Tanzania

Malaria facts

The entire population of Mainland Tanzania is considered at risk for malaria, although transmission varies significantly among and within regions. 93% of the population in Mainland Tanzania live in malaria transmission areas. The country has three malaria transmission seasons [1]:

  • Stable perennial transmission: 60% of the country falls in this category;
  • Stable malaria transmission (with seasonal variation): in 20 % of the country;
  • Unstable seasonal malaria transmission: This occurs in approximately 20 % of the country.

Tanzania is among the ten countries with the highest malaria cases and deaths (3% of the global cases, 13.4% of cases in East and Southern Africa, and 5% of global deaths). [2]  Between 2015 and 2019, case incidence decreased 14.5%, from  130 to 111 per 1000 of the population at risk, and  deaths fell by about 4% (from 0.39 to 0.38 per 1000 of the population at risk) during the same period. [2]

Plasmodium falciparum is responsible for 96 % of malaria infection in Tanzania, while P. malariae and P. ovale account for the remaining 4%. [1]

In 2017, under five mortality was at 5% while neonatal mortality (under 12 months) was at 9%. Incidence of under 5 cases was at 37%. [3]

There are 7,513 health facilities on mainland Tanzania. Out of these, 83 % are either public sector or faith-based facilities.[4]

Specialist hospitals owned by the Ministry of Health are at the highest level of the healthcare sector while primary health care facilities are at the lower level. 85 % of the population receive their health services from primary health care facilities (Ministry of Health and Social Welfare 2013). [4]

The Global Fund and PMI provide more than 90 % of malaria funding to mainland Tanzania. This does not include staff salaries, which are paid by the government.4 Other donors to the country’s healthcare system include African Development Bank, Danish International Development Agency (DANIDA), Japan International Cooperation Agency, UNICEF, United Kingdom’s Foreign, Commonwealth & Development Office (FCDO), the World Health Organization and research institutions. [4]

The malaria burden in Zanzibar has remained low over the past several years, with a positivity rate in those seeking treatment at 1.3 percent in 2018. [4] The number of reported total malaria cases increased from 4,171 in 2017 to 5,146 in 2018, with five malaria deaths reported in 2018. [4]

Treatment for malaria2

  Uncomplicated malaria Severe malaria Prevention during pregnancy (IPTp)
Mainland  artemether lumefantrine inj. artesunate, inj. artemether; inj. quinine sulfadoxine-pyrimethamine
Zanzibar artesunate+amodiaquine AS; QN sulfadoxine-pyrimethamine


The target of Tanzania’s national malaria strategy is to reduce case fatality rate in patients admitted due to malaria from 3% in 2012 to less than 1% in 2020. [2] In 2013, the National Malaria Control Programme revised the National Diagnostic and Treatment guidelines to include injectable artesunate for the treatment of severe malaria. [2]

The guidelines also call for the referral of patients with severe malaria from lower-level facilities to the nearest health center. Intramuscular injection of artesunate should be administered prior to the transfer of the patient.[2] Intramuscular artemether or quinine can be used as second-line drugs when artesunate is not available. [2] Use of pre-referral artesunate rectal capsules (ARC) at peripheral health facilities is also permitted when injectable artesunate is unavailable. [2] This presently does not occur as the government of Tanzania and its partners have not yet begun procuring rectal artesunate. [2]

Strategy and universal health coverage

The country has a Malaria National Strategic Plan (MNSP) for the period 2020 – 2025. [1] The focus of the MNSP is to achieve and maintain high coverage of timely parasitological diagnosis of malaria by ensuring that in both public and private points of care are available; skilled providers are in place; and high-quality testing services are available. [1] The Plan also calls for access to case management services for people with limited access and in hard-to-reach areas. [1]

These will be complemented by behaviour change communication actions to encourage patients to seek a confirmatory diagnostic test before treatment, and healthcare providers to adhere to the test results. [1]

Tanzania is also undertaking a reorganization of the health services to achieve Universal Health Coverage (UHC). This initiative entails reimbursement through a single national health insurance scheme whereby it will be the most prominent mechanism in financing health facilities. [1]

Prevention

The 2017 Tanzania HIV and Malaria Indicator Survey (THMIS) indicated that [1]:

  • 78% of households owned at least one insecticide-treated mosquito net (ITN), an
  • increase from 38% in 2007-8.
  • 54% of children slept under bed nets, an increase from 25% in 2007-8.
  • 57% of pregnant women received at least 2 doses of intermittent preventive treatment (IPTp), an increase from 35% in 2015–16.
  • 26% of pregnant women received 3 or more doses of IPTp (IPTp3 or IPTp3+), an increase from 8% in 2015–16.

Case management

The use of ACTs in mainland Tanzania began in 2006 with artemether-lumefantrine (AL) as the first-line drug for the treatment of uncomplicated malaria. [4] In 2013, the NMCP revised the National Diagnostic and Treatment guidelines to include injectable artesunate for the treatment of severe malaria. The guidelines call for referral of patients with severe malaria from lower-level facilities to the nearest health center after first giving the patient an intramuscular injection of artesunate. Intramuscular artemether or injectable quinine can be used as second-line drugs if artesunate is not available. [4]

Use of pre-referral ARC at peripheral health facilities is also permitted if injection is not available yet in practice this does not occur as rectal artesunate is not procured, neither by the Government of Tanzania nor its partners. [4]

Commodity needs:

For 2021, there is an estimated need of: 1.7 million injectable artesunate vials. [1] A surplus of 1.9 million vials was available from 2020, and it is estimated that a surplus of 1.2 million vials will be available at the end of 2021. [1]

It is estimated that 8 million sulfadoxine–pyrimethamine (SP) treatments will be required in 2021. [1] The Government of Tanzania has committed to procuring SP as part of its investments in maternal and child health.

Severe malaria policy and practice

National treatment guidelines
Recommendations Treatment
Strong IV artesunate*
Alternative IV quinine
Recommendations Pre-referral
Community level Rectal artesunate
Health facility IM artesunate
Health facility alternative IM quinine
First trimester pregnancy
Recommendation Treatment
Strong IV quinine