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Mboera et al.MWJ2013, 4:19

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Leonard E.G.

Mboera1*

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Humphrey D.

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ni6er"i)y,Durham(, 5ni)ed!)a)e" o+&meria *%mboeranimr.or.)z

Abstract

6er)heyear",ma%aria ha"remained )henumber oneau"eo+morbidi)yandmor)a%i)y inanzania.

-opu%a)ionba"ed")udie"ha6eindia)ed ade%ine ino6era%%ma%ariapre6a%eneamon

under7+i6e"+rom1;.1ui)obi)e" by inrea"eda6ai%abi%i)y o+ in"e)iide)rea)ed bedne)" and indoorre"idua% "prayin. heob?e)i6e o+ )hi" paper8a" )o re6ie8 )hehanin %and"ape o+ma%aria and i)" imp%ia)ion+or di"ea"e manaemen),6e)or on)ro%, and%i6e%ihood" in anzania. )"ee" )o eamine )he %in"8i)hin a broad +rame8or

)ha) on"ider" )he di++eren)pa)h8ay" i6en )hemu%)ip%ii)y o+ in)era)ion")ha) an produeunepe)ed ou)ome" and)rade7o++". De"pi)e )heremarab%e de%ine inma%aria burden, anzaniai" +aed 8i)h a number o+ha%%ene". he"e in%ude)he de6e%opmen) o+re"i")ane o+ ma%aria6e)or" )o pyre)hroid",hanin mo">ui)obeha6iour and %i6e%ihood

a)i6i)ie" )ha) inrea"emo">ui)o produ)i6i)y andepo"ure )o mo">ui)obi)e". n addi)ion, )hereare ha%%ene" re%a)ed )ohea%)h "y")em",ommuni)y perep)ion",ommuni)y in6o%6emen)and "u")ainabi%i)y o++undin )o )he na)iona%ma%aria on)ro%proramme. hi" re6ie8india)e" )ha) ma%ariaremain" an impor)an) andha%%enin di"ea"e )ha)i%%u")ra)e" )he in)era)ion"amon eo"y")em",%i6e%ihood", and hea%)h"y")em". Li6e%ihood" and"e6era% "e)ora%de6e%opmen) a)i6i)ie"in%udin on")ru)ion,
http://europepmc.org/abstract/MED/6206995/?whatizit_url_go_term=http://www.ebi.ac.uk/ego/GTerm?id=GO:0007275http://europepmc.org/abstract/MED/6206995/?whatizit_url_go_term=http://www.ebi.ac.uk/ego/GTerm?id=GO:0007610http://europepmc.org/abstract/MED/6206995/?whatizit_url_go_term=http://www.ebi.ac.uk/ego/GTerm?id=GO:0007610http://europepmc.org/abstract/MED/6206995/?whatizit_url_go_term=http://www.ebi.ac.uk/ego/GTerm?id=GO:0007275

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8a)erre"ourede6e%opmen)andariu%

)ura%pra)ie"on)ribu)e"ini+ian)%y)oma%ariamo">ui)oprodu

)i6i)y and )ran"mi""ion.on"e>uen)%y, )he"e"i)ua)ion" re>uireinno6a)i6e and in)era)i6ere7)hinin o+ )he")ra)eie" )o pre6en) andon)ro% ma%aria. n

on%u"ion, )o ae%era)eand "u")ain ma%ariaon)ro% in anzania, )hepre6en)ion ")ra)eie" mu")o hand in hand 8i)h anin)er"e)ora% par)iipa)ionapproah )ha) )ae" in)oaoun) eo"y")em" and%i6e%ihood" )ha) ha6e )hepo)en)ia% )o inrea"e orderea"e ma%aria)ran"mi""ion.

1In

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Ma%aria i"en

demiinmo")par)"o+anzania,and

remain"ama?orau"eo+morbidi)yandmor)a%i)ybo)hinrur

a% and urbanarea". #our

p%a"modia"peie",name%y

Plasmodiumfalciparum,P. vivax, P.malariae,andP. ovaleare pre6a7%en) in )heoun)ry.Ma%aria ri"in anzaniai"he)eroene7ou" 8i)h

ma%ariapre6a%enera)e",para"i)eden"i)ie"anden)omo%oia%inou%a)ionra)e"6aryin+rom onearea and"ea"on )oano)her @17

4A. hi"di")ribu)ioni"de)erminedin par) by%ima)i,eo%oia%and)oporaphi+a)or"8hihin+%uene)hedi")ribu)ionpa))ern" o+

)he 6e)or"@3,,A. naddi)ion,humana)i6i)ie",beha6iourand "oio7

eono

mi@=Aandhea%)h"y")em"+a)or"@;,9Amaypro6ideanaddi

7)iona%ri"a" are"u%) o+aninrea"edepo"ure )o)he

di"7ea"e.

nanzania,ma%ariai"main%y)ran"mi)

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An.arabiensisand

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An.merus@,11A,

An.rivulorumand

An.mar

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)empora%6ar

ia)ion"in)hemo">ui)opopu%a)ion,bi)inra)eandma%aria)ran"mi""ionin)en"i)yamon

di")ri)",6i%%a7e"andaro7eo"y")em"@3,

4,171=A. )ha"been"ho8n)ha))hehumanbi)inra)e i"hihe")

"hor)%y a+)er)hemo">ui)oden"i)ie"pea, nearbreedin"i)e" 8here

adu%)mo">ui)oe"emere, andaround )heede" o+ area" 8herehuman" arearea)ed@1;A. he"e"oure" o+"pa)ia% and)empora%he)eroenei)y in )hedi")ribu)iono+ mo">ui)opopu%a)ion"area""oia)ed8i)h )he6ariabi%i)y in)he humanbi)in ra)e,)hepropor)iono+mo">ui)oe")ha) arein+e)iou",and in )heri" o+

humanin+e)ion@1;A.!ea"ona%ma%aria)ran"mi"7"ion i"ommon inmany p%ae"o+ "ub7!aharan&+ria, 8i)hmo") o+ )he)ran"mi""ionourrin a)

)he end o+)he %onrainy"ea"on"@3,1A. ) ha"beenob"er6ed)ha) 6e)or"peie"beha6iour,den"i)y, and)heen)omo%oia% inou%a7)ion ra)e

BE$C aredependen)on "ea"ona%hane" inen6i7ronmen)a%6ariab%e"

@3,1;720A.

Ma%aria)ran

"mi""ionin)en"i)y inanzania i"%o"e%yre%a)ed)opre6a%eneo+ma%ariain)hepopu%a)ion.b"er76a)ion"

innor)h7ea")ernanden)ra%anzaniaha6eindia)7

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rura%di"ea"e8hereariu%)ure +orm")hebabone o+ )heeonomy. ariou"%i6e%ihooda)i6i)ie"ha6eimpa)

onmo">ui)oprodu)i6i)y,mo">ui)obi)inepo"ure

" andhenema%aria)ran"mi""ionin)en"i)y@23A.!omeariu%)ura%produ)ion"y")em"pro6ideondi)ion" 8e%%"ui)ed+or

mo">ui)obreedin,8i)h%ear,)emporary bodie"oinidin 8i)h)he )imeo+ ropu%)i6a)ion, ando)herhumana)i6i)ie"

. Hih7erma%ariapre6a%ene ha"beenrepor)edmoreo+)en in6i%7%ae"8i)hropirria)ion"heme"@3,4,24A.&riu%)ura%a)i6i)ie""uh a")i%%in)he "oi%and8eedinu"inhoe"enera)e%ar6a%breedin"i)e".Ho8e6er, )heno8%ed

e o+ an)hropoenia)i6i)ie")ha)on)ribu)

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e )oma%aria)ran"7mi""ionamon

rura%+arminommuni)ie"inanzaniaremain"%imi)ed@2A.

Ma%aria, in)urn,impede"human8or+oreou)pu) andariu%)ura%produ)ion,e"peia%%ya))ime"8hena)i6i)ie"are a)apea@2,2=A.!ine

6ariou"ariu%)ura%produ)ion"y")em""uppor)mo">ui)oprod

u)i6i)yandhenehiher

ma%ariapre6a%ene, ineonomie" )ha)dependhea6i%y

onariu%)ure,inno6a)i6eapproahe" arere>uired)o "a)i"+y+oodneed",inrea"ehou"eho%d 8e%+areanda%%e6ia)epo67er)y@2,2=A,8hi%eminimi"inma%aria)ran"mi""ion.

