Information made available by the WHO shows that in the entire population of mainland Tanzania lived in high-risk malaria transmission zones These figures are reported figures and generally underestimate the true malaria burden. Whilst significant steps have been taken to reduce the avoidable malaria deaths unfortunately confirmed cases appear to be on the rise.
Below is a table designed to show you what vaccines are mandatory, recommended or ones to consider when visiting Tanzania:. Tanzania has areas of high altitude around the border with Kenya, Rwanda and Burundi. High altitude is defined as being over m.
The most notable example in Tanzania is Mount Kilimanjaro m. Kilimanjaro treks are very difficult to acclimatise for as the ascents are far too rapid to allow for sufficient acclimatisation and whilst many individuals make the journey to the summit, many fail due to altitude-related illnesses. Symptoms of Acute Mountain Sickness include headache, fatigue, loss of appetite, nausea and sleep disturbance Improvement will only occur by descending to lower altitudes.
Complications can occur for persisting with an ascent that can lead to swelling around the brain or fluid collecting in the lungs. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.
If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to degrees F for at least five minutes or held in a storage tank for at least three days.
Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Bring adequate supplies of all medications in their original containers, clearly labeled.
Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity. Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.
State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States. Pack a personal medical kit , customized for your trip see description. Take appropriate measures to prevent motion sickness and jet lag , discussed elsewhere.
On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings. Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed.
Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles. For an ambulance in Tanzania, call Knight Support Emergency Services at 22 - 9 or mobile 0 Medical care in Tanzania is limited.
Essential medications and supplies are sometimes unavailable. Other facilities that provide medical care to travelers include the following:. For a guide to other physicians and dentists in Tanzania, go to the U. Embassy website. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance.
Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities. Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed. All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR measles-mumps-rubella vaccine, separated by at least 28 days, before international travel.
Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress.
Children less than one year of age may also need to receive other immunizations ahead of schedule see the accelerated immunization schedule. Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Tanzania. The recommendations for malaria prophylaxis are the same for young children as for adults, except that 1 dosages are lower; and 2 doxycycline should be avoided.
DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites. When traveling with young children, be particularly careful about what you allow them to eat and drink see food and water precautions , because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever , which are transmitted by contaminated food and water, are not approved for children under age two.
Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times. Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.
Because of the risk of malaria and yellow fever , pregnant women should not in general travel to Tanzania. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus.
Malaria may cause life-threatening illness in both the mother and the unborn child. Mefloquine Lariam is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.
If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
Americans living or traveling in Tanzania are encouraged to register with the nearest U. Americans without Internet access may register directly with the nearest U. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U. The international mailing address is Post Office Box , Dar es Salaam, Tanzania; telephone [] 22 and fax [] 22 Office hours are a. Monday through Thursday, and a. Travelers may also contact the U.
Embassy in Tanzania via email at consulardx state. For information on safety and security, go to the U. Been to Tanzania recently? What is the current health situation there? Do you have any information on the place. Is the information on this page as you found it? If you are not logged in, or choose to make the drop box anonymously you can tell the community honestly what you seen without any concern.
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If you want to use the sites without cookies or would like to know more, you can do that here. Would you like to Edit this page? Login or Sign up! Summary of recommendations Most travelers to Tanzania will need vaccinations for hepatitis A , typhoid fever , yellow fever , and polio , as well as medications for malaria prophylaxis and travelers' diarrhea.
Vaccinations: Polio One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult Yellow fever Recommended only for those at risk for a large number of mosquito bites. Required for travelers arriving from a yellow-fever-infected country in Africa or the Americas Hepatitis A Recommended for all travelers Typhoid Recommended for all travelers Hepatitis B Recommended for all travelers Rabies For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats Measles, mumps, rubella MMR Two doses recommended for all travelers born after , if not previously given Tetanus-diphtheria Revaccination recommended every 10 years.
Edit Comment. Save Cancel Delete. Medications Travelers' diarrhea is the most common travel-related ailment. Insect protection measures are essential. This was the fourth such survey conducted in mainland Tanzania. Detailed ACTwatch project and methodological information have been published elsewhere [ 16 , 17 ]. Briefly, all potential outlet types stocking anti-malarials and diagnostics in mainland Tanzania in both public and private sectors were included in the study.
