War against malaria goes a notch higher in Tanzania

By Naftali Mwaura

As the Malaria epidemic continues to spread virulently in Africa leaving in its wake a frightening toll of casualties; human, economic and social, the call to rise up and fight the disease with renewed vigour has never resonated more powerfully of late.

Malaria so far is the leading killer disease globally surpassing other dreaded epidemics like HIV and AIDS, Tuberculosis etc.

Sub-Saharan Africa currently takes the lion share of deaths associated with Malaria. Out of the three million people who succumb to Malaria annually, 90 percent are from Africa.

The toll of Malaria infections and even deaths is heaviest among the vulnerable groups of children below five years and pregnant women.

The intensity of Malaria epidemic has lately provoked the conscience of policy makers in higher echelons of Government, non Governmental organizations, bilateral and multi-lateral agencies who have all teemed up to establish a co-ordinate approach to fight the disease.

Most African Governments are signatory to various global initiatives that offer a well-organized platform to fight Malaria.

The roll back Malaria (RBM) global partnership that was launched in 1998 to provide a coordinated international approach to fight malaria has the blessing of almost all Malaria endemic African Countries.

The primary goal of Roll back Malaria is to halve the burden of malaria by the year 2010.

A number of targets for specific intervention strategies were established at the Abuja Malaria summit in April 2000 and were endorsed by the high-powered delegations in attendance.

The targets include among others, prompt access to effective treatment, provision of insecticide treated nets to reach sixty percent of those at risk from malaria; children under five years and pregnant mothers.

Malaria is the root cause of the debilitating poverty afflicting many African countries.

In Tanzania alone, the disease kills a staggering 100,000 people every year. Nearly thirty million people in Tanzania are at risk of the disease; a situation that create heavy burden on families and the Country’s health system. Malaria consumes 3.5 per cent or US $ 350 Million of the Country’s gross domestic product each year.

Malaria continues to blight struggling economies in Africa where 60 per cent of the population live below the poverty line.

Struggling economies in Africa are being overwhelmed by challenges posed by Malaria epidemic.

The shoestring budgetary allocation to the health sector by most African Governments has often stood in the way of taming the malaria devastations in our countries.

Malaria is also reversing backwards any gains African countries might have achieved towards sustainable development.

The Millennium Development Goals (MDGs) appears ever more like a distant mirage as the populations which could have been the catalyst to enable their countries attain the MDGs’ targets, die in large numbers from preventable causes like malaria.

Despite the gloomy scenario though, the fight against malaria is accelerating on a steady course in many African countries.

Tanzania for instance has stood out as a shining example of a country that has risen up to the challenge of battling the tropical epidemic which is responsible for about 40 per cent of fewer than five deaths in the country. Malaria also impacts heavily on pregnant women leading to an upsurge of Anemia and fetal weight loss.

The Government of Tanzania has set up fantastic programmes for malaria prevention and treatment. These programmes and initiatives have been developed through engagement with all concerned parties and the successes recorded on the ground are so impressive.

The Tanzanian ministry of health in collaboration with partners in research, donor community and the grassroots communities has developed innovative programmes to scale up an effective means of fighting malaria.

A number of projects like the provision of insecticide treated nets (ITNs) to vulnerable groups of children and pregnant women have achieved phenomenal results.

In October 2004,Tanzanian Government began to scale up an innovative programme that uses discount vouchers to provide pregnant women and infant’s access to insecticide treated nets at reduced prices.

The Tanzania National Voucher Scheme (TNVS) is a unique and innovative model that provides targeted subsidies to those who are vulnerable to malaria. The Voucher scheme is a collaborative venture involving various players like Government, private sector, Donors and community groups.

Through Voucher scheme, pregnant women who visit antenatal care at health facilities are issued with a voucher that they present to any recommended retailer and are given the net at reasonable cost.

Government and donors have developed social marketing strategy and the private sector is involved in the supply of the treated nets to reach a wide berth of population of vulnerable groups in an economically viable manner.

