A Tanzanian campaign to eradicate mosquitoes includes indoor residual spraying

DAR ES SALAM, 3 September 2009 (IRIN) - Health officials in Tanzania are confident they are on track to eradicate malaria deaths by 2015, even if significant challenges stand in the way of the target.

The National Malaria Control Programme (NMCP) says malaria is a leading killer in the East African country, infecting about 18 million people annually.

The disease is responsible for between 60,000 and 80,000 deaths each year – at least nine deaths every hour - mainly pregnant women and children under five.

Official records also show that 30-40 percent of attendance at health centres and hospitals are related to malaria cases, burdening overstretched facilities.

Malaria, according to the National Planning Commission (NPC) costs the country an estimated loss that is equivalent to 3.4 percent of gross domestic product.

Alex Mwita, a senior NMCP official, said initiatives being implemented under the Roll Back Malaria programme, such as insecticide-treated bed nets and indoor residual spraying (IRS), had helped reduce malaria cases, along with deaths of children under five and infants (younger than one).

“Under-five deaths have dropped to 91 per 1,000 live births in 2008, down from 147 in 1999,” Mwita said, presenting a paper in Dar es Salaam recently.

He said that although the decline could not be attributed to the fall in malaria cases alone, research showed a decline in prevalence of the disease had a big impact on childhood and maternal mortality.

“Since intervention initiatives have proven to work, we are now scaling up distribution of insecticide-treated bed nets, indoor spraying and behavioural change communication,” Mwita said.


Bed nets

Tanzania's President Jakaya Kikwete told the World Health Organization (WHO) Director-General Margaret Chan, who visited Tanzania recently, that his government was committed to attaining universal bed net coverage by December 2010 and eliminating malaria by 2015.

Kikwete told Chan there were plans to distribute 14 million mosquito bed nets within the next 16 months to cover all households. The move complements the current programme where all children under five are due to receive bed nets free of charge. NMCP said in its latest report that so far 30 percent of children under five had nets.

The UN Special Envoy for Malaria, Raymond Chambers, told a news conference that the Global Fund for AIDS, Malaria and Tuberculosis had approved a grant of US$110 million to Tanzania to support the procurement of 14 million bed nets.

"We are impressed by Tanzania's initiatives and political commitment shown by the country's leadership. It is our hope that malaria will be eliminated within the next seven years as planned," he said.

Chambers, however, said the challenge was to make all 40 million Tanzanians sleep under the insecticide-treated bed nets. "There must be an aggressive campaign by politicians and the media on the need to use the bed nets for the intended purpose instead of fishing," said Chambers, who accompanied the WHO chief on her visit to Tanzania.

"I know there is a lack of adequate resources, health personnel and infrastructure. I am, however, convinced that you don't have a shortage of political will," Chan said.

Treatment costs

David Mwakyusa, Tanzania’s Health Minister, said since 2006, the country had used Artemisinin-based combination therapy (ACT) as a first-line treatment for uncomplicated malaria and the drug had shown great success.

The minister, however, expressed concern over the cost of the medicine in pharmacies and private outlets, where a dose is up to 15,000 shillings (about $11).

He said that in public facilities a drug called ALU is prescribed and prices are affordable at between 300 shillings and 1,000 shillings (about 20 cents and 80 cents).

“We are working on a programme that will enable ACT to be available in all public and private facilities at affordable prices,” he said.


Photo: John Kulekana/IRIN
WHO Director-General Margaret Chan greets a mother and child at a health centre in Bagamoyo town near Dar es Salaam, Tanzania on 18 August 2009
Drug resistance

Mwakyusa said his ministry was following up reports of malaria parasites’ resistance to ACT along the Cambodia-Thailand border earlier this year.

Chan blamed doctors and patients. She said there were cases where patients did not use the whole dose and in others, doctors under-prescribed the medicines.

“If patients use only half a dose, there is the likelihood for the parasites to mutate and develop resistance to drugs administered,” she said. “We must be very careful in handling and administration of medicines,” she added.

Financial crisis

Despite the confidence expressed by government officials, the NMPC is worried that the global financial crisis might undermine the country’s efforts to wipe out malaria by 2015.

“When you have financial problems in countries like the United States, which contribute heavily to the Global Fund and other anti-malaria programmes, you cannot rule out adverse effects on our initiatives,” Mwita said. “Eradication of malaria by 2015 is possible, but I can assure you it is a tall order,” he added.

Zanzibar success

In semi-autonomous Zanzibar, authorities said they were on target to eliminate malaria by 2015.

“We have been recording admirable success in combating malaria in the islands through multiple interventions. We have managed to reduce the prevalence from 41 percent in 2001 to 0.4 percent this year,” Zanzibar Malaria Control Programme (ZMCP) manager, Abdullah Suleiman, told Chan.

However, he said, sustaining these achievements remained the biggest challenge for Zanzibar, and availability of funds was critical in sustaining the anti-malaria programme.

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