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

Abstract

BackgroundThe 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.MethodsA 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.ResultsFever 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).ConclusionLiving 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.

Economic Valuation of Nontimber Forest Products under the Changing Climate in Kilombero District, Tanzania

“…The area receives between 1200 and 1800 mm of rainfall per year and temperatures range from 26 ∘ C to 32 ∘ C [38,39]. However, the rains are currently unpredictable, whereby the onset and cessation are inconstant [27].…”

Livelihood, malaria and resilience

“…The health-seeking trajectories we identifi ed broadly correspond with previous studies in the Kilombero Valley (Hetzel et al, , 2008. After sponging the children and -if available -giving them an antipyretic, the caregivers brought them (a) directly to a drug store or (b) directly to a health facility, and then to a drug store, if the prescribed medicines were not in stock in the health facility.…”

“…The shamba study documented surprisingly high mosquito net usage (98 per cent) and anticipatory provision with antipyretics, although not with anti-malarials (Hetzel et al, 2008). In our family portraits, some parents gave antipyretics to their children while they were still at their farming sites, and women in the Mkwangawalo village FGD mentioned 'serious people' who take anti-malarials to the paddy fi elds for emergencies.…”

“Yes we are here, living, but malaria is surrounding us”: sustainable livelihoods and malaria in Tanzania

“…(1) The prevalence of malaria in Morogoro Region (including the Kilombero Valley) was 16% in 2007-2008(GoT 2013 (2) 43 of 99 countries have recorded a reduction of 50% or more in reported cases of malaria. Although the data can be problematic, in sub-Saharan Africa 95% of households have reported that they own at least one ITN, and surveys indicate that 96% of persons with access to an ITN claim they use it.…”

“…Although some studies report high usage of bednets in the Kilombero Valley (Hetzel et al 2008), there is also evidence of limited use of bednets in north-western Tanzania (Nnko et al 2012), while our own work in the Kilombero Valley has shown that shifting sleeping patterns due to cultural beliefs and livelihood patterns mitigate against the consistent and sustained bednet usage which is called for by public health policies (Dunn et al 2011). This article builds on our previous work by exploring further the patterns of work associated with livelihoods and villagers' subjective assessments of their increasing poverty, making the links between their daily lives and risky health behaviours.…”