&riu%)ura%in)er6en)ion" area6ai%ab%e)oon)ro%

)he"pread o+ma%aria.&6ai%ab%e)ehni>ue"in%ude+i%%inanddrainino+ "ma%%8a)erbodie",en6iron

men)a%modi+ia7)ion",anda%)erna)e8e))inanddryin o+rie+ie%d"Bin)ermi))en)irria)ionC.n)ermi))

en)irria)ionin rie+ie%d" in&+riaha" been"ho8n )o

"ini+ian)%yredue)heden"i)yo+ma%aria

6e)or"byur)ai%in )heir %ar6a%de6e%7opmen),8hi%e")i%%main)aininyie%d","a6in8a)er,andreduinme)haneemi""ion" @2=A.&ddre""in )head6er"eimpa)o+ariu%)ura% 8a)erpro?e)"on bo)hma%ariaand )heen6iron

men) i" aha%%ene.ommuni)ie" a"8e%% a")heariu%)ura% andirria)ion"e)or")end )o+ou" oneo7nomi

bene+i)",payin%i))%ea))en)ion)oa""e""inpub%ihea%)handen6ironmen)a%impa).&riu%)ura%pro?e)"

arenorma%%yp%annedandmanaedini"o%a)ion

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+romo)hera"pe)" o+ de6e%opmen).

Moreo6er,)he"ue""+u%imp%e7men)a)iono+mea"ure")ominimi"e"uhimpa)" i"on7")rained bypaui)y o+in+orma)ion,)ehnia%+a)or",and

%imi)a)ion" inhuman,+inania%andin")i)u)iona%apai)y a"8e%%a"

%aor8eain)er"e)ora%o%%abora)ion.naddi7)ion,ma%ariaon)r

o% i"di++iu%) inariu%)ura%area"

due )o)he +a))ha)muh o+i) i" rain7+ed, andhene

drainaeanno)bearriedou)e++e)i6e%y.

Li6e")oeepini"ano)herimpor)an)eonomi

a7)i6i)y +ora numbero+ommuni)ie" inanzaniaand o)her"ub7!aharan&+rianoun)rie"@2;A.Lareroup"o+ %i6e7

")oeeper"in )hereionare ei)hernomadi

or aro7pa")ora%i")".(omadipopu%a)ionmo6emen)" ha6eon)rib7u)ed )o)he"pread o+in+e)iou"di"ea"e"

@29A. heon")an)mira)iono+pa")ora%i")" +romhih7)ran"mi""ion area"in "earho+pa")ureand8a)er anin)roduema%ariapara"i)e"in)o %o87)ran"mi""ion area".i)h apoorhea%)h"y")em,)rainand)rea)in)he"epopu%a)ion" an beha%%eni

n a")hey areo+)enhih%ymobi%eandonen)ra)e inremo)e%oa)ion".) ha"beenob"er6ed)ha)+ai%ure )o

on"iderno7madimo6emen)"on)ribu)ed )o+ai%ure o+

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ma%ariaeradi7a)ionampain"

in )he190"and190"@30A.&")heoun)ry i"")ri6in )oe%imina)ema%aria, i)i"impor)an))oeamine)heimpa) o+ nomadipa")ora%i"m on)he)ran"7

mi""ion o+)hedi"ea"e.

hehoo+prin)"o+a))%e,"heepandoa)"ha6e

beeninrimina)ed )orea)ehabi)a)"+ormo">ui)obreedin@2,31A. naddi)ion,

"ome")udie"ha6e"ho8n )ha))he

pre"eneo+ a))%emayinrea"ema%ariapre6a%ene Ba phe7

nomenonno8n a"zoopo)en)ia)ionC@32A bya))ra)inmo">ui)oe" )o )heenera%proimi)y o+ )hehumanpopu%a7)ion @33A.Ho8e6er,)he ro%e

o+%i6e")oindi6er)inmo"7>ui)oe"+rom+eedinonhuman",and)ran"mi))inma%ariaBzooprophy%ai"Cha" %onbeenno8n@33,34A.he u"eo+anima%"a" bai) )oa))ra)mo">ui)oe" i"%ie%y )obe aprom7i"in

ma%ariaon)ro%")ra)ey@3A.

#i"hinon")i)u)e" animpor)an)"oure o+%i6e%ihood +or a"izeab%epropor)ion o+ )heanzanianpopu%a)ion.Ho8e6er,ma%ariaha" been

repor)eda" one o+)heoupa7)iona%hazard"o+ +i"hin

%i+eBh))p:FF888.+ao.orFdorepF00F&D10EF&D10E01.h)mC. &hihpre6a%ene o+ma%ariaha"reen)%ybeenrepor)edamonprenan)8omenin )he+i"hinommuni)ie" o+ 5anda@3A. ne")&+riahiherra)e" o+ma%aria

)ran"mi""ion ha6ebeenrepor)edin%aoon"andoa")a%area"8here

An. gam-biae and

An.melas are)he mo")

ommon6e)or"@3=A. nMa%i,moreadu%)mo">ui)oe" andmoreprodu)i6emo">ui7)o %ar6a%habi)a)"ha6e

been+ound in+i"hinham%e)"dur7in)he dry"ea"on

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and)he"e8erere"pon"ib%e+or"eedi

nneihbourinarea"8i)hmo">ui)oe"a) )he")ar)o+ )herainy"ea"on@3;A.

#i"hinha"beendoumen)ed )o+ai%i)a)eou)door e7po"ure o+indi6idua%")oma%aria6e)or" inndia@39Aand/razi%@40A.Mo")+i"hinommuni)

ie"%i6eei)herin)em7porary,"imp%e

mud7and78a))%ed8e%%in"8i)h ara""7 orreed7)ha)hed

roo+.!uhen6ironmen)a%ondi)ion" epo"eindi6idua%" )omo">ui)obi)e", andhenema%ariain+e7)ion". &")udyarriedou) in!enea%e")ab%i"hed )ha))heprobabi%i)y o+dyin a)ae" 174year"8a" 0ui)oe",)oe)her

8i)h a%%)he )ime"pen) onor near )he 8a)erdurin)he nih)mean")ha) )hepo""ibi%i)y o+epo"ure)oma%ariai"maimi"ed.

) ha"been"ho8n in'enya)ha)+i"hery7re%a)eda)i6i7)ie"ara6a)e)heprob%emo+

ma%ariaa%onLaei)oriaba"in. n'enya,)heommonu"e o+ ear)h8orm" a"+i"h bai)ha" beena))ribu)ed)o )he

inrea"einmo">ui)obreed7in"i)e". heear)h8orm" arenorma%%ye)ra)ed+rom 8e)

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"oi% by diin ho%e" u"in hand". he open ea6a)ed pi)" 3 Current malaria strategic interventions)ha) are %e+) behind ho%d 8a)er )ha) "uppor)" mo">ui)o

breedin, "o epo"in %oa% ommuni)ie" )o an inrea"ed 31 Malaria disease managementri" o+ mo">ui)o bi)e" B.$. Muabana et al., unpub%i"hed

da)aC. Mar"he", papyru" "8amp", and poo%" o+ ")anan) Ear%y and aura)e diano"i" o+ ma%aria i" ri)ia% +or prop78a)er are a%"o ommon +ea)ure" around +i"hin 6i%%ae" er a"e manaemen). Ho8e6er, mo") ma%aria diano"e" inand amp". he"e are no8n )o o++er idea% breedin habi7 anzania are ba"ed on hi")ory and %inia% eamina)ion.)a)" +or mo">ui)oe". Ma%aria a"e de+ini)ion po"e" a ha%%ene beau"e pa)ien)"

i)h )he urren) de+ore")a)ion in anzania, bri ma7 u"ua%%y pre"en) 8i)h "in" and "ymp)om" )ha) are hara7in i" beomin an impor)an) a%)erna)i6e in hou"e on7 )eri")i" o+ many o)her +ebri%e i%%ne""e". anzania ha" an")ru)ion. /ri main and )he need )o re7p%a")er mud e)en"i6e ne)8or o+ bo)h pub%i and pri6a)e hea%)h +ai%i7bui%) hou"e" re"u%) in )he inrea"e o+ borro8 pi)" )ha) "up7 )ie". he ma?ori)y, ho8e6er, do no) pro6ide %abora)orypor) mo">ui)o breedin @23A. Lie in 'enya @42A, bri "er6ie".

