Malaria is a major public health challenge in the United Republic of Tanzania. Ninety-three percent of the mainland population (and the entire population of Zanzibar) is at risk of infection; Plasmodium falciparum accounts for 96% of cases. These staggering levels of malaria endemicity result in 11 million clinically diagnosed cases of malaria each year, exacting a high toll on health facilities and human life. According to Population Services International (PSI), 80% of the 60 000–80 000 annual malaria deaths in the United Republic of Tanzania occur among pregnant women and children under five years of age.
The complexity of malaria control is in part due to the considerable variation in malaria epidemiology throughout the country. Stable, perennial transmission occurs along the coastal fringe, southern lowlands, and regions bordering Lake Victoria, while the southern, northern and western parts of the country experience stable malaria with seasonal peaks at the end of their respective rainy seasons. Unstable seasonal transmission occurs in the arid central plateau. This mix of unstable and stable transmission patterns accounts for the impact of malaria on adults as well as children and pregnant women in the United Republic of Tanzania, since those living in areas of unstable transmission do not develop immunity to the parasite.
Two separate malaria control programmes operate in the United Republic of Tanzania: the National Malaria Control Programme (NMCP) serves the Mainland; and the Zanzibar Malaria Control Programme (ZMCP) operates in Zanzibar. Both malaria programmes are currently drafting new strategic plans for 2014–2020. According to the ‘Lives Saved Tool’ estimation model, the NMCP’s malaria prevention and treatment efforts saved 63 000 child lives between 1999 and 2010, figures supported by concurrent declines in parasitaemia prevalence, severe childhood anaemia, and all-cause under-five child mortality. In Zanzibar, malaria prevalence remains extremely low (less than 1%) and the ZMCP is now pursuing strategies towards malaria elimination.
These achievements can be attributed to ongoing activities by multiple stakeholders to introduce and expand coverage of effective malaria prevention and treatment measures, including insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS) with insecticides, intermittent preventive treatment for pregnant women (IPTp), diagnosis with rapid diagnostic tests (RDTs) or microscopy, and treatment with artemisinin-based combination therapy (ACT).
The NMCP strategic plan for 2014–2020, which is under development, includes the following goals:
In order to meet these goals, the NMCP has specified objectives and strategies in the following thematic areas: 1) malaria case management; 2) integrated malaria vector control; 3) supportive interventions, such as behaviour change communication (BCC) and monitoring and evaluation (M&E); and 4) programme management.
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