Tanzania: Searching for a Solution to the Malaria Crisis

UN Integrated Regional Information Networks
NEWS
September 1, 2023
Posted to the web September 1, 2023
Dar Es Salaam

In the next six years, the number of Tanzanians killed by malaria could be halved. They just need to start using insecticide-treated nets.

"Treated nets can reduce mosquito bites by more than 80 percent and kill more than 50 percent of all mosquitoes that enter houses," Alex Mwita, manager of Tanzania's National Malaria Control Programme, said. Medical experts say the use of bed nets would cut the number of children killed by the disease by 27 percent.

Currently, Tanzania has the highest rate of death from malaria in southern Africa. A staggering 100,000 Tanzanians die from the disease each year. That is the equivalent to one person every five minutes.

About 70 percent of the deaths occur among pregnant women and children below the age of five years.

Efforts to combat Tanzania's number one killer have been minimal, until recently. "Malaria is a big challenge, but it can be prevented with the right interventions," Mwita said.

Changing sleeping habits is the issue, Mwita said. Tanzanians need to start using bed nets.

But many Tanzanians say they are not used to sleeping under mosquito nets. "I feel I can't breathe when I'm under a mosquito net," said Asha Munisi, 37, who lives in Tanzania's Coast Region, one of the hardest-hit malaria zones, and who admits he suffers recurrent bouts of malaria.

"And I don't trust those chemicals" he added, referring to the insecticide used to treat the nets.

Tanzania's National Institute of Medical Research (NIMR) has approved the insecticide as being safe for humans. Yet less than 1 percent of Tanzanians used bed nets before 2002, according to Ministry of Health officials.

In that year, the government eliminated taxes on mosquito nets and anti-malaria chemicals, in keeping with a pledge it made in 2000 along with 15 other African countries at a meeting on malaria in Abuja, Nigeria.

Waiving the taxes has lowered the costs of nets and encouraged investment in related industries. But a recent NIMR study found that even after the waiver not even 2 percent of Tanzanians slept under nets.

Officials remain hopeful that Tanzanian habits will change. "Most mothers already sleep with their babies," Mwita said, "so they can easily sleep under the same bed net."

And children above five years old normally share one large bed, he added, so they can all be shielded by one large net.

The country has received at least US $19.8 million from the UN Global Fund to support the country's National Insecticide-Treated Nets Implementation Plan (NatNets).

To reduce further the cost to pregnant women and women with children below age five, the government launched a pilot system in 2003. The women are given vouchers to buy bed nets from designated shops that cost them between 500 shillings (50 US cents) and 700 shillings (70 US cents) depending on size.

So far, the scheme, which is funded by the UN Children's Fund at a cost of $11 million, is only available in two of Tanzania's districts, Kibaha and Kilosa, where more people die from malaria than anywhere else in the country.

The scheme could eventually be available throughout the country if the government can raise the necessary funds. "The target is to have 60 percent of pregnant women and children below age five using insecticide-treated nets by 2007," Mwita said.

But at a health centre in Kigamboni, on the outskirts of Tanzania's commercial capital, Dar es Salaam, Mwantunu Ali, a mother of three, told IRIN she still could not afford to buy nets for the whole of her family.

"I was able to get only one mosquito net with the voucher, which I've given to my children to share. I can't afford to buy another mosquito net for myself," she said.

The chief medical officer of Kibaha, Mariam Ongara, told IRIN that even at the discounted price many poor women could not afford the nets. She and other health experts are calling on the government to distribute the nets without charge.

Malaria is already a major burden on the country's economy. The government spends $121 million each year on treatment and prevention, which is equivalent to 3.4 percent of the GDP.

About 18 million Tanzanians suffer from the disease each year. That is one in every two persons.

The treatment for outpatients costs around $1.50 a day; inpatient treatment costs $19 a day. That is far more than what the average Tanzanian can pay.

"These easily preventable deaths of our children every year are unacceptable," said Tanzanian President Benjamin Mkapa in his monthly address to the nation in July.

He said the disease infected five times more Tanzanians than AIDS, tuberculosis, measles and leprosy put together.

The malaria parasites in Tanzania are resistant to standard anti-malaria drugs like chloroquin and sulphadoxine-pyrithemaine. Choloroquine has become so ineffective the government has banned its use. The drugs currently in use include artemisinine and sulphadoxine-pyrethemaine.

If Tanzanians do not start using bed nets there is one other radical solution: widespread spraying of a pesticide called dichlorodiphenyltrichloroethane, commonly known as DDT. It is banned because of serious side effects for humans and the environment but it would be effective in reducing transmission of malaria.

An international anti-pesticide treaty allows for an exception to the ban in malarial areas. So far Tanzania has resisted using DDT.

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