Mboera Leonard E G, Mazigo Humphrey D, Rumisha Susan F, Kramer Randall A
National Institute for Medical Research, P.O. Box 9653, Dares Salaam, Tanzania.
Catholic University of Health and Allied Sciences-Bugando, P.O. Box 1464, Mwanza, Tanzania.
Malariaworld J. 2013 Dec 12;4:19. doi: 10.5281/zenodo.10928325. eCollection 2013.
Over the years, malaria has remained the number one cause of morbidity and mortality in Tanzania. Population based studies have indicated a decline in overall malaria prevalence among under-fives from 18.1% in 2008 to 9.7% in 2012. The decline of malaria infection has occurred in all geographical zones of the country. Malaria mortality and cumulative probability of deaths have also shown a marked decline from 2000 to 2010. During the same period, area specific studies in Muheza, Korogwe, Muleba and Mvomero have also reported a similar declining trend in malaria prevalence and incidence. The decline in malaria prevalence has been observed to coincide with a decline in transmission indices including anopheline mosquito densities. The decline in malaria prevalence has been attributed to a combination of factors including improved access to effective malaria treatment with artemisinin combination therapy and protection from mosquito bites by increased availability of insecticide treated bednets and indoor residual spraying. The objective of this paper was to review the changing landscape of malaria and its implication for disease management, vector control, and livelihoods in Tanzania. It seeks to examine the links within a broad framework that considers the different pathways given the multiplicity of interactions that can produce unexpected outcomes and trade-offs. Despite the remarkable decline in malaria burden, Tanzania is faced with a number of challenges. These include the development of resistance of malaria vectors to pyrethroids, changing mosquito behaviour and livelihood activities that increase mosquito productivity and exposure to mosquito bites. In addition, there are challenges related to health systems, community perceptions, community involvement and sustainability of funding to the national malaria control programme. This review indicates that malaria remains an important and challenging disease that illustrates the interactions among ecosystems, livelihoods, and health systems. Livelihoods and several sectoral development activities including construction, water resource development and agricultural practices contribute significantly to malaria mosquito productivity and transmission. Consequently, these situations require innovative and integrative re-thinking of the strategies to prevent and control malaria. In conclusion, to accelerate and sustain malaria control in Tanzania, the prevention strategies must go hand in hand with an intersectoral participation approach that takes into account ecosystems and livelihoods that have the potential to increase or decrease malaria transmission.
多年来，疟疾一直是坦桑尼亚发病和死亡的首要原因。基于人群的研究表明，五岁以下儿童的总体疟疾患病率从2008年的18.1%降至2012年的9.7%。该国所有地理区域的疟疾感染率均有所下降。2000年至2010年期间，疟疾死亡率和累积死亡概率也显著下降。同一时期，在穆赫扎、科罗格韦、穆莱巴和姆沃梅罗进行的特定地区研究也报告了疟疾患病率和发病率的类似下降趋势。人们观察到疟疾患病率的下降与包括按蚊密度在内的传播指数的下降相吻合。疟疾患病率的下降归因于多种因素，包括青蒿素联合疗法使有效疟疾治疗的可及性提高，以及经杀虫剂处理的蚊帐和室内滞留喷洒的可得性增加，从而减少了蚊虫叮咬。本文的目的是回顾坦桑尼亚疟疾形势的变化及其对疾病管理、病媒控制和生计的影响。它试图在一个广泛的框架内审视各种联系，该框架考虑到由于可能产生意外结果和权衡的多重相互作用而产生的不同途径。尽管疟疾负担显著下降，但坦桑尼亚仍面临一些挑战。这些挑战包括疟疾病媒对拟除虫菊酯产生抗性、蚊虫行为改变以及生计活动增加了蚊虫繁殖力和蚊虫叮咬暴露风险。此外，还存在与卫生系统、社区认知、社区参与以及国家疟疾控制项目资金可持续性相关的挑战。这篇综述表明，疟疾仍然是一种重要且具有挑战性的疾病，它体现了生态系统、生计和卫生系统之间的相互作用。生计以及包括建筑、水资源开发和农业实践在内的多个部门发展活动对疟蚊繁殖力和传播有重大影响。因此，这些情况需要对预防和控制疟疾的策略进行创新和综合的重新思考。总之，为了在坦桑尼亚加速并持续控制疟疾，预防策略必须与跨部门参与方法携手并进，该方法要考虑到有可能增加或减少疟疾传播的生态系统和生计。