main in anzania i" predominan)%y a dry "ea"on a)i6i)y. !)udie" in anzania ha6e "ho8n )ha) "er6ie pro6i"ionhe u"ed ")ae" in )he bri main proe"" are ea6a7 +or ma%aria a"e manaemen) ha" "ho8n "ome impro6e7)ion", +ermen)a)ion, mou%din, dryin and i%nin. Durin men) in )erm" o+ o6erae. n ")udie" arried ou) in)he mou%din ")ae, 8a)er i" brouh) in)o )he bri pi)" and 200;F2009 and 2012, )he apai)y +or bo)h ma%aria diano7mied 8i)h "oi%. ne )he pi)" are abandoned durin or "i" and )rea)men) 8a" repor)ed )o be a6ai%ab%e in o6er ;0ui)o mared inrea"e a" ompared )o 33< in 200. n anza7breedin "i)e". !ine bri main i" done mo")%y durin nia, muh impro6ed "er6ie" +or ma%aria )rea)men) ha6e)he dry "ea"on, i) may aid in main)ainin mo">ui)o popu%a7 been ob"er6ed in )erm" o+ pre"ene o+ )rained ")a++ and)ion" year round. a6ai%abi%i)y o+ ma%aria )rea)men) uide%ine".

22 Impact of malaria on livelihoodsn7"i)e ma%aria diano")i apai)y ha" impro6ed

mared%y +rom 30< in 2009 )o =< in 2012 @4,4=A. hi"

&riu%)ure and o)her ind" o+ %i6e%ihood" enera)e inomei" main%y due )o )he ma?or impro6emen) in )he a6ai%abi%i)yo+ ma%aria rapid diano")i )e")" Bm$DC @4;A, 8hih 8a"

and, )hu", in+%uene %i6in ondi)ion", 8hih an a++e) )he on%y a6ai%ab%e in < o+ +ai%i)ie" in 2009. he in)rodu)ion)ran"mi""ion and "e6eri)y o+ ma%aria. n anzania, im7 o+ m$D ha" redued unnee""ary u"e o+ an)ima%aria%pro6ed "oio7eonomi ")a)u" due )o rie ro8in ha" been dru" @49,0A. n )he o)her hand, )he a6ai%abi%i)y o+ &r)e7+ound )o %ead )o redued ma%aria pre6a%ene @2A. !imi%ar7 mi"inin7ba"ed ombina)ion herapy B&C 8a" )he "ame%y, ")udie" in 'enya ha6e "ho8n )ha) ma%aria pre6a%ene in bo)h )he 200;F2009 and 2012 +ai%i)y "ur6ey" 8i)h ==78a" %o8er in irria)ed 6i%%ae", in )hi" a"e apparen)%y be7 ;0< o+ )he +ai%i)ie" ha6in )he +ir")7%ine an)ima%aria% druau"e )he predominan) mo">ui)o "peie" pre+erred )o +eed in ")o.on a))%e ra)her )han on human" @2=A. hi" "i)ua)ion an be n)ermi))en) pre6en)i6e )rea)men) amon prenan)ep%ained by a number o+ rea"on" in%udin )he 8ide7 B-pC 8omen in anzania i" ")i%% %o8 and de%inin. &7"pread u"e o+ mo">ui)o bedne)" and an)ima%aria% dru" a" a ordin )o oun)ry78ide popu%a)ion "ur6ey", )he propor7re"u%) o+ )he enera% impro6ed %i6e%ihood". &" re"iden)" o+)he irria)ion "heme beome 8ea%)hier due )o inome

enera)ed +rom ariu%)ura% produ)ion, "ome o+ i) i" di7 Table 1 Ma%aria "er6ie readine"" o+ hea%)h +ai%i)ie" in anzania,6er)ed )o hea%)hare. ) ha" reen)%y been ob"er6ed in en7 2009 and 2012

)ra% anzania )ha) hou"eho%d" 8i)h rea)er +inania% re7"oure" are be))er ab%e )o purha"e and orre)%y u"e ma7 !ariable 2""#$ 2"12%aria pre6en)ion me)hod" @43A. 2""%

++erin diano"i" Bui)o ne)" B

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)iono+mo)her"8horeei6ed)8odo"e" o+-pdurin )he%a")prenany ha"remained%o8o6er)heyear"bein22ui)o ne)"+rom 9ui)o ne)" a"om7pared )ourbanarea"@3A.Ho8e6er, areen)"ur6eyindi7a)e")ha) )he%e6e% o+

mo">ui)o ne)o8ner"hip inrura%are7a"ha"inrea"ed )o92.=ui)oon)ro%)hrouh

L!M,in%udin%ar6iidin,i"%imi)ed. !o+ar,)heu"eo+%ar6iidinha"

beenre")ri)ed)oDare"!a%aam,bu))herearep%an")oe)end )hi"

in)er6en)ion )oo)herurbanarea".

(

Toward

s

malari

a

elimination in

Tanzan

ia

here i"e6idene)ha)ma%ariainideneandpre6a%ene ra)e"arede%inininanzania.#orin")ane,in 200;,)heo6era%%ma%ariapre6a%ene amonunder7+i6e" inanzania8a"1;.1ui)oe" andhanein )heompo"i)ion o+ )hemember"o+ )he

An.gambiaes.l.omp%eremain""omeho8 "peu7%a)i6e.Ho8e6er, "omere"earher" ha6erepor)ed)ha) im7pro6edae"" )o(" ha"on)ribu)ed )o an1;7+o%d

redu7)ion in)henumbero+in+e)iou" bi)e"per year@9A.

) ha"beenrepor)ede%"e8here )ha)mo">ui)

o on)ro%in)er6en)ion"u"in(" an%o8erabundane andhane)he"peie"ompo"i)ion o+ anophe%ine

mo">ui)oe"@=0,=1A.$een)")udie"in nor)h7ea")ern

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anzaniaand8e")ern'en7ya

ha"+ur)her"ue")ed)ha)("aremoree++e)i6eini%%inAn.

gambiae

s.s.and

An.funestus)han

An.ara-biensis@9,=0A.hehane"

in)heompo"i)ionandabun7dane o+

An.gambiae

s.l.omp%eha6eimpor)an) imp%i7a)ion"+or )he

)ran"mi""ion o+ ma%ariaandmih)par)%y be)hedri6er o+)heob"er6edde%ineinma%aria)ran"mi""ion inanzania@97=1A.

hede%ineo+ )hema%ariaburdenha" beenrepor)edreen)%yin o)herarea" o+"ub7!aharan&+ria

@=2A.&na%7y"e" o+ ma%ariainideneinendemireion"ha6edemon7")ra)edmaredredu)ion

" in a"e"o+ )hedi"ea"e%are%y)hrouh)he u"e o+%on

%a")inin"e)iida% ne)".#undin+orma%ariapre6en)ion in&+riao6er )hepa")deadeha" had a"ub")an)i

a% impa)onderea"in ma%aria7a))ribu)ab%e hi%ddea)h"and )ha)("aoun)ed +or 99< o+ )he %i6e""a6ed@=3A.

(one)he%e"", one%oni)udina% ")udyin nor)h7ea")ernanzaniaha"doumen)ed )ha))here 8a"a "ini+i7

Ma

lar

ia

World

Jo

urn

al,

88

8.ma

%ari

a8

or%d.o

r.!!

(

221

47

43=4

De

emb

er

2013

,

o%.4,

(o.19

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an)derea"einma%aria)ran"mi""ionbe+ore)he"e

area"8ere8ide%yo6ered8i)h("@=A.) i"%ie%y)ha),

inaddi)ion)o(and$!,en6ironmen)a%hane",eon

om7ide6e%opmen),demoraphi")abi%i"a)ion,rea)erpo%i)i7a%")abi%i)y,andimpro6ed

o6eraeo+ ba"i

hea%)h"er76ie"ha6eimpa)edma%ariamorbidi)y andmor)a%i)y in)he"earea"ando)herpar)" o+

"ub7!aharan&+ria.