This includes outlets that may not typically be expected to stock anti-malarial medicines, such as general retailers, village shops, or itinerant drug vendors.
These outlets may differ on a country-by-country basis, but broad categories are used to define public and private sector outlets. Outlets sampled in the public sector included public health facilities e. The private-sector outlet types sampled were private for-profit health facilities including private hospitals, clinics, diagnostic laboratories , pharmacies which are registered and licensed by a national regulatory authority, and staffed by pharmacists and qualified health practitioners , ADDOs drug stores that primarily sell medicines, registered with a national regulatory authority, where staff have received training , DLDBs drug stores that primarily sell medicines, with no formal licensing, and no guarantee of staff training , general retailers grocery stores and village shops , and itinerant drug vendors mobile, unregistered providers selling medicines.
The primary sampling approach taken for ACTwatch outlet surveys entails sampling a set of administrative units geographic clusters with a population of approximately 10, to 15, inhabitants. Clusters are selected with cluster probability of selection proportionate to size PPS. The most appropriate administrative unit in mainland Tanzania matching the desired population size was at the ward level. Clusters wards were selected using probability proportional to population size sampling, using data from the Tanzania Population and Housing Census [ 18 ].
Additional wards were selected for oversampling of public health facilities, private for-profit health facilities, pharmacies, and ADDOs. This booster sampling strategy was used to obtain a sufficient sample size for indicator estimates within these outlet types. The sample was stratified by urban—rural ward designation.
In total, 58 wards were selected for the main census sample 28 rural, 30 urban and a further wards were selected for the booster sample 84 rural, 88 urban. Within each selected cluster a census of all outlet types with the potential to provide anti-malarials or diagnostics to consumers was undertaken. The inclusion criteria for outlets were: 1 one or more anti-malarials in stock on the day of the survey; 2 one or more anti-malarials in stock in the three months preceding the survey; and, 3 malaria blood testing RDTs or microscopy available.
The number of study clusters was calculated for each research domain based on the required number of anti-malarial stockists and assumptions about the number of anti-malarial stockists per cluster.
Sample size requirements for the survey were calculated using information from the survey round including anti-malarial and QA ACT availability, outlet density per cluster, and design effect. Fieldworker training consisted of standardized classroom presentations and exercises as well as a field exercise. Examinations administered during training were used to select field workers, supervisors and quality controllers.
Additional training was provided for supervisors and quality controllers focused on field monitoring, verification visits and census procedures.
Fieldwork teams were provided with a list of selected clusters and official maps that illustrated administrative boundaries.
In each selected cluster, fieldworkers conducted a full enumeration of all the aforementioned outlet types. This included enumeration of outlets with a physical location, as well as identification of itinerant drug vendors using local informants.
To identify outlets, fieldworkers systematically walked through each cluster, looking for the outlets. To distinguish between pharmacies, ADDOs and DLDBs, fieldworkers were trained to look for licenses hanging up on the wall and to prompt providers for any clarification, especially when these licenses were not legible. In mainland Tanzania, pharmacies have licenses clearly displayed above counters, and ADDOs have a specific license that include a logo to recognise the outlet as part of the programme.
Interviews were conducted in Swahili using questionnaires that were translated from English to Swahili and back to English to confirm translations. A structured questionnaire programmed into mobile phones using DroidDB software was used to complete an audit of all anti-malarials and RDTs as well as a provider interview. Quality control measures implemented during the fieldwork included questionnaire review by supervisors. Provider interviews and product audits were completed only after administration of a standard informed consent form and provider consent to participate in the study.
Providers had the option to end the interview at any point during the study. Standard measures were employed to maintain provider confidentiality and anonymity. The outlet survey questionnaire included an audit of all available anti-malarial medicines and RDTs. Providers were asked to show the interviewer all anti-malarial medicines and RDTs currently available.
