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    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.


    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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Getting a handle on Malaria in Tanzania

 The  government of Tanzania is known  for  its  “determination”  to halt the malaria scourge. The East African  country  with  a  population  of nearly  45  million  has  attempted  to tackle malaria by improving case management, vector  control, prevention and control of malaria in pregnancy and preparedness against epidemics.

However, these approaches have encountered  some  challenges.  They include  problems  like  the  healthcare system  that  is  incapable  of  providing quality health services, limited access to prompt diagnosis and treatment, and an inefficient  health education communication mechanism. Through its Phase IV studies,  the  INDEPTH Network  has conducted a series of surveys from 2009 to 2012 with the aim of evaluating the effectiveness  of  artemisinin  based combination  therapy  (ACT)  and  the health system in Tanzania as a whole.

Similar survey were conducted in Ghana, Burgkina Faso and Mozambique. In Tanzania, the INDEPTH Effectiveness and Safety Studies (INESS) revealed that less than 50% of malaria patients  were  accessing  the  recommended  ACT  treatment  for  malaria within 24 hours of the onset of illness.

“This observation was not just less than 80% target set by the Roll Back Malaria, but it was far below the level that was necessary  to  optimize  ACT  potential benefits,” says Dr. Rashid Khatib who is the  coordinator  of  INESS  project  in Tanzania.  According  to  Dr.  Khatib, reduced  timely  access  to  treatment outlets is a major driver towards  ACT efficacy decay in Africa.

“Efficacy decay means the failure of  a drug to achieve good treatment results in the health systems similar to the one demonstrated  in  the  experimental studies,” explains Dr. Khatib. He added that if a drug is  not doing fine in the h e a l t h  systems its impact on the community in malaria control is critically challenged.  Treatment  outlets  include health  facilities  and  Accredited  Drug Dispensing  Outlets (ADDO) popularly dubbed in Swahili as “duka la dawa muhimu.”

Another  survey  conducted  by  Ifakara Health  Institute  (IHI)  in  collaboration with the London School of Hygiene and Tropical  Medicines  reconfirmed  that access  to  Artemether + Lumefantrine (ALu)—the approved  first-line  malaria treatment drug in the country - especially among the  rural areas population in the  southern regions of Tanzania remained a serious problem.

“Access to ACT is poor and very  often these drugs are not targeted at patients who are actually suffering from malaria,” says Dr. Admirabilis Kalolela who is the manager of the IMPACT2 project at IHI.

Dr.  Kalolela  told  stakeholders  at  a national dissemination meeting held in July  2013  that  ACT  subsidies  are  an effective  way  to  improve  availability, reduce price  and increase the market share  of  quality  assured  ACTs  in  the private for-profit sector.

Responding  to  one  of  the  challenges related to an inefficient  health education  communication  mechanism,  Dr. Khatib said IHI in collaboration with the Swiss Tropical and Public Health Institute (Swiss  TPH)  has  designed  and  implemented a “behavioral change communication intervention” in one of the Health and Demographic  Surveillance Systems (HDSS) sites.

This  community-based  implementation study  known  as  “Response  to  Efficacy Decay”  focuses  on  the  formulation  of health  education messages that will  be disseminated  in  the  community  to improve timely access to ACT outlets.

Phase one of the study involved  essay writing and cartoon drawing competition among primary schools children in Rufiji HDSS area.

The  INESS  country  coordinator  said  a sample of 11 out of 42 primary schools were selected and asked to engage their pupils to draw cartoons or write essays on malaria treatment  seeking practices as they experience in their  households and in their neighborhoods.

Leaders of the schools that were sampled to participate in the  competition were encouraged to select the best pupils at writing and drawing who would participate in the competition.

At the prize awarding ceremony held at the Rufiji HDSS site in mid-June, the Rufiji District  Education  Officer  Mr.  Rashid Savannah  said  the  district  has  14% malaria prevalence, which  is  far above the national average of 9.1% and that the essays  and  cartoons  would  boost  the level of ACT awareness among the Rufiji District population.

“We are extremely privileged to have this behavioral change communication project. It will surely change  positively the attitude of our people towards ACT,” said Mr. Savannah. The top-three winning schools  in each  of  the  two  categories were  awarded  sports  and  educational materials  worth  more  than  T Z S  1.3 million (US$850). Essay winners were from  Nyamakonge, Mkumbuka and Ikwiriri Primary Schools, while the  best cartoon  drawers  came  from  Uponda, Bungu and Msafiri Primary Schools.

“We are now embarking on the second phase that would involve the  development  and  distribution  of  Information, Education  and  Communication (IEC) materials  bearing  health  messages addressing the issues raised in the essays and cartoons,” explains Dr. Rashid Khatib. This  over  300-million  shilling  project (US$186,841) on  “Response to Efficacy D e cay ” intends to display  the IEC materials in every prominent location in the  study  community  such  as  market places,  in  schools,  in  health  facilities, retail drug outlets, places of worship and government offices.

By Mbarwa Kivuyo - Tanzania