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MALARIA CONTROL AT THE DISTRICT LEVEL IN AFRICA: THE CASE OF THE MUHEZA DISTRICT IN NORTHEASTERN TANZANIA

An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria transmission and incidence over time; use of facility-based care services for malaria; patients’ access to professional advice; the trend of treatment failure over time of sulfadoxine-pyrimethamine and chloroquine; survival rates of severe cases at the district hospital; a district malaria control strategy; number of malaria specific training for care providers; and the number of activities carried out on mosquito control measures. The data were collected from 1996 to 2003 in the Muheza district northeastern Tanzania. It covered household interviews with a stratified sample of 1,250 respondents, and in-depth interviews with all 175 health care providers in the 35 health facilities within the district. All six members of the district health management team were also interviewed. Additional data came from dispensary and hospital records, and published literature. The results show an unchanged malaria disease burden. The average number of clinical malaria episodes per child less than five years of age remained between 3 and 3.5 episodes per year in the district since the 1960s. The comparison of cases expected in the population less than five years old with those seen in the district health facilities shows a coverage rate of 33%. Furthermore, between 1990 and 2003, little training on malaria was provided to health staff. The findings imply a limited effectiveness of district health services on malaria control, suggesting a weak process of translating national malaria goals to activities at the district level.

Received September 3, 2003. Accepted for publication March 17, 2004.

Acknowledgments: We acknowledge with gratitude the support of the Danish Agency for International Development and the National Institute for Medical Research in Tanzania for funding the data collection phase in 1996–1998. We also acknowledge the support of the Fogarty International Center of the US-National Institutes of Health for providing funding that enabled Dr. Martin S. Alilio to complete the draft of this manuscript. We thank Dr. Joel Breman, Irene Edwards, Cherice Holloway, and Amanda Percival of the Fogarty International Center for editing the manuscript.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official position of any of the funding agencies mentioned here.

Authors’ addresses: Martin S. Alilio, Fogarty International Center, National Institutes of Health, Building 31, Room B2C29, 31 Center Drive, Bethesda, MD 20892-6705, Telephone: 301-402-6212 (current address: .NetMark Global Health, Population and Nutrition Department, Academy for Educational Development, 1825 Connecticut Avenue, NW, Washington, DC 20009-5721, Telephone: 202-884-8968, Fax: 202-884-8844, E-mail: malilio{at}aed.org). Jean Marc Depinay, Fogarty International Center, National Institutes of Health, Building 31, Room B2C29, 31 Center Drive, Bethesda, MD 20892-6705, Telephone: 301-402-6212. Aliliom{at}mail.nih.gov. Andrew Kitua, Kato Njunwa, Julius Mhina, Fikirini Msuya, and Judith Mahundi, National Institute for Medical Research, PO Box 9653, Dar es Salaam, Tanzania, Telephone: 255-51-130-770, Fax: 255-51-130-660, E-mail: Nimr{at}twiga.com. Marta Medina, Clarity Consulting Company, Copenhagen, Denmark, E-mail: Mim{at}clarity.dk. Anita Mandrup Rønn, Department of infectious Diseases, Rigshospitalet, Copenhagen, Denmark, E-mail: Ronn{at}dadlnet.dk. Susan Whyte, Institute of Anthropology, University of Copenhagen, Copenhagen, Denmark, E-mail: Susan.Reynolds.Whyte{at}anthro.ku.dk. Allan Krasnik, Institute of Public Health, Department of Health Services Research, University of Copenhagen, Copenhagen, Denmark, E-mail: Krasnik{at}pubhealth.ku.dk.Ib Christian Bygbjerg, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark and Institute of Public Health, Department of International Health, University of Copenhagen, Copenh agen, Denmark, E-mail: I.Bygbjerg{at}pubhealth.ku.dk.

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