Social economic factors and malaria transmission in Lower Moshi, Northern Tanzania

Parasites & Vectors Social economic factors and malaria transmission in Lower Moshi, Northern Tanzania Asanterabi Lowassa 0 Humphrey D Mazigo 2 Aneth M Mahande 1 Beda J Mwang'onde 1 Shandala Msangi 1 Michael J Mahande 4 Epiphania E Kimaro 1 Eliapenda Elisante 3 Eliningaya J Kweka 1 2 0 Tanzania Wildlife Research Institute , P.O. Box 661, Arusha , Tanzania 1 Tropical Pesticides Research Institute, Division of Livestock and Human Disease Vector Control, Mosquito Section , P.O. Box 3024, Arusha , Tanzania 2 Department of Medical Parasitology and Entomology, Catholic University of Health and Allied Sciences , P.O. Box 1464, Mwanza , Tanzania 3 Department of Physical Sciences, Faculty of Science, Sokoine University of Agriculture , P. O. Box 3038, Chuo Kikuu - Morogoro , Tanzania 4 KCM College of Tumaini University , P.O. Box 2240, Moshi , Tanzania Background: For many years social economic status has been used as an indicator to characterize malaria treatment seeking behaviors of communities and their adherence to malaria control programs. The present study was therefore conducted to assess the influence of household social economic status, knowledge, attitude and practice on treatment seeking behaviors, distance to health facilities and vector control measures in the Lower Moshi area, northern Tanzania. Methods: A cross-sectional household survey was carried out, a quantitative method was used to collect information from the households, and the household socio-economic status was estimated by employing a household asset-based approach. The structured questionnaire also collected information on malaria knowledge, attitudes and treatment seeking behaviors. Results: A total of 197 (68.8% were female) household heads were interviewed. Distance to the health centers influenced malaria treatment seeking behaviors especially for children (P = 0.001) and the number of visits to the health facilities made by the household members (P = 0.001). The head of the households' level of education had an influence on bed-net retreatment (P < 0.001) and acceptability of larval control programmes (P <0.001). Similarly, a significant association was observed between bed-net retreatment, larval control and occupation of the head of the household . Conclusion: Distance to the health centre influenced malaria treatment seeking behaviors, and the number of visits made by the household members. In addition, the education level of the household heads played a role in understanding and in the selection of malaria interventions for the households. Increasing the number of health facilities close to rural areas will improve malaria treatment seeking behavior, case management and hence reduce malaria-associated morbidities, especially in high risk groups. - Background In Sub-Saharan Africa malaria remains a major cause of morbidity and mortality compared to any other region of the world, it is responsible for about 515 million clinical cases and 1.7 million deaths annually [1,2]. The SubSaharan Africa region carries approximately 90% of the global malaria burden [2]. About 95% of the Tanzanian population are at risk of malaria and live in areas characterized by stable malaria transmission [3]. In these areas, about 1720 million clinical episodes of malaria are reported each year and almost 80,000 deaths are attributed to malaria every year [3,4]. In rural areas malaria contributes to approximately 40% of all outpatient visits; with children under five and pregnant women contributing the highest proportions [5-7]. Currently, there is evidence that malaria transmission is declining in many endemic areas of SubSaharan Africa [3,8-10]. The recent statistics in Tanzania indicate that mortalities due to malaria have decreased from 100,000 [4] to 80,000 deaths [3]. Lower Moshi is considered to be a holo-endemic area for malaria transmission [11,12]. Data from health facilities in the area indicate that malaria, upper respiratory infections, soil transmitted helminthes, intestinal protozoa and human immunodeficiency virus infections are the most common health problems [1316]. Similar to the national malaria control strategies, the use of bed nets and treatment of active malaria cases with a dose of effective anti-malarials are the main strategies used in the area against malaria [14,17,18]. The wide distribution of bed nets through subsidized prices, popularly referred to as hati punguzo, to pregnant women and children under five years old has increased the ownership and protection of these vulnerable groups against malaria [19]. In addition, several intervention trials against malaria that have been conducted in the area have increased the level of bed net ownership and coverage compared to other rural areas in the country [20,21]. Although control efforts have been stepped up in the area, malaria transmission continues to be a public health problem. Findings from previous studies have reported that the majority of individuals were aware of malaria transmission and they used various interventions such as plant repellants to reduce indoor vector density [22]. In addition, the previous studies have reported that the majority of inhabitants could afford to buy treated/nontreated bed nets from local markets [20]. The results from a household-based survey, carried out in Lower Moshi rural communities are reported here. The study focused on understanding how the household social economic status, knowledge, attitude and practice influence malaria treatment seeking behaviors and vector control measures in the Lower Moshi area, northern Tanzania. Methods Study area Lower Moshi is located on the southern foothills of Mount Kilimanjaro (321S, 3721E) (Figure 1). This area generally has an elevation ranging between 700 to 800 m above sea level. Malaria transmission occurs throughout the year with low parasitaemia [14,17,18] and low entomological inoculation rate [12,23]. The main malaria vectors in this area are An. arabiensis and An. funestus [12,23-25]. On the land surfaces, several water streams cross the area and form the irrigation channels for paddy (Oryza sativa) irrigation. The rice irrigation schemes have structured and unstructured canal networks; covering an area of about 1,100 hectares. During the rainy season, temporary pools that serve as malaria vector breeding sites are formed. Their persistence beyond the rains contributes to further malaria transmission. The area has two rainy seasons, the long rains which run from March to May and short rainy season from November to December. The average annual rainfall is 900 mm per year. In addition to paddy cultivation, the inhabitants are also involved in cultivating vegetables, maize (Zea mays), peas (Pisum sativum) and beans (Pisum sativum). Inhabitants also keep domestic animals such as cattle, goats, sheep and poultry. Study design This was an analytical cross-sectional survey, conducted with an objective of determining malaria vectors and larval control (...truncated)