Abstract:
Background: Tanzania is currently under an epidemiological transition of malaria
transmission with parts of the country having <1% (hypoendemic; pre-elimination) and >10%
malaria prevalence (mesoendemic). Hypoendemic areas in the pre-elimination phase require
high testing rates for fever cases and appropriate treatment of cases. There is paucity of
information on the quality of malaria case management in pre-elimination settings. This study
examined the influence of endemicity on the quality of malaria case management.
Methods: An analytical cross-sectional study was conducted amongst 1,713 health facilities
(HF) from all 26 regions of Tanzania Mainland during January through March 2019.
Secondary data were collected following introduction of an assessment tool for HF readiness
and performance of malaria case management by the National Malaria Control Programme.
HF performance were mapped according to malaria endemicity. Using standard readiness
indicators, mean scores from facilities in the different transmission settings were compared by
a student t-test. Simple and multiple linear regression analyses were performed to determine
the association between HF performance and endemicity (mesoendemic vs. hypoendemic).
Results: HFs located in hypoendemic settings fared poorly than those in mesoendemic
settings in terms of the overall quality of services [Difference in mean scores = -2.52; (95 %
CI -3.91, -1.12)], readiness [Difference in mean scores = -2.97; (95 % CI -4.61, -1.30)],
availability of malaria reference materials [Difference in mean scores = -4.91; (95 % CI -7.76,
-2.05)], information system tools [Difference in mean scores = -5.86; (95 % CI -7.92, -3.80)]
and client satisfaction [Difference in mean scores = -6.61; (95 % CI -9.48, -3.75)]. HFs in mesoendemic settings performed better than those in hypoendemic settings after controlling
for facility level and location [β: -2.12; (95 % CI -3.50, -0.73)]. HFs in rural areas were also
found to perform better than those in urban areas after controlling for malaria endemicity and
facility level [β: -4.12; (95 % CI -5.89, -2.34)].
Conclusion and Recommendations: Health Facilities located in Malaria Hypoendemic
settings performed poorly compared to those in Mesoendemic settings. The findings have
major implications for areas aiming at eliminating malaria. Further studies are required to
establish factors associated with poor quality of malaria case management in Hypoendemic
settings.
