Malaria during pregnancy and its impact on child health in Tanga, Tanzania

Background: Between 2000 and 2015, the incidence of malaria globally declined by 37 %, and the global malaria mortality rate by 60 % (WHO, 2015). The prevalence of malaria declined substantially in Tanzania as well; in Tanga region the decrease between 2008 and 2016 was from 10-15 % to only 1-5 %. The main objective of this study was to explore the reasons for the decline of child mortality and morbidity due to malaria in Tanga, with emphasis on mothers’ knowledge of malaria. An additional aim was to observe and compare the health centers’ management of prophylaxis and treatment of malaria during pregnancy, to assess to what extent they are following national and WHO guidelines. Material/method: This is a combined qualitative and semi-quantitative study which focuses on on-site interviews and observations, and data collection from annual report books. In total 150 mothers aged 18-40 years with newly born babies <1 year of age, attending Mikanjuni and Ngamiani health centers in Tanga, were interviewed. We investigated the level of knowledge of malaria among mothers and studied possible associations between malaria prophylaxis during pregnancy and child health. Data collection was carried out in January 2018 at these health centers. Results: Based on interviews of the mothers, only 11 % (n = 17/152) children, had consulted a doctor due to suspected malaria. Similarly, according to the annual report books at the health centers, only 0,14 % (n = 17/12190) of the attended children were reported to have malaria. These few reports of malaria were based on positive malaria rapid diagnostic tests (mRDT) only and not on clinical symptoms or positive blood slide. No cases of malaria among the interviewed mothers during pregnancy or their children were reported. Overall, the mothers interviewed had appropriate knowledge of symptoms, outcomes, prophylaxis and treatment of malaria, although none of them were aware that sulfadoxine-pyrimethamine (SP) is used as prophylaxis and no longer as treatment. The majority of the mothers had been informed about malaria during pregnancy. Most of them had gained information from other sources such as media in addition to information from health workers, primarily nurses/midwives. Conclusion: We believe that prophylactic approaches during pregnancy, educating pregnant women, malaria specific laboratory tests during pregnancy and adequate treatment of malaria have contributed to the substantial decline of malaria incidence in Tanga. For further reduction, both individual and plenary information, especially about SP, should be provided to the pregnant women