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

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.

Figure 1

Map of Greater Abidjan with its municipalities and selected health facilities.

Figure 2

Distribution of public, private and paramedical facilities in Greater Abidjan, 2001.

Figure 3

Numbers of overall consultations, suspected and confirmed malaria cases in Abidjan, 2001. 3a) children under five years; 3b) persons over five years; 3c) pregnant women.

Figure 4

Malaria prevalence detected in fever cases and non-fever controls in Yopougon, by residence of patients. Health facility-based surveys. Vertical bars represent 95% CI.