Tanzania Malaria Indicator Survey, ITNs and the View of the Press

Take away messages by the Press sometimes need a bit of clarification. A recent report in The Citizen (Dar es Salaam) expressed that the author was ‘startled’ to mean from the recent Malaria Indicator Suvey (MIS/DHS 2017) that there is high malaria prevalence in regions that also have high insecticide treated bednet ownership and use, implying that nets might not be effective. Actually the preliminary Key Indicators Report showed the overlap between prevalence and nets but did not actually present statistical analysis comparing the two to show whether actual sleeping under the net is associated with prevalence one way or the other.

The reporter quoted Dr William Kisinza, director and chief researcher at the Amani Research Centre of the National Institute for Medical Research as saying “This shows that mosquito bed-nets aren’t the only solution in addressing malaria in Tanzania,” and while this is true, it should not be construed as meaning nets don’t work. Any national malaria strategy uses ITNs in combination with other interventions to have a comprehensive program, including indoor residual spraying, which is also mentioned in the new article.

Dr Kisinza was also quoted as saying, “In Kigoma and Mtwara, bed-nets are used in fishing. There’s a need for behavioural change, if the problem is to be effectively addressed.” This is a real problem but anecdotal. In order to make a clearer point it would be necessary to test the connection between net ownership and use and do a follow-up study to see if in fact those owning but not sleeping under the nets are practicing alternative net usage.

Actually key findings from the preliminary MIS report include the fact that while 78% of households have one ITN, only 45% have at least one for every two people. Hence it is not surprising that only 55% of children under the age of 5 and 62% of pregnant women reported sleeping under a net. These are important service gaps that must be addressed.  Certainly all countries need to monitor the effectiveness of nets and insecticide resistance.

Analysis of net use and malaria parasitaemia among the children can and should be presented to address the reporter’s questions as well as provide a clue to potential insecticide resistance.

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