Malaria: leading cause of mortality and morbidity in Tanzania

With 16 million cases every year, malaria is the leading cause of mortality and morbidity in Tanzania. It is estimated that 93.7 % of Tanzania's 32.8 million people are at risk of the disease. 14 million people (42% of the total country population) live in areas where transmission is high the whole year round. They tend to develop a degree of immunity which partially protects them from the disease: adults usually have episodes with no apparent symptoms, or short-lived, uncomplicated episodes. But pregnant women and young children who have not yet developed immunity are more vulnerable: they have higher malaria mortality rates, high levels of anaemia and low birth weight. Treatment protocol Fighting malaria is one of the priorities of the Tanzanian Ministry of Health (MOH). In June 2000, the MOH officially announced a change in the national malaria treatment protocol, to be implemented in 2001. With resistance to chloroquine ranging from 28% to 72 % among regions, the government decided to switch to Fansidar® (sulphadoxine-pyrimethamine (SP)) as first line treatment. However, in some parts of the country, known parasite resistance to Fansidar® is already 15%. Research suggests that resistance to Fansidar® increases rapidly when it is administered on its own (in "monotherapy"). Artemisinin derivatives are known to be more effective, but they are still considered too expensive to introduce as standard treatment nation-wide. The report of the National Task Force on Antimalarial Drug Resistance states that "SP is interim, anticipating the development of low cost, generic, combination therapy within five years". MSF programme in rural Kigoma, a vulnerable area located on the shores of Lake Tanganyika In 1999, malaria was the most prevalent disease in the Kigoma district (41.3% of all outpatient consultations due to malaria). A 1997 study showed chloroquine treatment failure was 57%. MSF, which has been present in Kigoma for many years, set up a project to reduce malaria morbidity and mortality in Bitale and Nguruka Health Centres. The strategy of the project is to tackle malaria in a holistic and dynamic approach: some activities are aimed at improving the management of malaria cases through improved performance of health workers, while others seek to increase the rate at which patients seek health care and community use of insecticide-treated bednets. The project plans to include operational research on field effectiveness of artemisinin derivatives in Nguruka. Health authorities expressed their initial enthusiasm for this proposal, which is to be coordinated in partnership with the MOH.