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Evaluation of the malaria situation in Babati and Hanang districts,Arusha region

Njunwa, K.J. and Salum, F.M. (2000) Evaluation of the malaria situation in Babati and Hanang districts,Arusha region. CEDHA. (Unpublished)

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In April 1999, during the rainy season, the Ministry of Health (MoH), received alarming report of malaria epidemics in Babati and Hanang districts of Arusha region. As a matter of urgency, the National Institute for Medical Research (NIMR), headquarters, directed Amani Medical Research Centre (AMRC) to carry out a rapid assessment of the malaria situation in the two districts to enable the MoH to institute appropriate control measures. A team of researchers from AMRC and NIMR headquarters went to Babati and Hanang districts from 6th May-15th June 1999 to assess the malaria situation and evaluate the magnitude of the problem and provide recommendations for control. The malaria epidemic situation analysis focused on the following: antimalarial drug resistance, abnormal weather conditions, socio-economic factors, health-seeking behaviour, personal protection against malaria and population movements. These objectives were achieved through administering verbal autopsy questionnaires on recent deaths, administering semi-structured questionnaire to heads of households, holding some in-depth interviews with government health facility staff to seek their views on the worsening malaria situation in the areas, collecting data on malaria morbidity and mortality from hospital records, and by collecting data on rainfall and temperature from metereological department. Investigations into antimalarial drug resistance were made using a modified 7-day therapeutic efficacy trial for chloroquine and sulfadoxine!pyrimethamine, in children with uncomplicated falciparum malaria. Review of hospital and health centre admission records in Babati and Hanang Districts showed that there was a seasonal fluctuation in malaria transmission, and this was highly influenced by the rainfall pattern. The rain season October to May was associated with highest number of malaria hospital attendances. Between January and April 1999 there was a higher malaria case-fatality rate (2.8%) compared to (1.8%) for the same period in 1998 in Hanang district. Similar pattern was shown in Babati district for the same periods where the respective case fatality rates were 1.8% and 0.8%. During the January to April 1999 period, the number of malaria cases admitted at Babati hospital ( 1230) was about half as much as that seen in the whole of 1998 (2448). A remarkable difference in age distribution of cases attended in the two districts has shown that in Babati district the individuals most admitted for malaria were children under five year of age, while in Hanang district, both children and adults were almost equally affected. Fifty six deaths were reported by heads of household to have occurred between 1997 and 1999 in both districts. The results show that malaria was the main cause of death, accounting for 600/o, 78.9% and 88.2% of reported deaths for 1997, 1998, and 1999 respectively.

Assessment of people's awareness of malaria symptoms indicated that more than 50 to 90% in both districts could mention most malaria symptoms. In Babati and Hanang districts, 93 and
81.8% ofrespondents said malaria is transmitted by mosquitoes through biting. About 52.3% and 38.1% people in Babati and Hanang districts respectively used bednets as a malaria protective measure. However, only 13.7% and 9.2% used insecticide treated bednets in Babati and Hanang respectively. From the economic point of view, most people in Babati and Hanang districts can afford to buy insecticide treated bednets if made available. When asked where they sought for health care whenever they fell ill, over 85% of the household respondents said they went to health facilities while 11.4% went to buy medicine from the shops. The antimalarial drug mostly used is chloroquine .It was not possible to assess traditional medicine practices in the population. Screening for malaria and anaemia was done among children, aged 0-59 months, who were attending outpatient department of Babati and Bassotu (Hanang district) health facilities. Prevalence of parasitaemia was 23.4% and 38.7% at Babati and Hanang respectively. The prevalence of severe anaemia (PCV<25) was 9.8% at Babati and 5.9% at Hanang. In order to estimate drug efficacy, chloroquine (CQ) or sulfadoxine/pyrimethamine (SP) was administered orally to children found with uncomplicated falciparum malaria and aged 6-59 months, under supervision. Chloroquine (25 mglkg, over 3 days) was given to 54 children whilst a single dose SP ( 1.25 mglkg pyrimethamine and 25mglkg sulfadoxine) was given to 47 children at the same hospital. However, complete follow-up data was available for 45 children on CQ and 43 on SP respectively Clinical and parasitological followups were made on several occasions over a 7-day period. Early treatment failure rate (ETF) was (55.6%) for chloroquine and 16.3% for SP It should be noted that follow-up period of 7 days allows for partial evaluation of late treatment failures (LTF) as well as adequate clinical response (ACR)these normally require 14 day follow-up to document fully. The cases ofLTF were 2 and 1 in the CQ and SP groups respectively. ACR was seen in 40% (18/45) and 81.4% (35/43) cases with CQ and SP. The results revealed that SP was superior to CQ in terms of parasite clearance at both day 3 and day 7 (P<0.001 ). Efficacy results from Hanang have not been presented in details because the final cohort was too small for meaningful conclusions to be made. However, 7 out of 13 cases on CQ were classified as ETF whilst those with ETF response in the SP group were 4 out of 11 cases. In conclusion, our investigation confirmed that the outcry of people from both Babati and Hanang districts was justified because health facility data showed an increase in the number of cases and deaths in the first months of 1999. The importance of reviewing hospital data during epidemic investigations cannot be overemphasised. Combining such data with those on rainfall can assist in making meaningful conclusions.Based on our findings, recommendations were made to include: preparedness with drug stocks, educating drug suppliers and consumers, promotion of use of treated bednets, promotion of use of local insecticides, monitoring of drug and insecticide resistance, strengthening of laboratory services, establishment of malaria epidemic surveillance system, and improving health facility data recording and quality.

Item Type: Other
Keywords: malaria, Babati,Hanang districts, Arusha,National Institute for Medical Research (NIMR),antimalarial drug resistance
Subjects: Malaria > Surveillance, monitoring, evaluation
Malaria > Vector control
Divisions: National Institute for Medical Research
Depositing User: Mr Joseph Madata
Date Deposited: 29 Aug 2012 09:57
Last Modified: 29 Aug 2012 09:57

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