A product audit sheet captured information for each unique product in the outlet, including formulation, brand name, active ingredients and strengths, package size, manufacturer and country of manufacture for anti-malarials, and brand name, manufacturer, country of manufacture, antigens and parasite species for RDTs.
Providers were asked to report the retail and wholesale price for each product as well as the amount distributed to individual consumers in the last week. Standard indicators were constructed according to definitions applied across the ACTwatch project, descriptions of which have been provided in detail elsewhere [ 9 , 11 ]. Anti-malarials identified during the outlet drug audit were classified according to information on drug formulation, active ingredients and strengths as non-artemisinin therapy, artemisinin monotherapy and ACT.
Non-artemisinin therapy was classified as SP or other non-artemisinin therapy. Artemisinin monotherapy was further classified as oral and non-oral, the latter including medicines recommended for first-line treatment of severe malaria. Classification was completed by matching product audit information formulation, active ingredients, strengths, manufacturer, country of manufacture, package size to lists of approved medicines from the WHO, EMA and Global Fund.
QA ACT availability in the public sector was among all outlets screened, while in the private sector it was restricted to those outlets that had anti-malarials in stock. Anti-malarial market share, or the relative distribution of the anti-malarials to individual consumers recorded in the drug audit, was standardized to allow for meaningful comparisons between anti-malarials with different treatment courses and different formulations.
The adult equivalent treatment dose AETD was defined as the amount of active ingredient required to treat an adult weighing 60 kg according to WHO treatment guidelines [ 19 ]. Provider reports on the amount of the drug sold or distributed during the week preceding the survey were used to calculate volumes according to type of anti-malarial.
Measures of volume included all dosage forms to provide a complete assessment of anti-malarial market share. Diagnostic market share was calculated from the number of malaria blood tests i.
The interquartile range IQR is displayed as a measure of dispersion. Price data presented were collected in local currencies and converted to US dollar prices average exchange rate for the data collection period. Price measures included tablet anti-malarials only, given differences in unit costs for tablet and non-tablet formulations. These other formulations were excluded from median price calculations.
Provider knowledge was measured as the percentage of providers who identified ACT as the most effective treatment for uncomplicated malaria. Sampling weights were calculated as the inverse of the probability of cluster selection.
All point estimates were weighted using survey settings and all standard errors calculated taking account of the clustered and stratified sampling strategy with the relevant suite of survey commands in Stata. A finite population correction was also applied to adjust standard errors, as a relatively large proportion of available clusters were selected for inclusion in the sample. Table 1 shows the availability of anti-malarials and malaria diagnosis among all screened public sector outlets.
Across the public sector, QA ACT availability was SP accounted for the majority of available non-artemisinin therapy, stocked by Injectable artesunate was found in Malaria diagnostics were available in In the private sector, among all screened outlets, availability of any anti-malarial was highest among pharmacies Of the general retailers screened, only 0. Table 2 shows private sector availability of different types of anti-malarials among outlets with any anti-malarial in stock on the day of the survey.
Among anti-malarial stockists, In terms of availability of different pack sizes, Oral quinine was also stocked by Injectable artesunate was available in Malaria diagnosis was available among Availability of malarial microscopy was 5.
When disaggregated by outlet type, the price of these three anti-malarials was usually lower in DLDBs than other private outlet types Additional file 5. Of all anti-malarials distributed, Of all the anti-malarials distributed, SP was the most commonly distributed anti-malarial in the private sector Oral AMT was absent from the market in this survey round.
The relative anti-malarial market share within outlet type is shown in Additional file 6. Most of the diagnostic tests distributed across the public and private sector were RDTs Figure 3 shows the percentage of providers who reported that ACT was the most effective treatment for uncomplicated malaria for adults and children. Providers in the public sector perceived ACT as the most effective treatment for uncomplicated malaria for adults and children This paper has provided a comprehensive overview of the malaria testing and treatment landscape in mainland Tanzania in , in both public and private sectors.
While the public sector shows strong readiness to adhere to national guidelines, there is sub-optimal QA ACT availability and market share in the private sector.
