Roll Back Malaria Progress & Impact Series
Focus on Mainland Tanzania
Tanzania's National Malaria Control Programme (NMCP) has provided strong, stable leadership in coordinating malaria control activities since 1995.
Because of continuity and focus on programme implementation, both the number of partners and resources have been growing, most notably over the last seven years. Between 2003 and 2010, about US$ 450 million in external funding was allocated to scale up the malaria control programme.
These increasing contributions have been used to deliver preventive and curative services.
- 18 562 571 insecticide-treated mosquito nets (ITNs) were distributed between 2007 and 2010 through mass campaigns and the national voucher scheme.
- Indoor residual spraying (IRS) began in 2007 and had expanded to cover 94% of the targeted structures in 18 districts by March 2011.
- Rapid diagnostic tests (RDTs) and artemisininbased combination therapies (ACTs) have been deployed to reach half of the population so far, and health workers have been trained in using them. Efforts have also been made to make these new treatments available in the private sector, where up to 40% of the rural population seek care for fever.
This deployment of interventions has resulted in improved coverage.
- 63% of households owned at least one ITN in 2010, compared with 23% in 2004-2005.
- 64% of all children under five and 56% of all pregnant women nationwide used an ITN the night before the 2010 survey—a more than twofold increase since 2007.
- In addition, between 2001 and 2006, Tanzania changed its recommended antimalarial drug from chloroquine to sulfadoxine-pyrimethamine (SP) to ACTs, thereby providing access to more effective antimalarials.
Because of good coverage results, the Tanzanian government has been able to reduce disease burden and save lives.
- In the Ifakara surveillance area, the prevalence of parasitaemia in children under five was reduced by more than 5-fold, from 25% in 2004-2005 to less than 5% in 2010.
- Nationally, severe childhood anaemia was halved, dropping from 11% in 2004-2005 to 5.5% in 2010.
- All-cause under-five child mortality fell by 45% between 1999 and 2010—from 148 deaths per 1000 live births in 1999 to 81 per 1000 live births in 2010.
- According to the Lives Saved Tool (LiST estimation model), the lives of 63 000 children under five have been saved by malaria control interventions since 1999.
Tanzania's improved malaria and health indicators are all signs that malaria control efforts are working and delivering results. Consideration of other factors that might explain the declines in all-cause under-five mortality leads to the conclusion that the improvement in child health is due in large part to malaria control efforts. The country is also achieving equitable impact on major mortality and malaria coverage indicators.
With demonstrated ability to deliver and achieve impact on child survival, Tanzania has articulated even more ambitious malaria control goals: universal ITN coverage, IRS in half of the country, and enhanced diagnosis and ACT treatment of all malaria cases. This will require increased funding and a strengthened health infrastructure. If challenges of resource mobilization, boosting the work force, and strengthening the health system can be met, Tanzania will have paved the way towards unprecedented public health achievements and protection of its population against a major scourge.
The extent of malaria in Mainland Tanzania
- Tanzania has an estimated 43.2 million inhabitants in its 21 regions, 113 districts, approximately 10 300 villages, and approximately 10 million households.
- Malaria is endemic, with approximately 40 million of Tanzania's population living where malaria is transmitted.
- According to the latest Health Management Information System report, there were approximately 11.5 million clinical malaria cases in 2008.
- Up to 2009, the National Malaria Control Programme (NMCP) estimated that 60 000-80 000 malaria deaths among all ages occurred annually in Tanzania.
- Health facilities report malaria as the leading cause of outpatient and inpatient health care visits and as the primary cause of deaths among children.
- Malaria was estimated to have caused 24% of all deaths in Tanzanian children under five years of age in 2000.
The focus of this document is progress and impact of malaria interventions in Mainland Tanzania only. Henceforth, Mainland Tanzania will be referred to as Tanzania. A future document in the series will address progress and impact in Zanzibar, which together with Mainland Tanzania, makes up the United Republic of Tanzania.
Three malaria epidemiological strata exist in Tanzania:
- Unstable, seasonal malaria: In about 20% of the country, largely in the arid central plateau, malaria is unstable and seasonal.
- Stable malaria with seasonal variations: The southern part of the country has a single main rainy season (March-May), while northern and western Tanzania experience bimodal rainfall (November-January and March-May). Seasonal malaria peaks occur at the end of the rainy season.
- Perennial malaria: In the coastal fringe, southern lowlands, and regions bordering Lake Victoria, malaria transmission is stable with very high transmission intensities.
Plasmodium falciparum accounts for 96% of malaria infections in Tanzania. The principal malaria vector is Anopheles gambiae complex.
Many challenges exist to measuring the burden of malaria in Tanzania. Without the ability to confirm malaria by laboratory testing, many health professionals have had to rely on clinical symptoms, mainly fever. Now that rapid diagnostic tests (RDTs) for malaria are becoming more widely available — their deployment began in 2009 — this will facilitate collection of data on confirmed malaria cases.
Malaria has exacted a huge toll on the Tanzanian population. In addition to causing disease and death, malaria has a huge economic impact. It jeopardizes development, either directly—through the costs of health care and hospitalization—or indirectly—through working days lost to personal illness or to caring for a sick child. It consumes families' resources, leaving Tanzanians with less money to take care of their basic needs.
Prevalence of Plasmodium falciparum malaria among children 6-59 months, Tanzania, November 2007-February 2008
Malaria prevalence is highest along the coast, in the southern lowlands, and in regions bordering Lake Victoria.