Is there any malaria left in Tanzania?

This was the title of a talk I attended on Friday given by a scientist from the London School of Tropical Medicine and Hygeine.  He and his colleagues have been researching the prevalence of malaria in Tanzania for years; their results show malaria is declining. 

At the beginning of his talk, the scientist asked people in the audience if they believed malaria was decreasing in Tanzania. Of the fifty or so people in the room, only about 5 people (including myself) raised our hands.  Everybody else, (who were mostly Tanzanians) believed that malaria was as prevalent as before.  For the next 45 minutes, the speaker tried to convince the audience, that indeed, malaria is decreasing in Tanzania.  

Whenever a colleague or Tanzanian friend tells me that he or she was sick, 95% of the time, they say, "I had malaria."  The general accepted belief here is that fever = malaria, which is simply not true. The few times I have had fever here, my Tanzanian friends' responses were almost robotic: "You have malaria." But when I tested myself for malaria --the result was negative each time.  

The scientist did mention that although the prevalence of malaria is decreasing, more and more people are still being treated for malaria, even though they don’t actually have it.  Most people, when they are sick with fever, will go to their local health dispensaries/health centers.  Based on their clinical symptoms/signs and/or a blood smear, they may be diagnosed with malaria.  However, it has been shown that using just clinical symptoms/signs and a blood smear is a poor way to diagnose malaria.  

For example, we learned that looking at a blood smear to diagnose malaria was about as accurate as flipping a coin, because of the lack of technical experience here in reading the slides.  Yet, people are still constantly being told they have malaria for some unsettling reasons, including these:

1.  It is a diagnosis both the clinician and patient understands.  The clinician can charge the patient for the services and drugs, and the patient will walk away satisfied with the service.

2.  Malaria is a disease that attracts important foreign funds.  

3.  Clinicians are being taught in school that fever = malaria for most situations. 

 4.  Malaria is an acceptable disease to excuse a person from work, where as having the common cold or a viral upper respiratory tract infection may not warrant a sick day. 

Like with many beliefs, it will take time to convince people malaria is decreasing, and to train clinicians to think about other causes of fever besides malaria.  Even after the excellent talk on Friday, most of the audience did not seem to buy the scientist's findings.