Malaria control at the district level in Africa: the case of the muheza district in northeastern Tanzania.
An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria transmission and incidence over time; use of facility-based care services for malaria; patients' access to professional advice; the trend of treatment failure over time of sulfadoxine-pyrimethamine and chloroquine; survival rates of severe cases at the district hospital; a district malaria control strategy; number of malaria specific training for care providers; and the number of activities carried out on mosquito control measures. The data were collected from 1996 to 2003 in the Muheza district northeastern Tanzania. It covered household interviews with a stratified sample of 1,250 respondents, and in-depth interviews with all 175 health care providers in the 35 health facilities within the district. All six members of the district health management team were also interviewed. Additional data came from dispensary and hospital records, and published literature. The results show an unchanged malaria disease burden. The average number of clinical malaria episodes per child less than five years of age remained between 3 and 3.5 episodes per year in the district since the 1960s. The comparison of cases expected in the population less than five years old with those seen in the district health facilities shows a coverage rate of 33%. Furthermore, between 1990 and 2003, little training on malaria was provided to health staff. The findings imply a limited effectiveness of district health services on malaria control, suggesting a weak process of translating national malaria goals to activities at the district level.
Alilio
Martin S
MS
Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892-6705, USA. malilio@aed.org
Kitua
Andrew
A
Njunwa
Kato
K
Medina
Marta
M
Rønn
Anita Mandrup
AM
Mhina
Julius
J
Msuya
Fikirini
F
Mahundi
Judith
J
Depinay
Jean Marc
JM
Whyte
Susan
S
Krasnik
Allan
A
Bygbjerg
Ib Christian
IC
D000962:Antimalarials / Q000600:supply & distribution; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012040:Regional Health Planning / Q000592:standards; D013636:Tanzania / Q000453:epidemiology
D000962:Antimalarials