Dilemma in Tanzania malaria campaign

Dar es Salaam. It is a quiet and warm Friday night around 10pm. Mr Hubert Ishengoma and friends sit for a drink at an open-air pub in Dar es Salaam’s Mbagala Kuu suburb. But all is not well.

Enjoying the fresh air, with chairs and tables placed on a sultry grassy area, Ishengoma and friends are bothered by frequent interruptions and nuisance of the buzzing mosquitoes flapping their wings on and off their shoulders and legs. However, they are holding on to their beers.

“These are harmless after all,’’ says Ishengoma as he tries to ward them off, though. “You see, mosquitoes that bite at this time [he pulls his phone and checks time…], do not spread malaria.”

“I only fear those that bite after midnight. We’ve always been told that malaria is spread by mosquitoes that bite after midnight,” he recalls, reciting a popular malaria campaign message in Tanzania, Malaria Haikubaliki, literally translated ‘malaria is not acceptable.’

The campaign went along with distribution of insecticide-treated nets (ITNs) to every household across the country with messages that the malaria-carrying mosquitoes bite beyond mid night.

Such myths about malaria mosquitoes, which are currently being challenged by scientists, are, however, not limited to Ishengoma alone. Many Tanzanians are unaware that latest research findings are increasingly concluding that there is a significant risk of getting malaria before bedtime.

Tanzania has the third largest population at risk of malaria in Africa, according to the World Health Organization (WHO), with over 90 percent of the population living in high risk transmission areas.

Each year, 10 to 12 million people contract malaria in the country and some 80,000, most of them children, die from the disease.

However, a survey by The Citizen in most Dar es Salaam suburbs has established that what people think of the malaria mosquitoes was inconsistent with the reality on how to prevent the disease, prompting concerns from among researchers and anti-malaria campaigners.

A latest study, conducted between August 2016 and June 2017 in nine villages in Ulanga and Kilombero districts, both in the Kilombero valley in south-eastern Tanzania, shows that the behaviour of mosquitoes, such as biting times, has changed. Yet, the messages in public campaigns against the malaria-transmitting insects haven’t been improved.

“Insecticide-treated nets, where properly used, can still prevent most indoor exposures [to mosquito bites], but significant risk continues unabated before bedtime, outdoors and at communal gatherings,’’ says the study entitled: Linking human behaviours and malaria vector biting risk in south-eastern Tanzania, and appeared in the PlosOne Journal, which publishes science researches.

On most evenings, Ms Sophia Mkwizu watches TV drama in her living room with her family at Mabibo in Kinondoni District, Dar es Salaam. But the bites make the drama unexciting.

Despite being keen on using a treated net whenever she goes to bed, Sophia tells The Citizen that she, at times, endures bites of misquotes before bed time.

“Sometimes, it’s not easy to control mosquitoes entering the house. We’ve tried to use some repellents whenever watching TV to keep the mosquitoes away but not all times. There are times I go to bed already bitten all over my body. My daughters too,’’ she says, lowering her tone and smiling off.

Although the ITNs campaigns in Tanzania have been reported to have played a big role in reducing malaria cases, ironically, the mosquito-borne disease still persists in areas with high distribution of the nets.

In Kigoma Region, where 76 per cent of each of the households owns at least one ITN, the prevalence of malaria stands at 24 per cent, surpassing all other regions in Tanzania, according to the Tanzania Malaria Indicator Survey 2017 (TMIS 2017).

Countrywide, about three in four households in Tanzania own at least one ITN. More than half (62 percent of the households) obtained the ITNs during the mass distribution campaigns.

However, scientists say ownership of the ITNs is not a silver bullet.

The public must be updated with the right information about malaria prevention even if they own and use ITNs, says a research scientist and public engagement coordinator from the Ifakara Health Institute (IHI), Ms Marceline Finda.

“That malaria transmitting mosquitoes are biting from 6pm until morning is knowledge mostly known among scientists, not the public,’’ she tells The Citizen.

“We need to also consider new interventions now, such as improved housing, new technology, and putting more emphasis on killing mosquito larvae using larvicides,’’ says Ms Finda.

Anti-malaria campaigners want the government to review the communications strategy and campaign messages to reflect the current scientific and social developments, human rights, community behaviours and new technology.

“People in communities should be involved in addressing their own health issues,” recommends the Chief Executive Officer of the Tanzania National Malaria Movement (Tanam), Ms Beatrice Minja.

“The Ministry of Health should change the model [it’s currently using] in addressing vectors [that transmit malaria]. Change from vertical programs. A department or commission should also be established to deal with vector control,’’ advises Ms Minja.

The deputy health minister, Dr Fasutine Ndugulile, says he is aware of the changing behaviour of mosquitoes and why more research is needed to deal with the vectors more holistically.

Dr Ndugulile said in a recent interview: “We have prioritised the use of mosquito nets and spraying inside our houses. But, probably these efforts are ineffective because mosquitoes are now staying outdoor,” he said, adding that the government is currently scaling up efforts in vector control.

Dr Fredros Okumu, a scientist who has been researching on mosquitoes for many years, believes that the biology of malaria mosquitoes is intriguing and the more the insects will be understood, the closer stakeholders will get to achieve the “zero malaria,’’ targets.

“There are nearly 3,500 species of mosquitoes. About 400 belong to a family called Anopheles, and of these, only about 50 can actually transmit malaria to humans,’’ he says.

Additional Reporting by Elizabeth Edward