)

Imp

licat

ions

and

chal

lenges

of

mal

aria

elim

inat

ion

stra

tegi

esin

Tan

zani

a

De"pi)e)heremarab%eprore""inomba)inma%ariainanzania, )he

oun)ryi" +aed

bymu%)ip%eha%%ene".he"ein%udeha%%ene"re%a)ed)o )hehumanho"),mo"7>ui)o

6e)or",para"i)e"andhea%)h"y")em"Bab%e2C.

Table 2

ha%%ene

" in

ma%ariaon)ro% in

anzania

Challenges *pecific issue

related to+

Human" Lo"" o+ pro)e)i6e immuni)y

-a)ien)7pro6ider omp%iane 8i)h in)er6en)ion"

Mi"u"e o+ in)er6en)ion"Li6e%ihood +a)or" on)ribu)in )o ma%aria

)ran"mi""ion

e)or" Mo">ui)o re"i")aneMo">ui)o beha6ioura% hane"

-ara"i)e" -ara"i)e re"i")aneHea%)h Hea%)h are de%i6ery

"y")em" ea "ur6ei%%ane "y")em and moni)orin and

e6a%ua)ion

nade>ua)e %oa% bude) and donor dependenyManaemen) o+ non7ma%aria% +e6er"Go6ernane B%a o+ ommuni)y enaemen)

and in)er"e)ora% o%%abora)ionC

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)ie")ha)ha6ede6e%oped"ome

%e6e%o+an)i7ma%aria%im7muni)you%dre"u%)in%o""or+ai%ure )o

a>uirepro)e)i6eimmuni)yandinrea"e)heburden o+)hedi"ea"e in)he%on)erm.n!enea%andanzaniain)en"i6eu"eo+("ha"re"u%)

edin)oanae7"hi+)o+ma%ariare%a)edmorbidi)y@4,=4,=A and

aninrea"e in)hemedianae

o+hi%dren8ho 8ereadmi))ed8i)h"e6erema%aria

ha" beenob"er6ed@A. &derea"ein ma%aria)ran"mi""ionin)en"i)yi" no8n)o bea""oia)ed 8i)h aninrea"ein ae o+"e6erema%ariaa"e"@=A. ) i"po""ib%e)ha) )heini)ia%"ue""o+ ("and $!maydi"appeardurin%on7)ermapp%ia)ion beau"e

o+ +adinpre7ei")inimmuni)y%e6e%".he "hi+)in )hepopu%a)ion" mo")a) ri" o+ma%ariarai"e"impor)an)>ue")ion"+or

ma%aria7e%imina)inoun)rie","ine)radi7)iona%on)ro%in)er6en)ion" are%ie%y )obe %e""e++e)i6e.&pproahe" )o

e%imina)ion need)o bea%ined8i)h)he"ehane"

)hrouh)hede6e%opmen) andadop)iono+ no6e%")ra)eie"

andme)hod".here i" aneed +or+ur)her")udie" )oe%uida)e)heon"e>uene" o+ "u")ainedredu)ion" inma%aria)ran"mi""ion onommuni)ypro)e)i6eimmuni)y.

hereha6ebeenrepor)"+rom"ome&+rianoun)rie")ha) ("are u"ed+orpurpo"e"o)her)hanmo">ui)oon7)ro%@==A.$epor)"o+ mi"u"eo+ ne)" inanzaniain%ude)heimpro6i"i

n o+ ne)"a"8eddin6ei%", +or+i"hin,a" pro7)e)ion o+rop", a"hienoop" )opro)e)aain")6u%7)ure",orbeome

u"ed a"rope".on"iderab%emi"u"e o+mo">ui)one)" +or

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+i"hin anddryin o++i"hha"been

re7por)ed+rom'enya@==,=;A.&%)houh)hepropor)iono+mi"u"edne)"i"%ie%y)o be%o8,"uha)"

are %ie%y)oinrea"eand mayhamper)hee++or)" in

ma%ariaon)ro%.!ea"o

na% u"e o+(" ha"a%"o beenrepor)edin Ea")&+ria.!ome8orer"@=9Arepor)ed"omehou"eho%

d" in anumbero+di")ri)"o+anzania8ere no)

u"inne)"durin)he oo%and o%d"ea"on".n

8e")ern'enya, i)ha" been+ound)ha) one7)hird o+)hemo">ui)one)"reipien)" did no)adhere )one) u"eand )ha)ne) u"e8a"repor)ed)oderea"edurinho)8ea)her@;0A.

5.1 C

ha

lle

ng

es

rel

at

ed

to

th

e

hu

m

an

ho

st

an

d

be

ha

vi

ou

rs

-ro)e)i6e

immuni)yaain")

ma%ariai"a>uired8i)han

inrea"einepo"ure )oma%ariapara"i)e"@=4,=A.narea"

8i)hhih)ran"mi""ion)hepre6a%eneandden"i)yo+

P.

falciparumpara"i)aemia

and)heinideneo++e6er"

or"e6erema%ariaou)ome"inrea"e"8i)hae+or

)he+ir")mon)h"o+%i+eand)henderea"e"radua%%y@=4A

. n)he"earea",in+an)"

andyounhi%drenarry a

6eryhihdi"ea"eburdenbu)pro)e)i6eimmuni)y

de6e%op"8i)hinrea"e inae@=4A.&du%)"ando%d

erhi%drenareab%e )o

on)ro%par7a"i)aemiaand)her

e+oreon%yrare%y"u++er+rom"e6erema7%aria

"ymp)om"@=4A.ommuni)ie"orindi6idua%"%i6i

ninarea"8herema%

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aria)ran"mi""ion

i"%o8and"ea"ona%,on)heo)herhand,remaina)hihri"o+de6e%opin"e6ere

di"ea"ebeau"eo+)he"%o8de6e%opme

n)o+a>uiredim7muni)y@=A.

hehi

ho6eraean

din)en"i6eu"eo+(

"and$!derea"e"epo"ureandri"o+ma%aria)ou"er"@3,=2A.hu",)hein)en"i6eu"eo+)he"e

in)er6en)ion" inommuni7

5.2 Ch

alle

nge

s

rel

ated to

mal

ari

a

vec

tor

s

)2

1

Inse

ctici

deresi

stan

ce

$een)")udie"in&rumeru,Mo"

hi,MuhezaandMu%ebadi")ri)"o+anzaniaha6e

repor)ed)ha)

An.gambiae

s.l.i"re"i")an) )operme)hrin

,de%)ame)hrinand

%ambdayha%o7)hrin@;1,

;2A.n areen)")udy,"u"ep)ibi%i)y)e")"ha6e"ho

8n)ha)

An.arabiensison-emba"%andinanzib

ararere"i")an) )o)hepyre)hroid"u"edon("

and+or$!@;3A.!imi%ar%y,inhadand!enea%,

")udie"ha6ere6ea%e

dhih%e6e%"o+re"i

")ane)operme)hrinandde%)ame)hrin in"e67era%

An.ga

mbiae

s.l.popu%a)ion"@;4A. naddi)ion,")udie"inMo

zambi>ueandMa%a8ire6ea%ed)ha)

An.funestusi"

re"i")an) )opyre)hroid"@;,;A.heemereneand"pread

o+pyre)hroidre"i")an

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o+ba"e%ine)ran"mi""ionour"indoor".i)hanin)en"i6eu"e o+("and$!,ma%ariamo">ui)oe"ha6ebeenob7"er6ed )oinrea

"in%ybi)eou)door". &reen)")udyin"ou)h7ea")ernanzaniaha""ho8n )ha)hihu"aeo+("ha"drama)ia%%ya%)ered6e)orpopu%a)ion""o)ha)

in)en"e,predominan)%yindoo

r)ran"mi""ion ha"beenrep%aedbyrea)%y%o8eredre"idua%)ran"mi""ion, area)erpropor)ion o+8hihour"ou)door"

@9,=0A.n apre6iou"")udy innor)h7ea")ernanzania@;=A, inan area8i)h a6e)orpopu7%a)ion8hihon"i")ede%u"i6e%y o+ An.arabiensis, per7me)hrin7)rea)edne)" 8ere"ho8n )opro6ide"omepro)e7)ionaain")ma%aria.

