Open Access Open Badges Research

High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania

Netta Beer12*, Abdullah S Ali3, Delér Shakely24, Kristina Elfving25, Abdul-Wahiyd H Al-Mafazy3, Mwinyi Msellem3, Max Petzold6, Anders Björkman2 and Karin Källander178

Author Affiliations

1 Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden

2 Malaria Research Group, Infectious Disease Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

3 Zanzibar Malaria Control Programme (ZMCP), Ministry of Health, Zanzibar, Tanzania

4 Department of Medicine, Kungälv Hospital, Kungälv, Sweden

5 Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden

6 Akademistatistik-Centre for Applied Biostatistics, Sahlgenska Academy, University of Gothenburg, Gothenburg, Sweden

7 Makerere University School of Public Health, Kampala, Uganda

8 Malaria Consortium Africa, Kampala, Uganda

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Malaria Journal 2013, 12:38  doi:10.1186/1475-2875-12-38

Published: 29 January 2013



Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission.


A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases.


Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage.


While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions.