Abstract 2006 Version 2

B
UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH AND SOCIAL WELFARE
ANNUAL HEALTH STATISTICAL

ABSTRACT
April 2006
ISSUED BY:
HEALTH INFORMATION AND RESEARCH SECTION
POLICY AND PLANNING DEPARTMENT
P.O. BOX 90883
DAR ES SALAAM
TABLE OF CONTENTS
TABLE OF CONTENTS..................................................................................................................i
FIGURES.........................................................................................................................................ii
TABLES...........................................................................................................................................v
ACKNOWLEDGEMENTS............................................................................................................vi
PREFACE......................................................................................................................................vii
ABBREVIATIONS AND ACRONYMS.....................................................................................viii
CHAPTER 1: RESOURCE STATISTICS.......................................................................................1
1.0 Introduction..........................................................................................................................1
1.1 Human Resource Statistics..................................................................................................1
1.2 Health Facilities in Tanzania................................................................................................8
1.2.1 Distribution of health facilities by type, ownership and regions...................................8
1.2.2 Health facility beds......................................................................................................12
1.2.3 Health Facility Equipment...........................................................................................14
1.2.5 Proportion of health facilities in good state by type ..................................................16
1.3 Health financing on Tanzania Mainland............................................................................17
1.3.1 Health in relation to the total Government of Tanzania (GOT) budget.......................17
1.3.2 Other measures of health spending..............................................................................19
1.3.3 Regional level trend ....................................................................................................21
1.3.4 Local government trend ..............................................................................................22
CHAPTER 2: MORBIDITY AND MORTALITY STATISTICS.................................................23
2.1 Morbidity...........................................................................................................................24
2.2 Mortality............................................................................................................................27
2.3 Notifiable diseases.............................................................................................................29
2.3.1 Cholera otbreak............................................................................................................29
CHAPTER 3: DISEASES UNDER SPECIAL PROGRAMME..................................................31
3.1 Malaria control programme ..............................................................................................31
3.1.1 Monitoring and evaluation...........................................................................................32
3.1.2 Scaling up use of insecticide treated nets (ITNs).........................................................37
3.1.3 Use of intermittent preventive treatment by pregnant women....................................38
3.1.4 Prevention and containment of malaria epidemics......................................................38
3.2 National Tuberculosis and Leprosy Control Programme (NTLP).....................................38
3.2.1 Tuberculosis case finding.............................................................................................38
3.2.2 Tuberculosis treatment outcome results.......................................................................42
3.3 Leprosy control services....................................................................................................45
3.3.1 Case finding.................................................................................................................45
3.3.2 Registered prevalence .................................................................................................46
3.3.3 Disability grading and proportion of children notified................................................46
3.4 HIV/AIDS/STIS ................................................................................................................48
3.5 Surveillance of AIDS cases ...............................................................................................49
3.5.1 Distribution of AIDS cases..........................................................................................49
3.5.2 HIV prevalence among pregnant women attending ANC...........................................53
3.5.3 Syphilis prevalence .....................................................................................................57
3.5.4 Trends of HIV infection among blood donors ............................................................58
3.5.5 Age and sex specific HIV infection trends..................................................................58
3.5.6 HIV infection trends by regions and districts..............................................................59
CHAPTER 4: REPRODUCTIVE AND HEALTH STATISTICS.................................................62
4.1 Introduction .......................................................................................................................62
4.2 Clinical...............................................................................................................................62
4.3 Family planning.................................................................................................................66
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4.4 Antenatal care.....................................................................................................................69
4.4 Deliveries...........................................................................................................................70
4.5 Vaccination.........................................................................................................................71
4.5.1 Tetanus Vaccination.....................................................................................................71
4.5.2 BCG Vaccination.........................................................................................................73
4.5.3 DPT3 vaccination.........................................................................................................74
4.5.4 Polio Vaccination.........................................................................................................74
4.5.5 Measles vaccination....................................................................................................75
4.6 Nutrition.............................................................................................................................76