on)rary)o )hi"ob"er6a)ion, in )hearea 8i)ha mi)ureo+ An.gambiaeand An.arabiensis, nopro)e)ion 8a"de)e)ed,due )o )hedi++erene in )hebi)inpa))ern o+)he6e)or" in

)he )8oarea". n)he area8i)he%u"i6e%y An.arabiensis 6e)or",)he bi)inpea 8a"ob"er6eda) aroundmidnih))hen+a%%in")eadi%y)o i)"

minimum%e6e% a)0:00 am.non)ra"),in )hearea8hereAn.gambiaeand An.arabiensis ei"))oe)her,)he pea8a"ob"er6eda+)er02:00 am")re)hin)o around04:00 am.hebi)inon)inuedun)i%0=:00 am8i)h o6er< o+ )he

bi)inourrinbe)8een0:00 and0=:00 am7 india)7in anou)doorbi)inpre+erene+o%%o8in)hein)rodu)ion o+ in"e)iide )rea)edma)eria%"@;=A. hehe)eroenei)y in

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mo">ui)obi)inandre")inbeha6

iourre>uire""pei+i)are)edin)er6en)ion".Ear%yand6ery%a)e

bi)ina)i6i)y byma%aria6e)or" i"%ie%y)oha6eanea)i6eimpa) on

)hee++iienyo+mo">ui)one)")oon)ro%ma%aria@;;A.

5.3Challeng

es

relat

ed to

healt

h

sste

ms

De%i6erinpub%i

hea%)h"er6ie"re>ui

re"+un)iona% ande++e)i6ehea%)h"y")em"in%udin

apab%einno6a)i6e hea%)h%eader"hip,>ua%i+iedhea%)harepro6ider",e++e)i6ehumanre"oure"y")em",re%iab%e

da)a andade>ua)ephy"i7a%in+ra")ru)ure@;9A. oda)e, )heae"" )ohea%)hin)er76en)ion"i" ")i%% ama?orha%%ene +or a

%arepropor)ion o+ )herura%popu%a)ion.De"pi)e)hena)iona%andin)erna)iona%e++or)" )o"uppor)ma%aria

in)er6en)ion" in)erm" o+an)ima7%aria%"anddi")ribu)ion o+ (", )hehea%)h"y")em inan7zaniaon)inue" )o be

8ea and"u++er"+rominade>ua)emehani"

m" +or de%i6erinprimaryhea%)hare"er6ie"

)oindi6idua%" andommuni)ie" inneed@23A. #orin")ane,many o+)he%imi)a)ion" o+ urren)6e)oron)ro%

pra)ie"an bea))ribu)ed )ode+iienie" inhea%)hin+ra")ru)ure )ha)pre6en)ae"" )opro6enin)er6en)ion". obe e++e7

)i6e,in)er6en)ion )oo%"need )obe u"ab%e8i)hin)hea6ai%a7b%ehea%)h"y")em+rame8or andimp%emen)ed

appropri7a)e%y "o)ha) )heend u"eri" ab%e )obene+i)+rom)hem.

)31

Malaria

case

manage

ment

hein)rodu)ion o+ m$D i"+ain a

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number o+ ha%%en7e".) ha"re"u%)ed ino6er7pre"rip)iono+an)ibio)i")ha)po"ea)hrea)ondrure"i")ane@4;A.herearea%"o anumber o+ "hor)omin"re%a)ed )o)heper+ormane andauray o+)he)e")",8hihdepend on)e")prepara)ionandin)erpre)a)[email protected])prepara)ion" andin)erpre)a7)iono+ )e")re"u%)"

ou%dre"u%)in)oinorre)dian

o"i",%eadin )ounnee""ary u"e o+an)ima%aria%)rea)men), and

)here+ore+ai%ure )oaddre"")he rea%au"e o+

+e6er inpa7)ien)"8ho dono) ha6ema%aria@91,92A.

Ma%aria rapiddiano")i )e")"a""i") in)hediano"i"o+

ma%ariabyde)e)ine6ideneo+ma%ariapara"i)e"in hu7manb%ood@93A. he+a) )ha))heurren)%ya6ai%ab%em$D"

"u++er+rom %o8"en"i)i6i)y 8henu"ed inindi6idu7a%" 8i)h%o8ma%ariapara"i)aemia@94,9Aempha"i"e" )heneed +or)he )e")

)o beu"ed inon?un)ion 8i)ho)herme)h7od")oon+irm)here"u%)",hara)erizein+e)ionandmoni7)or

)rea)men)@9A. hehiho")" o+)rea)inma%aria,)o7e)her

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8i)hreoni)iono+ )heimpor)aneo+

non7ma%aria%+e6er", ha"promp)ed areon"idera)iono+an)i7ma%aria")ra)eie"

ba"edone6ideneo+ma%ariapara"i)aemia.heor%dHea%)hraniza)ionha"reommended)heneed+orpara"i)o%oia%7on+irmedan)im

a%aria%)rea)men)8herepo""ib%e@9Aand8hene6erma%aria i""u"pe)ed.

Durin)hepa"))8e%6e

year",anzaniaha"hanedi)" +ir")7%inean)ima%ar

ia% dru)8ie. n2001,+ir")7%inean)i7ma%aria%)rea)men)8a"haned+romh%oro>uine )o"u%+a7doine7pyrime)hamineB!-C andin 200+rom !-)o ar)e7mi"inin7ba"edombina)ion)herapyB&C@9=A. &nim7pro6emen) inae"" )o

ma%aria)rea)men)u"in&"di"7pen"ed)hrouharedi)ed drudi"pen"in ou)%e)"ha" beenob"er6edinanzania

@9;A.Ho8e6er, )heir 8ide7"preadu"e +or )rea)inpa)ien)"8i)h P.

falciparumma%ariarai"e" )he>ue")ion"o+

emerindrure"i")ane @99A.!)udie"inambodi

a andhai%andha6e"ho8nro8ine6idene)ha) P.

falciparumpara"i)e"arede6e%opin re7"i")aneaain")ar)emi"ininmono)[email protected])e,)here arenorepor)" o+re"i")ane )o&" inanzania.

&n)ima%aria%dru")oou)i"ommoninanzania@23,4,99A. ) ha"beenrepor)ed)ha) )heperen)ae a6er7ae ")oou) day"o+ a%%)ype" o+&rane"+rom 1.3)o 4day"@101A.

he mainrea"on"+or")oou)o+an)ima%ar7ia%" a)pub%ihea%)h+ai%i)ie"are poor+orea")in and>uan)i+ia)ion

@101A.!imi%ar+indin"ha6ebeenrepor)ed+rom

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'enya@102AandMa%a8i@103A.

naddi)ion )o+re7>uen)")oou) o+an)ima%aria%dru",ma%ariaa"emanae7men)inanzania i"+ain anumber o+ ha%%ene"in)erm"o+ )he>ua%i)

y o+an)ima%aria%dru".&%mo") a)hirdo+an)i7ma%aria%dru""o%d

inanzaniaare"ub")andard@104A.!ub")andard&"areamon )he

)hrea)"dri6in%inia%+ai%ur

e o+ma%aria)rea)men)@10710=A. na ")udyon an)i7

ma%aria%dru>ua%i)y inpar)" o+&+ria i)8a"ob"er6ed)ha) 3uire"+un)iona%ande++e)i6eoun)ry7%e6e%hea%)

h"y")em":apab%ehea%)h

%eader",>ua%i+iedhea%)harepro6ider",e++e)i6ehumanre"oure"y")em",re%iab%ehea%)hin+orma)ion,ade>ua)ephy"ia%in+ra")ru

)ure, andmanyo)herri)ia%inpu)". )i"impor)an) )ha)anzaniaaddre""e"humanre"ourei""ue"anden"ure"

)ha) )hereareade>ua)enumber"o+ 8e%%7)rainedper"onne% )odiano"ema%aria,manaea"e",pre76en))ran"mi""

ion and6ii%an)%y)rama%aria.

