 
age groups and altitude strata Challenges….. 
• Health System  Issues including HIS, logistics 
• Data Management; Completeness, Timely Reporting, and Use 
of data.  
• Emerging Malaria vector resistance against pyrethroid. 
• Need for continuous mobilization & Advocacy programmes on 
all interventions. 
• Funding to Sustain the achieved coverage and  scale up 
recommended interventions.  
New Malaria Strategic Plan 2014-2020 
(Draft) VISION, MISSION &GOAL 
 
• Vision: Tanzania is a society free from malaria 
 
• Mission: All Tanzanians have access to quality, effective,  safe and 
affordable malaria interventions through timely and sustainable 
collaborative effort with partners and communities at all levels 
 
• Goal: to reduce the average malaria prevalence from 10% in 2012 
to 5% in 2016 and further down to less than 1% in 2020 
 Malaria Control Phases and Timelines 
 
  
 
Strategies Integrated Malaria Vector Control 
• Main Objective: To reduce transmission of malaria 
by scaling up and maintaining effective vector 
control interventions 
 
 Maintain universal access of LLINs  through replacement 
campaign,  continuous distribution mechanisms, targeted 
distribution,  re-create viable commercial sector, promotion) 
 
 Consolidate and expand IRS in epidemiologically and 
operationally suitable areas: capacity building local govt and 
implementation in targeted areas 
 
 Implement  larviciding and environmental measures to 
complement LLINs and IRS in targeted communities 
 Integrated Malaria Vector Control… 
 Promote effective environmental management for malaria 
control amongst  targeted communities (development 
projects,  promote intervention at community level, 
community led initiatives in urban areas) 
 Malaria case management 
• Main Objective: To prevent the occurrence of severe morbidity and 
mortality related to malaria infection through promotion of universal 
access to appropriate early diagnosis and prompt treatment and 
provision of preventive therapies in vulnerable groups  
 
 Provide universal access to high-quality malaria diagnosis to guide appropriate 
treatment both from the public and private sector 
 
 Provide universal access to high-quality malaria treatment as guided by 
malaria diagnostic test results and SOPs 
 
 Reduce vulnerability to malaria infection and  complications among vulnerable 
populations: PW, infants, PLWHIV, Sickle cell , non immune travelers 
 
 Provide appropriate logistics for continuous availability  of quality 
commodities for  malaria case management and ensure commodities are of 
high quality  
 
 Supportive interventions 
• BCC/IEC: Increase awareness on malaria and appropriate use 
of prevention, diagnosis and malaria treatment, and advocate 
for more resources (local and external) 
• Surveillance, Monitoring and Evaluation:  Summary 
• When resources are well invested in proven effective malaria 
control, targets are achievable 
 
• Reduced  burden  of  the  disease  have  significant  social  and 
economic benefits 
 
• Despite declining  malaria prevalence, Tanzania remains 
highly vulnerable for malaria transmission due to climatic 
conditions suitability 
 
• Evidence has shown that, a rebound effect is likely, if control 
measures were scaled down or stopped completely. 
 Summary… 
• Malaria is too big a burden to be left to individual countries, to the 
MoHSW alone, we need to work together; Partnership is central 
to the achievements  
 
• As we move into a new strategic plan, need engagement of the 
community,  different  sectors,  donors  etc  to  ensure  maintenance 
and further reductions 
 
• Community  engagement  is  important  to  ensure  appropriate 
actions are taken for malaria prevention and treatment 
 
• Mobilisation  of  resources  including  funds  is  critical  to 
maintain the coverage and sustain the gains achieved so far 
 
 
 
 
 41 
  
 
 
Thank you…. 
 
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Malaria status in Tanzania Mainland: an Overview

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