Rapid Urban Malaria Appraisal (RUMA) II: Epidemiology of urban malaria in Dar es Salaam (Tanzania)

Shr-Jie Wang¹ , Christian Lengeler¹ , Deodatus Mtasiwa² , Thomas Mshana³ , Lusinge Manane⁴ , Godson Maro⁴ and Marcel Tanner¹

¹Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland

²The Dar es Salaam Regional/City Medical Office of Health, P.O. Box 9084, Dar es Salaam, Tanzania

³Medical Laboratory Scientists Association of Tanzania, P.O. Box 65094, Dar es Salaam, Tanzania

⁴The Muhimbili University College of Health Sciences, P.O. Box 35091, Dar es Salaam, Tanzania

author email corresponding author email

Malaria Journal 2006, 5:28doi:10.1186/1475-2875-5-28


Published:	4 April 2006

Abstract

Background

The thinking behind malaria research and control strategies stems largely from experience gained in rural areas and needs to be adapted to the urban environment.

Methods

A rapid assessment of urban malaria was conducted in Dar es Salaam in June-August, 2003 using a standard Rapid Urban Malaria Appraisal (RUMA) methodology. This study was part of a multi-site study in sub-Saharan Africa supported by the Roll Back Malaria Partnership.

Results

Overall, around one million cases of malaria are reported every year by health facilities. However, school surveys in Dar es Salaam during a dry spell in 2003 showed that the prevalence of malaria parasites was low: 0.8%, 1.4%, 2.7% and 3.7% in the centre, intermediate, periphery and surrounding rural areas, respectively. Health facilities surveys showed that only 37/717 (5.2%) of presenting fever cases and 22/781 (2.8%) of non-fever cases were positive by blood slide. As a result, malaria-attributable fractions for fever episodes were low in all age groups and there was an important over-reporting of malaria cases. Increased malarial infection rates were seen in persons who travelled to rural areas within the past three months. A remarkably high coverage of insecticide-treated nets and a corresponding reduction in malarial infection risk were found.

Conclusion

The number of clinical malaria cases was much lower than routine reporting suggested. Improved malaria diagnosis and re-defined clinical guidelines are urgently required to avoid over-treatment with antimalarials.