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).1  Over the last few years, there has been an increase in case incidence and mortality. Between 2015 and 2018, case incidence has plateaued at between 122 to 124 per 1000 of the population at risk while deaths fell by about 4% (from 0.4 to 0.38 per 1000 of the population at risk) during that same period .1

93% of the population in Mainland Tanzania live in malaria transmission areas. The country has three malaria transmission seasons2:

  • 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.

Plasmodium falciparum is responsible for 96 % of malaria infection in Tanzania, while Plasmodium malariae and Plasmodium ovale account for the remaining 4%.2

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

Data from the 2017 Management Information System surveys show improvement in the uptake of IPTp2 (second dose of IPTP) from 35% in 2015/2016 to 57% in 2017.2 IPTp3 (third dose of IPTp) uptake in 2015/2016 was at 8% and 26% in 2017.2

There are 7,513 health facilities on mainland Tanzania. Out of these, 83 % of these 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 Department for International Development, the World Health Organization and research institutions.4

Treatment for malaria1

  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.

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 rectal artesunate 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

The poor are at higher risk and experience an elevated risk of progression to severe malaria due to poor living conditions and limited access to quality treatment and malaria control interventions.

WHO World Malaria Report: Inpatient malaria cases and deaths

Malaria distribution

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

Commodity needs:

Estimated need of injectable artesunate: 8,000,000 vials 

  • Funded by PMI (50%), the Global Fund (44%) and the national government (6%)