There are so many retail outlets in malaria endemic regions of Tanzania that are actively involved in supplying treated nets to every household with either infants or a pregnant mother at a partly price of two dollars.

The Global fund to fight Aids, Tuberculosis and Malaria has availed a grant of US $ 11.6 to the Tanzania Ministry of Health to enable the ministry avail low cost insecticide treated nets to households through the discount voucher scheme.

With support from UNICEF, a pilot project was tested in two malaria endemic Districts of Kibaha and Kilosa to ascertain the effectiveness of the voucher scheme.

The two projects bore impressive results that provoked the Government to expand discount voucher scheme to cover wider geographical location.

Mtwara Province in southern Tanzania is a malaria hotspot that is home to 1.2 million people. The province is a behemoth covering 16,000 square kilometers and has a sizeable coastline.

The extensive marshlands provide a fertile ground for mosquito breeding hence high incidences of Malaria infections that are recorded in the region especially during the December to January Rainfall season.

Tanzanian Government has concentrated most of Anti-malaria initiatives in Mtwara. At a visit to the Lugulu Provincial Hospital, we were informed by the medical personnel about the intervention measures that have been put in place to contain Malaria in this expansive province.

The measures involve a well-coordinated strategy of well equipped medical officers who liaise with communities in the grassroots to seek ways of defeating malaria in the region. Communities are empowered with information on how to prevent, detect and treat malaria.

The Ministry of Health has also trained drug dispensers in the communities to ease the workload of reaching the sick in their remotest frontiers. Every village has a number of trained drug dispensers who supply Rector artesunate drugs to sick mothers and infants.

A pediatric ward at the Provincial hospital has all the beds covered with treated nets. According to Dr Rashid Mnandowa, acting Regional Medical Officer, Malaria infections in Mtwara are so pronounced that they sometimes overwhelm the capacity of health facilities in the area.

Every health facility in Mtwara provides pregnant women with a numbered voucher that enables them purchase an insecticide treated net from the local vendors or a commercial outlet near the health center.

The Tanzanian health infrastructure provides an ideal system for the distribution of insecticide treated nets and so far a critical mass of the vulnerable groups have access to the nets thereby leading to a drastic decline in malaria infections.

The fight against malaria in Tanzania is being carried out in a multi-disciplinary approach. Use of insecticide treated nets is going hand in hand with other initiatives like Intermittent Preventive Treatment (IPT).

The Intermittent preventive treatment is carried out in children and basically involves the delivery of an anti-malarial treatment dose at a pre-specified time, regardless of the presence of any malaria symptom or parasitaemia.

The Intermittent preventive treatment is actively being implemented in five Districts of Southern Tanzania.

Research has been done on the extent to which IPT can help scale down the war on Malaria. A health clinic at Mnolela in Lindi District has qualified medical staffs that have been taught on the applications of IPT to infants and pregnant mothers.

Intermittent preventive treatment also involves availing a treated net to mothers in every household that has Children below five years.

The Intermittent preventive treatment is a bottom up approach to addressing malaria epidemic where communities are empowered in order to be a critical component of foot soldiers to fight the disease.

The emergence of drug resistant malaria is reversing backwards any stride we might have achieved before in the malaria battle. In Tanzania, so many testimonies filtered out on the impotence of many drugs recommended in hospitals.

At present, most malaria drugs are no longer working and therefore the scientific community is challenged to go back to the drawing board and research on possible new drugs and even a vaccine to arrest malaria’s deadly pangs.

Artemisinin drug that is extracted from the plant, artemisia annua is the only one that has stood the test of time in malaria treatment. Artemisinin has origins in china and is today highly recommended for Malaria treatment in Tanzania and many other Malaria endemic African Countries. The drug has overwhelming efficacy and has no known side effects.

Alongside artemisinin, Tanzanian Government has also recommended Rector artesunate in Malaria treatment.

Rectar artesunate is recommended to the pregnant mothers and infants with malaria symptoms. Drugs are critical component in the war against malaria and their efficacy is the only guarantee whether we are making any headway.

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