The global fight against malaria has made dramatic progress. From 2001 to 2015, there were 6.2 million fewer deaths from malaria—a halving of the global mortality rate.
In recent years, Tanzania has emerged as a national success story in malaria prevention and control. Between 2005–2016 alone, nearly all malaria indicators for mainland Tanzania improved. Efforts to control malaria in Zanzibar, a semi-autonomous archipelago that is part of Tanzania, have returned particularly dramatic results: In 2011, malaria prevalence reached near-elimination levels of less than 1 percent, and has been maintained at low levels.
Creating an Integrated and Sustainable Response to Malaria
This progress was made possible in large part by the Tanzania Vector Control Scale-Up Project (TVCSP), funded under the U.S. President’s Malaria Initiative (PMI) by USAID.
From 2006–2016, our team led the implementation of this comprehensive project, which supported the malaria control efforts on both mainland Tanzania and Zanzibar. Our efforts to reduce the country’s malaria burden included
- Scaling up the spraying of insecticide in homes—called indoor residual spraying (IRS)—to kill malaria-infected mosquitoes
- Developing a community-driven and evidence-based strategy for IRS, including trainings
- Generating an environmental compliance strategy and monitoring plan to guide and track IRS activities
- Distributing long-lasting insecticidal bed nets
- Establishing malaria surveillance systems
- Strengthening the institutional capacity of mainland Tanzania and Zanzibar malaria programs.
Delivering Innovative Surveillance Tools
To support TVCSP, we developed two state-of-the-art tools to support the detection and reporting of malaria cases.
Our internationally acclaimed Malaria Early Epidemic Detection System (MEEDS) uses mobile phones to report malaria cases in real time. Originally piloted in 2008 in 10 health facilities in Zanzibar, MEEDS now supports a full malaria case notification system in 160 health facilities, covering all public facilities and 77 private health facilities throughout Zanzibar.
In 2012, we developed and implemented a case-based surveillance software tool called Coconut, which alerts district malaria surveillance officers to new malaria case reports via a mobile application. Surveillance officers access Coconut through mobile phones and Android tablets and respond to each new case, travelling by motorbike. On site, officers test other household members for malaria and—if positive—treat them, assess environmental factors, and report data through Coconut. This innovative system captures malaria data from all public and private sector health facilities in Zanzibar, allowing officials to monitor and swiftly respond to increases in malaria, ultimately paving the road toward malaria elimination.
In mainland Tanzania, we trained health care providers in more than 2,000 health facilities to use the Integrated Disease Surveillance and Response (eIDSR) system. This system captures disease data that are collected and reported by health facilities via mobile phones. Prior to eIDSR, data on malaria and other potentially epidemic diseases were collected and reported using a paper-based system, often resulting in incomplete and untimely data. Now, decision-makers can more quickly and easily share information to rapidly respond to disease outbreaks and other public health emergencies.
Protecting Millions of People Every Year and Guiding Future Efforts
Together, integrated activities led by our experts under TVCSP protect millions of people every year from malaria.
Over the course of a decade, we sprayed a cumulative total of about 4.5 million homes with insecticide. At the peak of spraying activities, more than a million people in Zanzibar and 6.3 million people in mainland Tanzania were protected from malaria. This included about 2 million children under five years of age and pregnant women. Additionally, we strengthened capacity and sustainability at local and national levels by training more than 100,000 program personnel to plan for, implement, and monitor IRS operations.
In 2014, we distributed half a million bed nets in more than 2,300 schools across 19 districts of the Southern Zone of mainland Tanzania. We also supported the National Institute for Medical Research (NIMR) to establish an entomology laboratory and network of insectaries that will comprehensively monitor for insecticide resistance in surveillance sites throughout the country.
To impact and guide Tanzania’s progress in the fight against malaria for many years to come, our team helped develop and influence several policy and strategy documents, including national malaria vector control guidelines, surveillance guidelines, and training packages for IRS personnel. We also conducted a range of operational research studies to answer key questions that will inform malaria control in Tanzania in the future, including investigations on insecticide resistance and malaria prevalence among pregnant women and infants. Findings and knowledge from TVCSP programmatic efforts and operational research has been disseminated through 66 conference presentation and 12 publications in the peer-reviewed literature.