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.
