Understanding and improving malaria diagnosis in health facilities in Dar es Salaam, Tanzania

Swiss Coordinator : Christian Lengeler, Swiss Tropical Institute
Main Foreign partner : Deo Mtasiwa, Dar es Salaam City Medical Office
Cooperation with : Tanzania
Disciplines : Tropical Medicine, infectious diseases.

Abstract : Malaria remains the first cause of morbidity and mortality in sub-Saharan Africa (SSA). Intense malaria transmission results in a heavy burden of malaria disease in Tanzania: 16 million cases per year and 80,000 deaths - mainly in children. The burden is also very heavy in Dar es Salaam, the capital city, with nearly 1 million malaria cases presenting each year at already under-funded health services. Accurate diagnosis and prompt and effective treatment are the most important malaria control measures.

In Dar es Salaam, access to malaria treatment is satisfactory but a recent series of studies demonstrated that because transmission levels were much lower than in the rest of the country, only a small fraction of all fever episodes in children and adults were actually due to malaria. This has two major consequences: firstly, there is substantial over-treatment with malaria drugs (95-99% of all treatments are unnecessary) and secondly, there is a very much increased risk of missing an alternative diagnosis with potentially fatal consequences. To address this issue of high public health importance we plan to undertake two related work components:

(1) Introducing laboratory diagnosis for malaria in the routine management of fever cases; we propose to introduce either rapid diagnostic tests based on the detection of the Plasmodium antigen (RDTs), or improve existing microscopy facilities. The focus of this operational research is to document how feasible and effective the introduction of laboratory tests is in the context of the routine management of fever cases.

(2) Understanding the aetiologies of fever cases in children; in this second work component we will be screening a sub-group of 300 children with detailed clinical assessments and a range of laboratory tests in order to better identify the diversity of the causes of fever in children aged 1-9 years.

As a result of this work we hope to be able to improve the diagnostic approach and management of fever cases in health facilities in Dar es Salaam, contribute to a more efficient and effective health sector, and help Tanzania on its way to reducing infant and child mortality.

Our work is linked to a number of other projects and initiatives in Tanzania, as well as in other SSA countries, and the upscaling of malaria diagnosis for all fever cases will proceed rapidly in the coming 1-2 years in the frame of the recent US Presidential Initiative on Malaria.

See also: Spatial analysis of the impact of insecticide-treated nets (ITNs) for malaria control in Tanzania, a Project of the last Phase

Contact Addresses:

Dr. Deo Mtasiwa
City Medical Officer of Health
P.O. Box 9084
Dar es Salaam, Tanzania
+255 (0)744 47 43 46
rcmoh@raha.com

Dr. Christian Lengeler
Department of Public Health and Epidemiology
Swiss Tropical Institute
Socinstrasse 57
CH – 4002 Basel
+41 (0)61 284 82 21
christian.lengeler@unibas.ch