Salum Juma has put up a residence at the mosquito infested Kinondoni Mkwajuni area in Dar es Salaam. He is not quite sure about how long he has been there, but points out that it is difficult for him to secure accommodation elsewhere owing to the high rates attached to houses for rent. Next to his house there is stagnant dirty water, an obvious breeding ground for mosquitoes.
Trouble begins when dusk approaches. Salum says the area ceases becoming peaceful, actually turning nightmarish as swarms and swarms of mosquitoes, predators in reality, hover around the unprotected residents, ever ready to bite them with relish, teeming in a manner he describes as menacing and troubling, especially for exhausted children who have wound up daily games, and now helplessly feeling the need to rest.
“We are suffering. Our health is at detriment, and there is no relief in sight because of disturbance from mosquitoes. So long the breeding sites of these creatures remain untouched, so will health continue to be poor,” he complains.
Now, sensing that his message is not clear enough, Salum gives a severe look at the stream-cum-pond adjacent to the house, tucks his shirt and goes resigned: “The mosquito net is helpless to us. We spend most of our time outside where there are a lot of mosquitoes and we cannot protect ourselves.”
He continues: “There is a lot of stagnant water around the houses here, attracts more mosquitoes than you can imagine. You will never relax outside of your house around 6:00 pm due to swarms of mosquitoes.”
While the community in neighbourhood also suffers malaria endemic, the Tanzania joins other countries to commemorate the World Malaria Day every April 25. To this community and many others in Tanzania, the commemoration is of little importance, and sometimes they find the value is perhaps not meant for them.
“Since the day was started to be commemorated years ago, the malaria problem continues to haunt us, killing scores of infants, children, men and women, despite the various efforts taken to combat it.
“We are told of so many strategies taken by the government against the disease, but the question remains whether those strategies to fight malaria are useful and helping to control the disease,” comments Salum with disappointment.
Strategies include provision free mosquito nets with priority to pregnant women, aimed at protecting them against the leading cause of death in Tanzania.
In 2007/8, nearly 20% of Tanzanians under tested positive for malaria according to the Ifakara Health Institute. Prevalence in rural areas was more than double in urban areas, and there were huge variations across regions.
Data from previous surveys and studies showed that malaria prevalence in Tanzania had roughly halved over the past decade. There has been a decline of similar timing and magnitude in malaria transmission, severe anaemia, fever incidence, malaria inpatient admissions and the proportion of fever cases positive for malaria.
The reduction in malaria transmission, prevalence and morbidity corresponded closely to the increase in use of nets and ITNs, protection nets extended beyond individual users to benefit the community as a whole. The fact that multiple malaria interventions had been implemented in conjunction made it difficult to assign causation to any one particular control measure.
The research showed that all-cause under-five mortality had declined by nearly 40% since 1999. The evidence suggested that malaria-related deaths had declined by a similar extent. But the fact the proportion of deaths directly attributable to malaria had not changed might be explained by a large control on all-cause mortality.
Despite all these advancements in the fight against malaria, Salum and colleagues at Mkwajuni do not see much, and actually ask the government to make an evaluation so as to realise the extent the mosquito nets have achieved to decelerate the spread of the disease in the country. They see the effort as being good although they insist is not a perfect solution for malaria in Tanzania.
They urge that by providing the mosquito nets only the malaria problem will be here to stay.
“If you come back and look at our environmental condition which we are living in, you will see why the existing strategies are not useful for the problem. And you will get the answer of why malaria is still killing us,” charges Salum, adding with rejection:“Many of our houses are surrounded by these mosquito breeding conditions. Pay a brief visit to Kinondoni Mkwajuni, Sinza and Tandale Kwa Mtogole and you’ll realise what I’m talking about.”
A visit to the country’s biggest Muhimbili National Hospital (MNH) at around 6:00 pm will put you off following the threatening big number mosquitoes, said to originate from nearby Msimbazi valley.
Malaria accounts for over 30% of the national disease burden, with transmission and the estimated levels of exposure to malaria infected mosquitoes (EIR) varying with season, altitude, proximity to breeding sites, socio-economic status, and agro-ecological system. Multi-faceted malaria control strategies are yielding significant results in malaria indicators.
Statistics, however, show that there has been significant progress over the last decade:2000-2010 following declines in parasite prevalence, with only 18% of children aged 6-59 months tested positive for malaria in mainland Tanzania; expected to be even lower, significant urban/rural difference in prevalence, relative decline in anaemia ~30% over 3 years only.
There has also been significant decline in under-five mortality by 45%.
By the year 2003 USAID showed that malaria, a leading cause of morbidity and mortality, accounted for 40 per cent of all outpatient attendances in Tanzania.
Nets not free
Neema Nyang’oro (34) from Kisarawe District in Coast region claims that although the government declares to provide the mosquito net free of charge, the situation where she lives is quite different.
“The local leaders decided to provide a single net to one house in our village and the remaining nets were sold.
“When I was pregnant, I decided against taking the free net following the prevailing bureaucratic system involved. I was not alone as many other pregnant women had also lost hope after getting tired of the system,” Nyang’oro explained.
In remarks during the Malaria Day cerebration in Dar es Salaam, Vice-President Mohammed Gharib Bilal had noted that the government was working on a national strategy of distributing mosquito nets at schools so as to make them available to a sustainable larger user audience.
“In ensuring that the use of bed nets are sustainable and attain 80 percent of the target, various strategies are under way, including distributing the nets to pregnant mothers and children under one year.” said Bilal.
On Monday this week The Guardian on Sunday went to the Ministry of Health and Social Welfare’s Information Unit to find authoritative details regarding when the malaria mosquito should be avoided most, the time it is said to bite and transmit the malaria parasite. The writer was asked to leave questions whose answers could be collected at a later day.
On Thursday 10, the there was nobody at the Information Unit to give answers to the requested questions. At the office of the Permanent Secretary the writer was directed to contact the office of the Medical Officer where two women asked for written questions they would send to the medical officer who was then attending a meeting.
But when the two women learned that the issue was about malaria, they said the meeting that the medical officer was attending would be prolonged, advising this reporter to contact another authority away from the ministry. That is how things are when seeking information that could be vital for public use.
The common man shares Salum Juma views that there is solution to malaria and that is destroying mosquito breeding sites such as stagnant water pools and overgrown grass around houses.