Joint Efforts to Improve Malaria Control in Three Refugee Camps in Kigoma, Tanzania

A team affiliated with the USAID-supported Boresha Afya health project in Tanzania prepared a presentation for the 68th Annual Meeting of the American Society of Tropical Medicine and Hygiene entitled, “Joint Efforts to Improve Malaria Control in Three Refugee Camps in Kigoma, Tanzania: Successes, Challenges and Lessons Learned,” as seen below. Team members included Shabani K. Muller, Juma Ng’akola, Zephani Nyakiha, Godfrey Smart, Tesha Goodluck, Jasmine Chadewa, Agnes Kosia, Zahra Mkomwa, Abdallah Lusasi, Dustana Bishanga, Rita Noronha, Lusekelo Njonge, Ally Mohamed, Gaudensia Tibajiuka, Chonge Kitojo, and Erik Reaves (Affiliations: USAID Boresha Afya Project -Path Tanzania; USAID Boresha Afya Project –Jhiego Tanzania; National Malaria Control Program, Regional Health Management Team-Kigoma. President’s Malaria Initiative/United States Agency for International Development)

Overview of USAID Boresha Afya Lake and Western Zones: USAID’s 5-year project was implemented in seven regions of Tanzania, including Kigoma. It supports the Government of Tanzania increasing access to high-quality, comprehensive, and integrated health services, with a focus on women and children. Its goal is to improve the quality of malaria case management, including malaria in pregnancy.

Malaria prevalence in Tanzania has decreased by half, from 14.8% in 2016 to 7.3% in 2017 (2015 and 2017 Tanzania Malaria Indicator Surveys). Malaria prevalence in Kigoma is 24% (above national prevalence). According to quarterly District Health Information System 2 data at facility level, about 50% of all malaria cases in Kigoma Region are from the three refugee camps.

Overview of Refugee Situation in Kigoma Region: The majority of refugees fleeing conflicts in Burundi and Democratic Republic of the Congo are hosted in Kigoma.
The three major refugee camps in Kigoma are Nyarugusu, Nduta, and Mtendeli.

Interventions to Improve Malaria Case Management included the following

  • Conducted on-the-job training and mentorship.
  • Conducted joint supportive supervision.
  • Discussed challenges and how to address them in refugee camp settings with other malaria partners.
  • Identified poor-performing indicators.
  • Collaborated with community providers.

Results of these interventions included the malaria lab reporting rate increased from 42% to 100%. This means that the rate of facilities reporting laboratory results in the District Heath Information System was very low. Clinical malaria diagnosis decreased from 4% to 0%. Nyarugusu’s malaria positivity rate decreased from 61% to 52%. Kigoma Region’s number of annual deaths due to malaria decreased from 359 in 2017 to 191 in 2018.

Results also showed an increased percentage of pregnant women who received the second dose of intermittent preventive treatment of malaria in pregnancy (IPTp2) from 26.7% in 2017 to 84.3% by June 2019. Increased IPTp3 coverage from 9.4% in 2017 to 13.2% in 2018.

Challenges and Mitigation are outlined in the attached table.

Several Lessons were Learned from the interventions. On-the-job and malaria mentorship training are important components in improving malaria case management in refugee camps. Supportive supervision is mainly based on gaps identification, and mentorship is focused on hands-on skill and capacity-building. Regular supportive supervision, when correctly using the MSDQI Tool, improves malaria service provision.

Working in collaboration with other stakeholders to implement vector control, social and behavior change communication, and other interventions is important in the fight against malaria in refugee camps.

This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the USAID Boresha Afya and do not necessarily reflect the views of USAID or the United States government.

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