Association for Public Policy Analysis & Management

[Background] In Tanzania malaria causes more mortality and morbidity than any other disease, accounting for 40% of the country’s annual national health expenditures, nearly half of its outpatient hospital attendance, and 32% of deaths in the entire population. Conventional techniques to combat malaria have accomplished notable improvement over the past several decades, yet for eradication, novel approaches and new perspectives are needed. Geographic Information Systems (GIS) and spatial analyses can provide that. Most malaria studies are based on environmental factors; few on the role of infrastructure design and the correlation with malarial health outcomes. My research looks at the dispersion of health sites (hospitals, clinics and dispensaries) relating to present day incidence of p.falciparum, the most common and dangerous strain of malaria for humans.

[Objective] When controlling for major environmental aspects, determine if a spatial correlation exists between the dispersion of established health sites and levels of malaria incidence in mainland Tanzania.

[Methods] Six risk factors were assessed: rainfall, altitude, distance to water, distance to roads, Insecticide Treated Bed Nets (ITNS) usage, and health site distribution. Each risk factor was spatially classified in GIS and assigned a level of low, medium and high risk in accordance with literature. Factors were then weighted and the final malaria prediction used a model combining the six risk factors and their derived weights through an index overlay in GIS.

[Results & Conclusion] Clear terrestrial “hotspots” of high malaria incidence are revealed within southern Kigoma and western Shinyanga regions, correlating with notable low and absent numbers of health sites of any type. The potential implications of such a relationship warrants further research, funding allocation, and policy consideration not only now for diagnostic and treatment efforts (secondary and tertiary care), but also for future preventative (primary) measures especially considering recent advancements in developing efficacious vaccines.