Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania

Hetzel, Manuel W., Alba, Sandra, Fankhauser, Mariette, Mayumana, Iddy, Lengeler, Christian, Obrist, Brigit, Nathan, Rose, Makemba, Ahmed M., Mshana, Christopher, Schulze, Alexander and Mshinda, Hassan (2008) Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania. Malaria Journal, 7 7: 1-13. doi:10.1186/1475-2875-7-7

Author Hetzel, Manuel W.
Alba, Sandra
Fankhauser, Mariette
Mayumana, Iddy
Lengeler, Christian
Obrist, Brigit
Nathan, Rose
Makemba, Ahmed M.
Mshana, Christopher
Schulze, Alexander
Mshinda, Hassan
Title Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2008-01-09
Sub-type Article (original research)
DOI 10.1186/1475-2875-7-7
Open Access Status DOI
Volume 7
Issue 7
Start page 1
End page 13
Total pages 13
Place of publication London, U.K.
Publisher BioMed Central
Language eng
Formatted abstract
Background: The Kilombero Valley is a highly malaria-endemic agricultural area in south-eastern Tanzania. Seasonal flooding of the valley is favourable to malaria transmission. During the farming season, many households move to distant field sites (shamba in Swahili) in the fertile river floodplain for the cultivation of rice. In the shamba, people live for several months in temporary shelters, far from the nearest health services. This study assessed the impact of seasonal movements to remote fields on malaria risk and treatment-seeking behaviour.

Methods: A longitudinal study followed approximately 100 randomly selected farming households over six months. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded.

Results: Fever incidence rates were lower in the shamba compared to the villages and moving to the shamba did not increase the risk of having a fever episode. Children aged 1–4 years, who usually spend a considerable amount of time in the shamba with their caretakers, were more likely to have a fever than adults (odds ratio = 4.47, 95% confidence interval 2.35–8.51). Protection with mosquito nets in the fields was extremely good (98% usage) but home-stocking of antimalarials was uncommon. Despite the long distances to health services, 55.8% (37.9–72.8) of the fever episodes were treated at a health facility, while home-management was less common (37%, 17.4–50.5).

Conclusion: Living in the shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 22 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 25 times in Scopus Article | Citations
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Created: Fri, 23 Sep 2011, 11:43:02 EST by Dr Manuel Hetzel on behalf of School of Public Health