An Epidemiological Profile of Malaria and its Control in Mainland Tanzania.

Type Report
Title An Epidemiological Profile of Malaria and its Control in Mainland Tanzania.
Publication (Day/Month/Year) 2013
This report is a product of a collaboration between the Tanzanian National Malaria Control Programme,
the Ifakara Health Institute and the Malaria Public Health Department of the KEMRI‐Wellcome Trust
Programme in Kenya.  
The report serves as a review of  critical epidemiological features of malaria over the last decade within
the context of both historical and current malaria control activities. The work has drawn heavily on
assemblies of empirical, geo‐coded parasite, vector and control coverage data and the use of model‐based
geo‐statistics to provide information at district council levels necessary for federal resource allocation.  
The review has been developed to assist national level partners involved in malaria control to understand
the impact of recent scaled intervention coverage, define what is required to achieve universal access and
to prioritize future funding needs to meet unmet intervention ambitions or to revise recommendations to
accelerate impact.  
This work has highlighted a number of key observations as useful inputs to the new malaria strategic plan,
which is currently being developed. Observations that will have implications for the design of future
malaria control in Tanzania include the following:
 There has been a greater than 50% reduction in predicted mean population‐adjusted parasite
prevalence in children aged 2‐10 years (PAPfPR2‐10) across Tanzania between 2000 and 2010. The
proportion of Tanzania's population living in areas of intense transmission (PAPfPR2‐10 ≥ 50%) has declined
from 11.6% to only 2.3% by 2010. While only 30% of Tanzania's population lived in areas where
transmission would be regarded as hypo‐endemic in 2000, by 2010 almost 60% of Tanzanian's were living
under these conditions.
 Dramatic declines in malaria transmission intensity have not been witnessed everywhere; areas that
have been resistant to the epidemiological transition are located in the Southern and parts of the North
Western regions of Tanzania. Revised vector control coverage targets and possibilities of seasonal drug‐
based prevention should be considered options for future control in these areas.  
 Modeled predictions of LLIN use by 2012 indicate that 64% of all Tanzanians were sleeping under an
LLIN. Approximately 5 million people were protected by IRS. However, there are significant differences
between districts in LLIN coverage and no district to date has achieved "universal coverage."
 Reports suggest that Anopheles arabiensis has become more ubiquitous across the country since 2000
and in some regions An. funestus has emerged as a highly significant vector despite a widely held view that
An. gambiae s.s. is the dominant vector. Biological insecticide resistance and behavioral adaptations by
dominant vectors has emerged in the face of wide‐spread insecticide use.  
This work was made possible because of the generosity of many researchers, institutes and control
agencies working in Tanzania who are prepared to share their survey data collected over the last three
decades. The databases are by their very nature opportunistic, but their application within an analytical
framework is clearly valuable.  
The NMCP recognizes the need to move from a position of opportunistic data collection to a pro‐active,
regular surveillance of parasite prevalence, vector distributions and intervention coverage. This will form
the basis of future evaluation metrics and form the basis of a "live" mapping product to gauge success,
gaps and opportunities to decide on priority interventions based on scientific evidence in malaria control
investment nationwide.    

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