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More than 248,000 people—mostly from Burundi and the Democratic Republic of Congo—reside in the Nyarugusu, Nduta, and Mtendeli refugee camps in Tanzania’s Kigoma region after being driven from their homes by political unrest. People living in these camps are often confined within them, with limited work, with limited work opportunities, and must rely on humanitarian assistance to meet their basic needs.
They also face multiple health challenges, including malaria. This disease can be particularly dangerous for pregnant women and children under five, two groups that also make up a substantial population in the refugee camps.
One way to protect people from malaria is to apply a chemical to the inside walls and ceilings that is safe for people but kills the malaria-carrying mosquitoes after they land on it. This process is called indoor residual spraying (IRS) and many countries, including Tanzania, conduct annual campaigns to spray homes each year.
Tanzania’s National Malaria Control Program requested that the U.S. President’s Malaria Initiative (PMI) study whether IRS could be conducted safely and effectively within each camp environment. The February 2019 study found that structures within the camps were eligible for IRS. Working in partnership with the local district health authorities, PMI through VectorLink then sprayed Mtendeli camp in Kakonko district, Nyarugusu camp in Kasulu District, and Nduta camp in Kobondo District starting in 2019 and continuing each year since.
For 2021, PMI transitioned leadership to the local ministry of health staff known as District IRS Technical Teams (DITTs) to lead spraying within the three refugee camps. PMI provided support through the provision of supervisory tools and assistance with the recruitment process. All necessary IRS training materials were shared with the DITTs before the start of the supervisor training.
Tanzania’s Ministry of Home Affairs and the United Nations High Commissioner for Refugees (UNHCR), which manages the camps, recognized that it was vital to recruit camp residents to play a role in IRS. They hired camp residents—half of whom were women—to work as mobilizers, security guards, water fetchers, and washers. Mobilizers help inform families about the spraying and encourage them to agree to have their sleeping spaces sprayed. The local residents doing the mobilization were known and trusted within the community and were also able to communicate the importance of IRS in their native language, which helped to increase IRS acceptance within the camps.
In 2021, PMI worked with Tanzania to protect in total a vulnerable population of 224,393 people, or about 98 percent of the population of the three refugee camps. This included 10,346 pregnant women and 50,368 children under five.
Mercy Msirikale has worked as a public health officer for the Ministry of Home Affairs for three years. She witnessed the devastating impact of malaria on the camp residents as well as the drop in cases after IRS implementation.
“We appreciate the presence of IRS in the refugee camps because the cases of patients presenting with malaria were frequent sometime back before implementation of IRS, but this has changed over the last three years; malaria cases significantly dropped,” Mercy said.
From 2018 to 2021, the proportion of people with malaria in the refugee camps fell from 63 to 15 percent in Mtendeli and from 43 to 12 percent in Nyarugusu.
The Nduta refugee camp saw a smaller decrease—a trend that is consistent with Kibondo district, where malaria cases were lower to begin with—at 25 percent pre-spray and just below 24 percent after. This camp had a number of structures made out of plastic, meaning they cannot be sprayed with insecticide, so the team is planning to coordinate with UNHCR and other partners such as Médecins Sans Frontièrs and Tanzania Red Cross to harmonize other malaria prevention interventions, such as distributing insecticide-treated bed nets to harness greater impact.
Isaya Mihayo