There is also persistent widespread distribution of SP, which continues to predominate the anti-malarial market. The National Malaria Strategic Plan [ 3 ] aims for the provision of universal access to malaria testing and first-line treatment, and these results indicate that universal access has almost been achieved in this sector.
Only a small fraction 5. Furthermore, three-quarters of public health facilities had injectable artesunate, the first-line treatment for severe malaria, and this reflects a substantial increase in the public sector since the previous survey round, from National efforts to align with the WHO recommendations for treatment of severe malaria are reflected in these findings. The results for provider knowledge in the public sector were also encouraging, and stand in contrast to a previous study that found overall poor levels of knowledge of AL in this sector [ 21 ].
Despite these promising findings, there are some gaps in public sector readiness for malaria case management that require attention. Of concern is the finding that SP was available in just over half of all screened outlets in the public sector, meaning that much of the public sector is not equipped to provide IPTp, although this reflects an increase from and [ 22 ].
The findings from the most recent outlet survey suggest there are key challenges to be addressed, including maintaining a constant supply of SP across the public health sector. QA ACT market share within the public sector was also at its lowest level since before the launch of the AMFm, only one in three anti-malarials distributed in the public sector were a QA ACT in compared to one in every two in [ 22 ]. In the public sector, availability of the different weight categories was variable.
For example, a pack size of 12 tablets of QA AL was available in less than half of the public sector outlets. Providers may ration ACTs because of uncertainty with supply coupled with availability of non-recommended treatments [ 23 ].
Alternatively, this may reflect an increase of RDTs in this sector and better management of patients through confirmatory testing, lending to a reduction of QA ACT market share. Other population based evidence from mainland Tanzania between and reported a significant decrease in the percentage of people with fever obtaining ACT from As such, the market share findings from this outlet survey may reflect increases in diagnostic coverage and better management of patients.
In , almost all pharmacies, ADDOs and DLDBs that were screened were in the business of stocking malaria commodities, as were around three-quarters of private not for-profit facilities.
Consistent with previous outlet surveys [ 20 ], general retailers are not typically anti-malarial stockists. Of the screened outlets, only ten had anti-malarials in stock in Market share data also illustrate the importance of the private sector, which accounted for Anti-malarials in the private sector were also most commonly distributed through ADDOs. Since , the ADDO programme has been implemented as a means to regulate and improve service provision of health care in the private sector.
The findings from illustrate that ADDOs accounted for over anti-malarials stockists in the private sector compared to DLDBs, representing the greatest concentration of private sector service delivery points for malaria.
These findings are reflective of the several initiatives by the mainland Tanzania government over the years to scale up the ADDO programme and increase coverage of regulated private sector outlets. Where anti-malarials were available in the private sector, just over half of the anti-malarial stockists had QA ACT available. Non-artemisinin therapy, typically SP, accounted for one-half of all anti-malarials distributed.
The availability of malaria confirmatory testing was also very low in the private sector. This is corroborated by household survey data that found only 2. However, where confirmatory testing was available, the results also demonstrate that the median price of all malaria diagnostics was lower than QA ACT, which is encouraging as it may provide a cost incentive for a patient to test before treatment.
While ADDOs accounted for the largest distribution of QA ACT, and comprised most of the market share in the private sector, there was very little difference in the anti-malarial mix across outlet types, given SP was the most commonly dispensed anti-malarial across all outlets.
Lessons on how to maintain and improve ACT availability and distribution among these outlet types can be learnt from several studies that have investigated factors which influence ADDO ACT stocking characteristics. Studies have found that ADDOs with greater client load and which are in close proximity to other outlets that sell ACT medicines, are more likely to stock ACT as compared to isolated outlets which serve fewer customers [ 25 , 26 ].
Another determinant of ACT stocking practices among ADDOs has been the presence of a licensed pharmacist [ 25 , 26 ], and somewhat related to this, staff retention. Future strategies to improve the retention rate of trained personnel at ADDOs will be key to ensure the sustainability of an effective ADDO programme and may want to consider the targeting of busier outlets in competitive markets to encourage faster uptake of ACT.
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