Equity &IPTp &ITNs &Malaria in Pregnancy &Private Sector Bill Brieger | 18 Nov 2018 10:15 am
Tanzania: Slow Progress in Preventing Malaria
The full 2017 Malaria Indicator Survey (MIS) results have been published for Tanzania providing an opportunity to look at the findings in more detail. Several important factors need highlighting since Tanzania is part of a regional block where some countries are activly considering malaria elimination – the E8 countries of the Southern Africa Development Community.
So far Tanzania has come close to achieving a target of 80% of households owning insecticide treated nets (ITNs) with 78% on the mainland and 79% in Zanzibar. A closer look shows that there is still a ways to go to get to universal coverage or at least one net for every two persons in the household. With this indicator 45% of mainland and 42% of Zanzibar households have met the target, meaning that there are unprotected people in a majority of households across the country. This indicator experienced a drop from a 2011 “high” of 56%, a drop to 39% in 2015 and a slight recovery to 45% in 2017.
Even the universal coverage target requires that people actually sleep under the nets. What the MIS report shows is that although 63% of people had access to an ITN, only 52% reported sleeping under one the night before the survey.
Equity remains an issue with 69% of households in the lowest wealth quintile owning at least one net compared to 81% and 83% in the middle and fourth quintiles. Although households in the highest quintile had 78% ownership, this group is more likely to live in better quality housing that prevents the ingress of most mosquitoes. Also residents in urban areas have an edge over rural counterparts in terms of net access.
The report show that 55% of children under 5 years of age and 51% of pregnant women slept under an ITN. This is down from 72% and 75% respectively in 2011.
We learn that 90% of existing nets were obtained through some form of public sector campaign including mass distribution (62%), village coupons redeemable at health centers (15%), and school campaigns (4%). Only 5% were obtained through routine services (ANC, child immunization) 
indicating that efforts to ‘keep up’ after mass campaigns need to be strengthened. The 10% of nets, whether treated or not, that were obtained in shops and markets cost the owner in the neighborhood of US$5.00.
Uptake of doses of intermittent preventive treatment for malaria in pregnancy has slowly but steadily increased over the past 15 years and stood at 83% for one dose, 56% for two doses and 26% for three in this most recent MIS. With the current target being three or more doses needed for optimal protection, Tanzania still has a far long way to go, especially considering that accessing ITNs through ANC services is also low..
on 18 Nov 2018 at 6:15 pm 1.Tanzania: Slow Progress in Preventing Malaria said …
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on 20 Nov 2018 at 7:50 am 2.Bill Brieger said …
To Malaria/Tropical Health Matters:
Tanzania’s levels of parasitemia have dropped to an overall 7% in this MIS – that’s halved from 15% in 2015. I think there’s a lot to celebrate in this report. Everyone needs to realize that the ITN coverage indicators tell different stories – % of households owning at least 1 ITN is a measure of the reach of ITN activities, not of ‘coverage’ or protection, since households might have just 1 ITN but not enough for the members of their household. Likewise, % of households owning at least 1 ITN for every 2 people is an indicator of ‘perfect protection’, but it’s incredibly difficult for large households to reach and maintain this standard. There’s a lot more on this in our recent paper on the topic. Population ITN access, because it’s based on people as the unit of analysis (not households!) provides a better picture of ‘universal coverage’, in terms of people who have the opportunity to sleep under an ITN.
In Tanzania’s case, if 52% of the population slept under an ITN, and 63% have access to an ITN, that means that 52/63=83% of people who could have used an ITN did so. See our ITN Access and Use Report for more info on this plus data on ITN use behaviors from 44 countries. Let’s not blame people for not using nets, when in fact the problem is that they don’t have enough available to use. ITN use rates among those who have access to an ITN are consistently at or above 80% in Tanzania.
Remember that the 2011 THMIS followed closely after the 2010-2011 universal coverage campaign – so all ITN indicators were much higher then. And that routine health facility delivery of ITNs to pregnant women and infants was suspended from 2014-2016 entirely. Small wonder then that health facility ITNs represent such a small proportion of all nets.
Overall, I would not characterize Tanzania’s progress as “slow”. They have a lot to be proud of.
Best, Hannah Koenker
Project Director, VectorWorks, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs
111 Market Place, Suite 310, Baltimore, Maryland 21202
Phone: 443-839-2701, Skype: hkoenker, Email: hkoenker@jhu.edu
Web: ccp.jhu.edu, Web: vector-works.org