)33

Malaria

surveilla

nce

De"pi)e)he"ue""reordedin ma%ariaon)ro% inanza7nia)hedi"ea"e"ur6ei%%ane "y")em

i" 8ea.hee++e)i6e7ne"" o+ a"ur6ei%%ane "y")ema) )hedi")ri)and+ai%i)y%e6e%"depend"on )heabi%i)y o+")a++ )ou)i%i"e )hein+or7

ma)ionproper%y.!ine2001,anzaniaha" beenmainoner)ede++or)" )o")ren)hen i)"n)era)edDi"ea"e!ur7

6ei%%aneand$e"pon"e"y")em.n )hi""y")em,ma%aria i"one o+ )hepriori)ydi"ea"e")ha) are )oberepor)edmon)h%y.

n areen)")udy inen)ra%anzaniai) 8a"+ound)ha) mo")o+ )hehea%)h+ai%i)ie"+aedi++iu%)ie" in

"ubmi))in repor)"due )o%a o+ re"oure"and

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+eedba+rom)hedi")ri)au)ho

ri)y.Mo")o+ )hehea%)h+ai%i)ie"per+ormminima%da)aana%y"i"@23A.

) i"o6er10year""ine)hein)rodu)iono+ )hen)era)edDi"ea"e!ur6e

i%%ane and$e"pon"e")ra)ey inanzania,ye)da)amanaemen) ha"remai

ned8eainmo")o+ )hedi")ri)"@11A.

)3(

Inad

e&uat

e

local

budget

and

dono

r.

depe

ndence

Eih)y7+i6eperen)o+ )hea)i6i)ie"

in )he")ra)eip%an o+)hena)iona%ma%ariaon)ro%proramme inanzaniai" +undedbye)erna%donor"@11A.

Muh o+)heanzanian"ue""e"inma%ariaon)ro%an)here+orebea))ribu)ed)o )he+inania%"uppor)+rom )heG%oba%#und )o#ih)&D!,uberu%o"i" andMa%ariaand )he5!-re"iden)"Ma%ariani)ia)i6e. heG%oba%

#undon)ribu)e" abou))8o7)hird" o+)he8or%d"+undin+orma%ariaproramme", and"ine i)"inep)ionha"

"uppor)eddi")ribu)ion o+ 230mi%%ion(" anda "imi%ar

numbero+ do"e"o+ar)emi"inin7ba"eddru"@11=A.

5n+or)una)e%y, )hedonor+undinha""pa8nedde7pendenyandepe)a)ionamoni)"reipien)". !hou%di)di"appear, orradia%%ydimini"h,anzaniaand o)herdonor7dependen)oun)rie"8ou%d behard7pre""ed)o+inane

ma%ariaon)ro%e++or)"and )heon"e>uene" 8i%%be "e6ereBh))p:FF888.na)ure.omFne8"F%oba%7hea%)h7hi)"7ri"i"7poin)7

1.991C.n)er6

en)ion")ha) aree)erna%%y +undedare no)"u")ain7ab%e@11;A.n)erna%+undin"hou%da%8ay"repre"en)

)heu%)ima)eoa% o+ %oa%ma%ariain)er6en)ion" )o

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en"ure )ha)"uhin)er6en)ion" are"u")ai

nab%ein )he%on)erm.5n+or7)una)e%y,)hi"ha"no)beenapriori)y +ormanyhea%)hin)er76en)ion"andha"re"u%)ed in)he+ai%ure )o"u")ain )heini)ia%

ain"made.$e%ianeonou)"ide

+undini" one o+)he rea7"on" +orin)er6en)ion+ai%ureonee)erna%+undinandpo%i)ia%8i%%dimini"h

e" @119A.he

urren)uni6er"a%o6erae8i)hin)er6en)ion"need" )obemain)ained un)i%)hebeinnin o+ )he

e%imina7)ion")ae,re>uirin%on7)ermpo%i)ia%ommi)men) andhih andpredi)ab%e+undin.Ho8e6er, a""ue""+u% on7)ro%e++or)"redue)heburdeno+ma%aria,)here i" a")ronri" o+ donor+a)iueand )ha)in)ere")in

ma%ariae%imina7)ionou%ddropamon")ey

")aeho%der". #oro6ern7men)", i)i" %ie%y)ha) )hea))en)ion

onma%aria8i%%na)ura%7%y "hi+) )oo)herhea%)hpriori)ie".n )heo)herhand,)here 8i%%be %i))%emo)i6a)ion amonindi6idua%" )o"%eepunder(",)hu"pu))in)hem"e%6e" a) ri"o+ma%ariain+e)ion.$i" o+ Nma%aria+a)iueneed" )o

beaddre""edappropri7a)e%y a" i)ou%d%eaddonor" )o%o8er+undin+orma%ariaon)ro%,)heo6ernm

en) )o pu)%e""empha"i"onma%ariaon)ro%and )hepub%i )oredueu)i%i"a)ion o+pre6en)i6e and)rea)men)mea"ure"

@119A.n a"muh a"in)erna)iona% donor"uppor)i"

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impor)an),anzaniaando)heroun)

rie"in"ub7!aharan&+ria"hou%d beenouraed)oinrea"e)he%e6e%o+in)erna%re"oure""pen)onma%aria )oapoin)8here )heyan"u")ai

n)heiro8nproramme".nrea"inna)iona%hea%)hbude)"and

)he"harea%%oa)ed )oma%ariare"earhandon)ro%8i%%mae+und"and

+undinap"morepredi)ab%e.

Moreo6er, a"eonomi ro8)hin hihma%ariaburden

oun)rie"8i%%%ie%yrebounda+)erinideneoe"do8n, i)i"impor)an) )ha) )hi"i")ran"%a)ed in)oinrea"edna)iona%hea%)h"pend7in +or ma%ariaand u"ed)oad6oa)e+or in7oun)ryin)er7"e)ora%andommuni)y7ba"edapproah

e" indi"ea"eon7)ro%.&%ready,)hepub%i7pri6a)epar)ner"hip ha"been de7"ribed)o maema?oron)ribu)ion" )o

ma%ariaon)ro%inanzania@23,120A.

)3)

Commu

nit

involve

ment

nanzania, )heurren)ma%ariain)er6en)ion" are6er)ia%7%y

p%annedandimp%emen)ed, and)here i"%imi)edin6o%6e7

men) o+)heommuni)y. ) i"impor)an) )ha) )heommuni)y "hou%d)aere"pon"ibi%i)y +or)heir o8nhea%)hand )ha)ommuni

)y %eader""hou%d bein6o%6edinma%ariapre6en7)ionampain". hi"i"beau"ei) ha"been"ho8n)ha)

ommuni)ypar)iipa)ion inhea%)hproramme"enhane")heir"u")ainabi%i)y anda++ordabi%i)yompared )o non7

par)iipa)oryproramme"@121A.De"pi)e)hi"no8%ede )ha)ommuni)ypar)iipa)ion i"6i)a% in")ren)he

nin pri7maryhea%)hin)er6en)ion"@122,123

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A %i))%eprore""ha"beenmade)o

in6o%6eommuni)ie" inma%ariaon)ro%p%an7ninandimp%emen)a)ion

inanzania.5n%e""indi6idua%"inom

muni)ie"and o)herey")aeho%der" "ee)hebene+i)"

o+ma%ariaon)ro%,e6en )hebe")7de"inedpre6en)ion ")ra)7eie" areun%ie%y)o bee++e)i6eand"u")ainab%e.

