Malaria

Malaria is a life-threatening disease caused by Plasmodium parasites transmitted through the bite of infected female Anopheles mosquitoes. Plasmodium falciparum is the predominant and most dangerous species in Tanzania, and malaria remains a leading cause of illness and death, particularly among children under five and pregnant women.

• Caused by Plasmodium parasites (mainly P. falciparum in Tanzania, also P. malariae and P. ovale) transmitted by the bite of infective female Anopheles mosquitoes, usually between dusk and dawn.
• Rarely transmitted through blood transfusion, shared needles, or from mother to child during pregnancy or delivery.
• Risk is highest in high-transmission areas, during and after the rainy season, and among young children, pregnant women, and people without prior immunity.

• Parasitological confirmation with a malaria rapid diagnostic test (mRDT) or microscopy of a blood smear is required before treatment wherever possible.
• Presumptive treatment based on symptoms alone is discouraged and reserved only for settings where testing cannot be done immediately.
• Severe malaria is diagnosed when a patient with a positive parasitological test has one or more danger signs or evidence of vital organ dysfunction.

At dispensary and health centre level, uncomplicated malaria confirmed by mRDT or microscopy is treated with a fixed-dose oral combination of artemether-lumefantrine (AL), the first-line antimalarial in Tanzania, taken twice daily for three days according to body weight. Dihydroartemisinin-piperaquine is used as the alternative first-line option.

Pregnant women with uncomplicated malaria in the first trimester are treated with quinine plus clindamycin, since artemisinin-based combinations are preferred from the second trimester onward.

Severe malaria is a medical emergency managed at hospital level with intravenous or intramuscular artesunate as the medicine of choice, followed by a full oral course of an artemisinin-based combination once the patient can tolerate oral medicines. Supportive care includes correcting hypoglycaemia, careful fluid management, controlling convulsions, and treating complications such as severe anaemia.

Patients with danger signs who cannot take oral medicine at a lower-level facility should be given a pre-referral dose of rectal (or intramuscular) artesunate and referred urgently for inpatient care.

• Sleep under a long-lasting insecticide-treated mosquito net (LLIN) every night.
• Support indoor residual spraying where provided by local vector-control programmes.
• Clear stagnant water around homes to reduce mosquito breeding sites.
• Pregnant women should receive intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine at each scheduled antenatal visit from the second trimester.
• Seek prompt testing and treatment for any fever, especially in children under five.