Why Kigoma has the highest malaria prevalence ratio

04Sep 2019
Felister Peter
KIGOMA
The Guardian
Why Kigoma has the highest malaria prevalence ratio

DEPSITE the countrywide decrease of malaria prevalence to 7.3 per cent, Kigoma region in north western Tanzania has the highest positivity ratio of 24 per cent.

Revania Bruno (29)a resident of Murusi village in Kasulu district is being diagnosed for malaria at Kiganamo health Centre in Kigoma region. Photo: Felister Peter

According to the 2017 Tanzania Malaria Indicator Survey (TMIS) by the National Bureau of Statistics (NBS), the country has made significant gains in the fight against malaria with the prevalence decreasing to 7.3 per cent in 2017 from 14.4 per cent in 2015.

However clinical malaria cases in the region has been recording a downward trend, according to acting regional medical officer, Kiza Kiseka. The decrease in clinical malaria imply the increase in testing of fever cases which is significant in ensuring those positive are treated accordingly.

Kiseka who is the regional pharmacist at Maweni hospital linked the current highest ratio of malaria positivity in Kigoma with the presence of refugees at the three camps namely, Mtendeli in Kakonko district, Nduta in Kibondondo and Nyarugusu in Kasulu.

He noted that as per 2018 data, malaria prevalence ration in the region stands at 35 percent whereby over 30 percent of the prevalence is in refugee’s camps. He said the mostly affected population includes pregnant women and under-five children.

“Most of the refugees do not use mosquito nets”, said Kiseka noting the region has been taking a number of interventions to combat prevalence of malaria including spraying of malaria parasite breeding sites and strengthening of laboratory diagnosis and treatment. He said the various efforts taken by the region are supported by stakeholders including the United States Agency for International Development (USAID) funded project—‘USAID Boresha Afya’ and the United Nation’s Refugee Agency (UNHCR).

2018 data from UNHCR indicates that there are 268,664 Burundian refugees and asylum seekers living in Tanzania. Of the number, 112,112 refugees are at Nduta camp, 70,747 at Nyarugusu camp and 43,571 others accommodated at the Mtendeli camp.

The prevalence ratio is also high at Kasulu district’s Kibiama area in Murusi ward, according to Hussein Idd, the Clinician at Kiganamo Health Center. He linked the problem with poor housing construction, misuse of insecticide treated mosquito nets and availability of swamps.

The 2017 Tanzania malaria Indicator Survey (TMIS) names the councils with high malaria prevalence and their percentage in brackets as Kakonko (30.8), Kasulu DC (27.6), Kibondo DC (25.4), Kigoma DC (25.1), Buhigwe (24), Geita DC (22.4), Nanyamba TC (19.5), Muleba DC (19.4) and Mtwara DC (19.1).

The survey also named the 14 councils with malaria prevalence of less than 0.1 per cent as Mbulu TC, Mbulu DC, Hanang, Siha, Hai, Moshi MC and Mwanga DC. Others are Kondoa TC, Meru DC, Arusha, Arusha DC, Moduli, Ngorongoro DC and Rombo DC.

Interventions

According to Kiseka, a number of interventions have been taken by the government in collaboration with stakeholders. He commended the USAID Boresha Afya project for the support specifically on curative measures which includes improvement of quality laboratory investigations and proper administration of drugs.

He said under the project some key health care providers at the Maweni regional hospital have undergone trainings on proper diagnosis and treatment of malaria through the capacity building program.

“USAID Boresha Afya is our greatest partner since it has assisted to improve the quality of services at the outpatient department (OPD) and mother and children health. We are also working together in a number of projects including the Malaria Service Data Quality Improvement (MSDQI) and management of medicines supply chain”, he noted.

Among other things, the MSDQI system facilitates continuous monitoring and improvement of recorded malaria data at health facilities, health service providers’ adherence to the national guidelines in delivering malaria services and improving service provider’s knowledge and skills for quality services to suspected malaria patients.

Maweni regional hospital’s general medicine doctor, Magdalena Mushi said malaria is still a challenge in Kigoma insisting the hospital records more cases during rainy season where stagnant water provides a breeding ground for mosquitoes.

“We educate the residents on preventive measures and insist on them to use insecticide treated bed nets”, said Mushi who had benefited with the training offered by USAID Boresha Afya project.

According to Mushi the trainings have helped to sharpen the skills of health care providers especially on malaria cases management, laboratory investigation, and interpretation of results and administration of antimalarial drugs.

Assistant Laboratory Technician at Kiganamo helath centre in Kasulu district, Gerson Lifashe said: “We are grateful to the USAID Boresha Afya project since we were trained on proper use of Malaria Rapid Diagnostic Tests (MRDTs) to ensure correct results within a short period”.

Achievements

Hussein Idd, Clinician at Kiganamo Health Center in Kasulu district admitted improvements in management of malaria cases at the facility. He said the use of MRDTs has increased efficiency adding they can now diagnose and treat a good number of patients as the results come out within a short period.

“We have the best equipment and better skills on the use of malaria diagnostic tools, we are more efficient with the use MRDTs compared to the previous period when malaria tests were microscopy-based”, Idd noted. The use of MRDTs was firstly introduced in the country in 2013.

The Clinician asserted that the number of patients diagnosed with malaria at the health facility has been decreasing compared to over 200 people who were diagnosed malaria positive every month. He said in January this year there were 130 patients, February (158), March (147), April (146), May ((151), June (149) and July (139).

Most of the positive cases were detected through MRDTs, he noted.

Five months pregnant Revania Bruno (29) commended the services offered at Kiganamo health center insisting to spend a short period for consultations as well as laboratory test.

“I was not feeling well and decided to come for malaria test…results show I do not have malaria”, said Bruno advising residents to always consult professional health care providers before taking antimalarial drugs.

In Tanzania, about 35 million people are at risk of malaria whereas the most vulnerable group are pregnant women and under five children. The USAID Boresha Afya project implemented in Lake Zone and Western regions works to promote universal access to appropriate early diagnosis, prompt treatment and provision of preventive therapies to vulnerable groups.

The project has from 2016 to 2018 managed to decrease overall proportion of malaria deaths out of total deaths from 32.5 percent to 18 percent in supported regions. There has been a decreased overall malaria admissions from 43,842 to 29,826 in the specific regions.

Overall clinical malaria cases decreased from 0.7 percent in April-June 2017 to 0.3 percent in April-June 2018 following capacitation of health service providers to conduct quality malaria testing through MRDT and ensuring availability of MRDTs.