16'ut

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)ha)anzania i"headin +orma%ariae%imina)ion.Ma%ariarepre"en)"aomp%e,mu%)i7dimen"iona%hea%)hprob%em8i)ha"ui)eo+

in)era)in6ariab%e"ranin+rom)hepara7"i)e,mo">ui)o6e)or,eo"y

")em",humanho"),hea%)h7de%i6ery"y")em" )o%i6e%ihood"and%ima)ehane. &"oundunder")andin o+

)hena)ureanddynami"o+ er)aineo"y")em6ariab%e"and )heirre%a)ion"hip )oma%aria)ran"7mi""ioni" anee""ary ")ep iniden)i+yi

n andaddre""inin)er6en)ion" )ha)maye%imina)ema%aria8hi%einrea"inhou"eho%dprodu)i6i)y and

main)ainin ahea%)hyen6iron7men). )ha"a%readybeenreoni"ed )ha))he"e+a)or"a++e)hea%)h,epo"ure)o i%%ne"",ri" +ori%%ne""7produinbeha6iour", and)hehou"eho%dFommuni)yre"pon"e)o )here"pe)i6e hea%)hprob%em

@124A.he

+a) )ha))here are%inae"be)8een

eo"y")em",%i6e%ihood" andhea%)hpo"e" anoppor)uni)y andha%%ene+or )he6ariou""e)or" )o8or)oe)her)o addre""ma%aria.Ho8e6er,

inanzania,)here i" ama?ordi"onne) be)8een)he hea%)hare"y")em"and o)her"e)or"y")em"8i)hin )hepo%iyand

p%anninarena.E")ab%i"hin in)er7"e)ora%%in7ae"i"impor)an))o+ai%i)a)e?oin)e++or)" )o)a%ema%aria a))he

ommuni)y %e6e%beau"ea) )ha)%e6e%de6e%opmen)prob%em"are o+)enperei6edho%i")ia%%y.n")i)u)iona%%inae i"epe)ed)o")imu%a)e"y")emhane"by ena7

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b%inro""7"e)ora%hea%)h%eader"hip

)eam")ode6e%opand%aunhinno6a)i6eini)ia)i6e")ha)in)era)epi6o)a

%hea%)h"y")emoppor)uni)ie" or addre"" )hebo))%ene".hi"need"uren)re7addre""ini+ a"ue""+u%hea%)hde%i6ery"y")em i")o berea%i"ed@121A.

herei" apre""inneed)o")ren)hen)heoun)ry"apai)ie"+ore++e)i

6epro7rammeimp%emen)a

)ion andinno6a)i6emodi+ia)ion" )oope 8i)h)he

haninma%aria%and"apeand )he"a%inup o+ in)er6en)ion" )ha)areurren)%ybeinin")i)u)ed.

&ne8approah)o ma%ariaon)ro%"hou%don")i)u)ea brideamonpub%ihea%)h, a")ra)ey+orin)era)edman7aemen)o+ )heen6ironmen) andaneohea%)happroah)opromo)in humanhea%)h.hi"mean")ha)eohea%)hap7proahe"

)o ma%ariamu")promo)e aho%i")i6ie8 o+hu7manhea%)h,%i6e%ihood" andeo"y")em""u")ainabi%i)yBh))p:FF888.idr.

aFeohea%)hC.De"pi)e)hi"under")and7in, +or

a numbero+ year",on6en)iona%ma%ariare"earhand

on)ro%ha")ended )ohoo"e"pei+iou)ome"and 6ie8)hem a")he re"u%)o+ a %inearhain o+e6en)". )i"en6i"aed)ha) a

moreomp%eandrea%i")i6ie8re>uire"iden)i+ia)ion o+ er)ainind" o+%i6e%ihood+a)or",8hih,a%)houh)he"e arepo""ib%ede)erminan)" o+ ma%aria)ran"7mi""ion,a%"oenera)einome )oimpro6e)he 8e%%bein o+)hepopu%a)io

n.on"iderin )hi"6ie8,re"o%u)iono+ ma%ar7ia and%i6e%ihood" re>uire"oinbeyond)radi)iona% hea%)h"e)oronern"

andpayina))en)ion)o )heeo%oia% and

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"oio7eonomion)e).hu",i) i"

no)"urpri"in)o+indou))ha)proramme" )ha)areen)ire%yunre%a)ed )o

)heon76en)iona%hea%)h"e)or, "uha"ariu%)ure,8a)er,irria7)ionandin+ra")ru)urede6e%opmen),ha6ema?or,u"ua%%yon)radi)ory,e++e)" on

humanhea%)h.

/eau"e o+)heuni>uena)ure o+)hema%aria

"i)ua)ion a"are"u%)o+miro7

epidemio%oia%,eo%oia% and%i6e%i7hood+a)or",

inno6a)i6eapproahe" )o )heprob%emarenee""ary. ) i"impor)an) )ha)re"earher", po%iymaer"andma%aria

on)ro%imp%emen)er"ini)ia)ene8"o%u)ion"

appropria)e +or "pei+i"i)ua)ion".Mu%)ip%e")ra)eie"

,appropria)e )o"oio7u%)ura%%yandeo%oia%%yuni>ue"e))in",mu") beimp%emen)ed inanin)era)edapproah. i)h)heurren)de%inin)rend inma%ariainanzania,8e need+ou"edma%ariaon)ro%")ra)eie")ha) ha6e

dire)bene+i)"no) ?u")+or )heindi6idua%" 8hoarein%udedin )heon)ro%e++or)"bu) a%"oa) )heommuni)y %e6e%.

urren)6e)oron)ro%")ra)eie"+ou"%are%yon indoormea"ure". ) i"a%"oimpor)an) )ha)re"earhand")ra)eie"

)are)inou)door+eedinmo">ui)oe" areon"idered. #or

7/24/2019 MWJ2013_4_19

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eamp%e,a))ra)i6e)oi"uarbai)",

ei)her"prayed on6ee)a)ionorpro6idedinou)doorbai)")a)ion",ha6ebeen"ho8n )o"i7ni+ian)%yreduemo">ui)oden"i)ie"@12A.

E%imina)inma%aria inanzania8i%%re>uire aoordi7na)ed,in)er7"e)ora%dei"ion

mainapproahba"edon)hebe")a6ai%ab%e"ien)i+ie6idene.he

+ie%do+dei"ionana%y"i"an

he%pdei"ionmaer"addre"")heomp%eprob%em

o+ma%ariaon)ro%bypro6idin a"y")ema)i ap7proah )o8eihin)he o")"andbene+i)"o+di++eren)om7bina)ion"o+in)er6en)ion". ne+rame8or +or enoura7in )hi"approahi" )heMa%ariaDei"ion&na%y"i"!uppor)oo%

BMD&!C )ha)a%%o8"po%iymaer" )o8eih)hehea%)h,en6ironmen)a% andeonomi )rade7o++" o+ di++eren)ombina)

ion" o+ ma%ariain)er6en)ion"@12A.he )oo%ha" beende6e%opedo%%abora)i6e%y8i)he)en"i6e")aeho%der

in6o%6emen) inanzania,5anda,and'enya. )

i" de7"ined )o+ai%i)a)ema%ariaon)ro%dei"ionmain

in7+ormedby anumbero+di++eren)on)e)ua% +a)or"Be..pre6a%ene o+ )hedi"ea"eC,8ea)her+a)or"Be..rain+a%%Cand"oia%+a)or"Be..aep)ane o+ di++eren)ma%ariaon)ro%me)hod"C@12=A.heMD&!a%%o8"ana%y"i"

o+a%)erna)i6e" +or imp%emen)inpre6en)ion anddi"ea"eman7aemen)in)er6en)ion", a"8e%% a"o+di++eren)

mehani"m" +or de%i6erin )hein)er6en)ion" )o)he )are)popu%a)ion. hedei"ionana%y"i"+rame8or anpromo)ean

in)era)7edapproah)oma%ariamanaemen) by

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dra8ina))en)ion )oa8iderane

o+ma%ariaon)ro%op)ion"anda%%o8indei"ionmaer" )oep%ore )heimpa)" o+6aryinombi7na)ion" o+on)ro%")ra)eie"onbo)h)he

di"ea"emanae7men)and6e)oron)ro%"ide".

/

Con

clusions

$een)"ini+ian)ad6ane" inma%ar

ia 6e)oron)ro%anddi"ea"emanaemen) inanzania

are bein)hrea)ened byde6e%opmen) o+ a"emi7immunehumanpopu%a)ion, para7"i)e andin"e)iidere"i")ane,

mo">ui)obeha6ioura%hane"and%i6e%ihood +a)or".&"ma%ariaon)inue")ode%ine,i) i"impor)an) )o )ae

a morein)era)edapproah)o 6e)oron)ro%,a))ainonmu%)ip%e+ron)", )odri6e)ran"mi""ion )ozero. &nin)era)e

dapproahemp%oyinmu%)ip%ein)er6en)ion" )ha)are"u")ainab%e and%oa%%y

ap7propria)e,i" %ie%y)o de%i6erbe))er,"yneri")i and

"u"7)ainab%eou)ome". !uh anapproahmu")in%udeen6i7ronmen)a%manaemen) )oreduemo">ui)oprodu)i6

i)y andano6era%%bi)inpre""ure.&ne++e)i6ema%aria")ra)e7ymu")in%udepromo)ion o+"reenino+

hou"e",en6i7ronmen)a%manaemen) o+mo">ui)obreedinandre")in"i)e",dire)a))a"on )hemo">ui)o

%ar6ae,%e6erde"inandopera)iono+ 8a)erre"ourede6e%opmen)pro?e)",and

Ma

lar

ia

Wo

rld

Journ

al,

88

8.m

a%ari

a8or%d.

or.!!

