Outdoor activities and behaviors increase the vulnerability of school-age children to malaria infections in south-eastern Tanzania

Abstract

Background: Strengthening malaria control activities in Tanzania has dramatically declined human malaria infections. However, the burden is now higher among school-age children, but with the inconsistency of evidence on risk factors and underlying causes for such an epidemiological shift. This study explored activities and behaviors that increase the vulnerability of school-age children to transmission risk. Methods: Twenty-four focus group discussions (FGDs) were conducted in three districts of Rufiji, Kibiti and Kilwa in south-eastern Tanzania. Sixteen FGDs worked with school-age children (13 to 18 years) and eight FGDs with their parents. Results: Routine domestic activities such as fetching water, washing kitchen utensils, cooking, recreational activities such as playing and watching television as well as studying were the reported activities that kept school-age children outdoors late into the evening and therefore, likely to predispose them to malaria infection. Likewise, the social and cultural events such as initiation ceremonies and livelihood activities also kept this age group outdoors from late evening to early night and sometimes past midnight hours. Parents migrating to farms from December to June, leaving behind school-age children unsupervised and the behavior of children sprawling legs and hands while sleeping were also mentioned as drivers increasing school-age children’s vulnerability to infectious mosquito bites. Conclusion: The risky activities, behaviors, and social events mostly occurring outdoors increase school-age children's vulnerability to malaria infections. The evidence presented calls for the urgent need to integrate outdoor malaria vector control measures into the existing interventions to control infection before bedtime. That will speed up efforts toward having society free of malaria by 2030.

Geospatial analysis of malaria burden in Kagera region, North-western Tanzania using health facility and community survey data

“…This observation has consistently been reported in other studies that were conducted in different settings [41,59,60]. In previous studies, this observation was associated with the fact that school children spend most of their time in the evening playing outside, which tends to increase their chances of mosquito bites and hence increase the risk of malaria infections [61–63]. To reduce malaria transmission and accelerate elimination efforts in the country [64], various initiatives have been undertaken by NMCP and other stakeholders to protect this risky group; including the distribution of ITNs through different channels like school net program [6,65].…”