Managing Malaria in Mwanza
December 12, 2014
Sekou Toure Referral Hospital is a public facility serving the population of Mwanza Region on the shore of Lake Victoria in western Tanzania. Set in Mwanza Town, the regional capital, the hospital is a sprawling collection of low buildings arranged around courtyards planted with shady trees. Compared with the hustle and bustle of a fast-growing city and hub of Tanzania’s fish-export industry, the hospital is an oasis of calm, with white-coated doctors and nurses in blue dresses attending patients of all ages.
The pediatric ward at Sekou Toure is a long hallway not far from the hospital dispensary. In the rooms on either side of the corridor, children, most of whom are under the age of five, lie one, or sometimes more, to a bed. As their mothers hold the children or sit next to them, the young patients sleep or take medicine, waiting to feel better. Children are placed in rooms according to their symptoms. The room for children with diarrhea is close enough to the latrines at the far end of the building that a mother can try to quickly run down the hall with her child to squat him or her over the hole in the floor. Another room houses children who are recovering from burns, most often from exposure to cooking fires or pots of boiling water in the home. One room is dedicated to newborns, whatever their illness or concern. But one of the larger rooms on the Sekou Toure Hospital pediatric ward houses children suffering from fevers, and malaria is most often the cause.
While 93 percent of Mainland Tanzania’s population lives in malaria endemic areas, malaria prevalence is highest along the coast, in the southern lowlands, and in regions bordering Lake Victoria, including Mwanza. Plasmodium falciparum is the main source of infection in Tanzania. More than 40 percent of all outpatient visits to health facilities are attributable to malaria, resulting in an estimated 10 to 12 million clinical malaria cases annually. An estimated 60,000 to 80,000 malaria deaths occur annually among all age groups. Malaria is one of the leading causes of death for children, accounting for 10% of deaths among children under age five, and is also a major cause of maternal mortality.
In November 2014, a small team from the CSIS Global Health Policy Center traveled to Tanzania to examine U.S. bilateral support for maternal, neonatal, and child health programs in advance of a larger delegation visit planned for February 2015. We traveled to Mwanza and met there with caregivers, health providers, and program managers from the community level to the referral hospital to learn about the challenge of malaria for maternal and child health and steps U.S.- supported programs are taking to help partner programs in Tanzania prevent and treat it.
In the district of Magu, east of the regional capital of Mwanza, we had an opportunity to speak with women and men who have assumed responsibility for caring for young members of their community through the USAID-funded Pumoja Tuwalee program, which is implemented by Pact in cooperation with the Tanzanian Red Cross. Pamoja Tuwalee is Kiswahili for "Let's bring up children together" and aims to improve the quality of life of Tanzania's most vulnerable children by empowering households and communities to provide comprehensive and sustainable care and support. Many of these children have lost one or more parents to illnesses, including HIV, but others are considered vulnerable because their families cannot provide them with adequate food or shelter. The caregivers shared that malaria is a key cause of illness among the children for whom they have assumed responsibility. They also told us that when a child in the household is sick, caregivers incur expenses for travel to, and treatment at, a health facility, which may be located at some distance from the community. When sick children are not able to attend school, caregivers are not able to participate in their usual household economic activities, which results in lost income.
With the aim of preventing children – and adults – in the region from being infected with malaria in the first place, the U.S. President's Malaria Initiative (PMI) funds efforts, through RTI International, to spray the interiors of homes and other buildings with insecticide, which has been proven effective in reducing malaria transmission if at least 85 percent of households in a community are treated. Tanzania is a PMI priority country, and indoor residual spraying activities are a key component of U.S. support for Tanzania's malaria control strategies. In FY 2014, the U.S.-supported program in Mwanza, covered 223,417 households, with an estimated 91 percent of identified eligible households sprayed. A total of 237,319 children under the age of 5 and 41,586 pregnant women benefited. Further, 1,971 community members received temporary employment. The next spraying period in Mwanza region will occur in February of 2015.
But for those children who do become infected, the USAID-funded Tibu Homa project, which is implemented by University Research Co., LLC (URC), in collaboration with Management Sciences for Health (MSH) and the African Medical and Research Foundation (AMREF), provides staff working in health facilities with technical assistance related to malaria diagnosis and treatment. Because malaria is such a common malady in Mwanza Region, at some facilities medical staff have historically assumed that any child presenting with fever has malaria. But Tibu Homa, which means “treat fever” in Kiswahili, is focused on helping medical staff use rapid diagnostic kits, along with microscopy, to make a definitive malaria diagnosis and to ensure the availability and use of appropriate medicines to treat malaria.
These interventions to better prevent, diagnose, and treat malaria are vitally important and have led to improved health and economic outcomes for children and their communities. The Roll Back Malaria Partnership estimates that between 1999 and 2012, malaria control interventions have saved the lives of 63,000 children under five in Mainland Tanzania. However, malaria is only one of several diseases to affect the health of children in Tanzania. The CSIS Global Health Policy Center delegation that travels to Tanzania in February will examine how malaria activities are integrated into other maternal, neonatal, and child health programs and the extent to which U.S.-supported malaria interventions are supporting other health goals.