(

2214

7

43=4

9

De

ember

201

3,

o%.

4,

(o. 19

7/24/2019 MWJ2013_4_19

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anin)er+ai)hommuni)ya)ionomponen).(oneo+

)he"e")ra)eie"i"mu)ua%%ye%u"i6eo+ )heo)her",and aombi7na)io

n o+e++or)"promi"e")oo++eraddi)i6e ore6en"yner7i")ire8ar

d".

6er)he%a")deade,ma%ariain)er6en)ion"ha6ebeen6er)i

a%%yimp%emen)ed byna)iona%o6er

nmen)"8i)h6ery%i))%ein6o%6emen) o+)heommuni)y. nre"oure7poor"e)7)in",ommuni)ypar)iipa)ion indi"ea"e

on)ro%i" e""en7)ia%.&ddinaommuni)yomponen) i"ri)ia%,)hu"eahei")inommuni)y

"hou%dbe par)andpare%o+ )hema7%ariaon)ro%proramme.ommuni)ie"ane++e)i6e%y bein6o%6ed)oreduenearbymo">ui)obreedin"i)e" by%oa%drainaee++or)"in6i%%ae",+ie%d"andaroundpond"

and )oimpro6eand"reenhome" Oand )o

re"pond)o )heneed +orear%ydiano"i" and)rea)men).

Ma%aria i" apar)iu%ar%yimpor)an)di"ea"e)ha)i%%u"7)ra)e"

)hein)era)ion"amon%i6e%ihood,eo"y")em" andhea%)h"y")em"J )hu",ma%ariai" no8more o+a

de6e%op7men)prob%em)hane6eron"ideredbe+ore.!e6era%"e7)ora%a)i6i)ie" )ha)in%udeon")ru

)ion,8a)erre"ourede6e%opmen),andariu%)ure,on)ribu)ehih%y)oma%ariamo">ui)o

breedin "i)e"andhene)ran"mi""ion. )

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i" im7por)an))here+ore,)oeam

ine)he%in"8i)hin abroad+rame8or )ha)on"ider")hedi++eren)pa)h8ay",i6en)hemu%)ip%ii)y o+in)era)ion" )ha)anprodueunepe)edou)o

me"and)rade7o++".) i"impor)an))ha)in6e")men)" )ha)"uppor)"oio7

eonomide6e%opmen) inma%aria"e)7)in"areenouraed )o"uppor)

e++e)i6eand"u")ainab%ein)er6en)i

on"aain")ma%aria.o"u")ain)heain" in

ma7%ariaon)ro%and )omo6e)o8ard"i)"e%imina)ion, i) i"im7por)an))ha) )hena)iona%ma%ariaon)ro%proramme inanzaniabroaden" i)"ba"e andmobi%i"e"re"oure" morebroad%y)oin%udena)iona%bude)"and

o)her%oa%"oure".

non%u"ion,ma%ariapre6en)ion mu")o handin hand8i)hommuni)y andin)er7

"e)ora%par)iipa)ion.he+u)urema%ariaon)ro%")ra)ey"hou%dbe broadba"ed,andin)er7"e)ora%in i)"

p%anninandopera)ion a) a%%%e6e%".here i"a%"o a

")ronneed )o")ren)hen )he"ur6ei%%aneand

moni)orin ande6a%ua)ion"y")em"+orma%ariaon)ro%proramme".he"e"y")em"need )obe"iene7ba"edand"hou%den"ure)ime%ya6ai%abi%i)y o+ in+orma)ion onma%ariapre6a%eneo6erin a%%orner"o+ )he

oun)rya" amean")opromo)ee6idene ba"eddei"ion7main.

#

Ac0no

wledg

ements

heau)hor"8ou%d%ie )oano8%edeDr".!)ephenMae"a,&%pha

adMan?urano andDeu""henoma +or

7/24/2019 MWJ2013_4_19

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)heirri)ia%re6ie8 o+an

ear%y6er"ion o+)hemanu"rip).

efe

renc

es

1. Mboer

aLE

G:Fift

y

ear

s of

!ea

lth"es

earc

h in

#an

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nia%&'(

'-

&''

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Ann

otated

*ibl

iogr

aph

y.

D5-

B199

CL)d.,

200

0,3=3

pp.

2. /ou"ema,Drae%ey ,Ge"a"e

!,Ha"him$ etal.:den)i+i

a)iono+ho)

"po)"o+ma%aria)ran"mi"

"ion+or)are)edma%ariaon)ro%.J.+nfect.is

.2010,2"1:1=471==4.

3. MboeraLEG,

$8eo"hora$,!enoro'-,$umi"ha!#etal.:

!pa)io7)empora%6aria)ioninma%aria)ran"mi""io

nin)en"i)y in+i6earo7eo"y")em" inM6omeroDi"

)ri),anzania.eosp.!ealth2010,(:1=7

1=;.

4. MboeraLE

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G,!enoro'-,$umi"ha!#

,Maya%a/'etal

.:Plasmodiumfal

ciparumandhe%m

in)ho

7in+e)ion"amon"hoo%hi%dren inre%a)ion)oaro7eo"y")em"inM6omero

Di")ri),anzania.Acta#rop.2011,112:97102.

5. Mn

za6a&-:pidemiologyand/ontrolofMalari

a#ransmissionby"esidual!ouse0praying1it

h#and2ambdac

yhalothrinint1oPo

pulationsofthe&nophe%e"ambiaecomplexin

#anga"egion,#an$ania.-hDhe7"i",5ni6er"i)yo+/a"e%,!8i)zer%and,1991.

6. %arD,Greenhou"e/,(?ama7MeyaD,(zarubara /et

al.:#a)or"de)erminin

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)heh

e)eroenei)yo+m

a%ariainideneinhi%drenin

'ampa%a,5anda.J.+nfe

ct.is.200;,1%#:39

37400.

7. M8

ene"iH,Harpham,!no8$:

hi%dma%aria)rea)7men)pra)ie"amonmo)her"

in'enya.0oc.0ci.Med.199,(":12=1712==.

8. MboeraLEG,'amui"haML,$umi"ha!#,M"aneniH&etal.:he

re%a)ion"hipbe)8eenma%ariapara"i)aemiaanda6ai%abi%i)yo+hea%)hare+ai

%i)yinMp8ap8aDi"7)ri),en)ra%anzania.#a

n$an.!ealth"es.*ull.200,#:2272=.

9. Mboer

aLEG,'amui"haML,$umi"ha!#,'i"inza(etal.:Ma%ari

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aandmo">ui)one)u)i%i

"a)ionamon"h

oo%hi%drenin6

i%%ae"8i)hor8

i)hou)h

ea%)hare+ai%i)ie" a)di++eren)a%)i)ude" inrinaDi")ri),anzania.Afr.!ealth0ci.

200;,#:1147119.

10. hi)eG/:heAnophelesgambi

aeomp%eandma%aria)ran"mi""ion in&+ria.#rans.

".0oc.#rop.Med.!yg.19=4,#:2=;7301

.11. 'i

adye E:Mos3u

itoabundanceand

malariatransmis-sioninthe"ufi4i"iver

*asin,#an$ania.-hDhe"i",5ni6er"i)yo+Dar

e"!a%aam,anzania,200.

12. Ma

e"

a

!M,

i%

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Mn

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1991,(%:

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10;

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13. i%

e"P,Ma)o%aQG,har%8oodPD:Anopheles

rivulo-rum, a6e)oro+humanma%ariain&+ri

a.Med.5et.n-tomol.199,1":10;7110.

14. Ma%ima$:!porozoi)e$a)

e"and!peie"den)i)

yo+Mo">ui)oe"o%%e)ed+romHih%andandLo8%andinanzania.M!.Di""er)a)ion,5ni6er"i)y

o+London,5',1999.

15. MboeraLEG,-eder"

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