4.5.7 Maternal care...............................................................................................................77
4.6 School health programme..................................................................................................80
4.6.2 Primary School Visit....................................................................................................80
CHAPTER 5: ENVIRONMENTAL HEALTH AND SANITATION STATISTICS....................82
5.1 Introduction........................................................................................................................82
5.1 Water and sanitation ..........................................................................................................82
5.1.1 Water ...........................................................................................................................82
5.1.2 Sanitation.....................................................................................................................84
5.3 Occupational health and safety.........................................................................................85
CHAPTER 6: DEMOGRAPHIC DATA FROM SELECTED......................................................88
SENTINEL SITES........................................................................................................................88
6.1 Introduction........................................................................................................................88
6.2 Intervention Addressable Burden of Disease Graphics Broad Causes .............................88
6.2.1 Broad causes of burden of diseases.............................................................................88
6.2.2 Main causes .................................................................................................................89
ANNEXES...................................................................................................................................100
Annex 1 OPD attendances, Tanzania Mainland: 2004..........................................................101
Annex 2 Admissions, Tanzania Mainland: 2004...................................................................102
Annex 3 Cumulative number of reported AIDS cases by region, ...........................104
Annex 4 Prevalence of HIV and syphilis infection by ANC sites, ......................................105
Annex 5 Prevalence of HIV infection among blood donors by region and district, ...........107
FIGURES
Figure 1.1 Health workers by type of employer Tanzania Mainland: 2004/05.............................2
Figure 1.2 Population ratio per one medical doctor by region......................................................3
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Figure 1.3 Population per one assistant medical officers by region year 2004/05........................4
Figure 1.4 Population per one clinical officer by region year 2004/05.........................................5
Figure 1.5 Population per one nursing officer by region year 2004/05.........................................6
Figure 1.6 Population per dental surgeon by region year 2004 /05...............................................7
Figure 1.7 Population per assistant dental officer by region year 2004/05...................................8
Figure 1.8 The number of health facilities by ownership.......................................................10
Figure 1.9 The number of hospitals by ownership, Tanzania Mainland: 2004/05......................11
Figure 1.10 The number of health centres by ownership .......................................................11
Figure 1.11 Number of hospital beds by type of ownership.......................................................13
Figure 1.12 Proportion of health facilities in good state of repair...............................................16
Figure 1.13 Spending on the health sector as a proportion of the total ......................................17
Figure 1.14 Nominal government spending on health and its rate of growth, ............................18
Figure 1.15 Distribution of the government budget for health by administrative.......................21
Figure 1.16 Allocation of funds for health purposes to regions ..................................................21
Figure 2.1 Top ten OPD patients diagnoses age below five years, ...........................................24
.......................................................................................................................................................24
Figure 2.2 Top ten OPD diagnosis for patient age 5 years and above ........................................24
Figure 2.3 Top ten leading causes of admission for patients age below five years, ...................25
Figure 2.4 Top ten leading causes of admission for patients age five and above........................26
Figure 2.5 Top ten leading causes of deaths for patients age below five years, .........................27
Figure 2.6 Top ten leading causes of deaths for patients age five years and above, ...................28
Figure 2.7 Case Fatality Rates for top ten leading causes of deaths for < 5 yrs..........................28
Figure 2.8 Case Fatality Rate for top ten leading causes of deaths for 5+ yrs.............................29
Figure 2.9 Monthly cholera cases, Tanzania Mainland: 2005.....................................................29
Figure 2.10 Distribution of reported cholera cases by region, Tanzania Mainland: ...................29
Figure 2.11 Number of Measles, Meningitis and Rabies cases recorded, ..................................30
Figure 2.12 Monthly Number of Neonatal Tetanus (NNT) and AFP..........................................30
Figure 3.1 All ages malaria cases versus other cases, Tanzania Mainland: ...............................33
Figure 3.2 All ages IPD malaria admission versus other case, Tanzania Mainland: ..................34
Figure 3.3 All ages deaths due to malaria versus other cases, Tanzania Mainland: ...................35
Figure 3.4 Malaria cases as a proportion of all attending OPD by region ..................................35
Figure 3.5 Admissions due to malaria as proportion of all admissions by region .....................35
Figure 3.6 Deaths due to malaria as proportion of all deaths that occurred in HFs....................36
Figure 3.7 Tuberculosis cases (all forms) by region notified in 2004.........................................38
Figure 3.8 Tuberculosis notification rate (smear positive per 100,000) .....................................40
Figure 3.9 Tuberculosis cases notified by category in Tanzania: 2000 – 2004...........................40
Figure 3.10 Distribution of New smear positive TB cases notified in 2004 ..............................41
Figure 3.11 Treatment success rate for cohort notified in 2003 by region.................................43
Figure 3.12 Death among smear positive cases notified in 2003 by regions..............................43
Figure 3.13 Treatment outcome results of new smear positive TB cases notified, .....................44
Figure 3.14 The outcome for each category retreated, Tanzania Mainland: 2003.......................44
Figure 3.15 Leprosy detection rate per 10,000 of the population by region: 2004......................45
Figure 3.16 Leprosy case detected by category, Tanzania Mainland: 2000 – 2004.....................45
Figure 3.17 Leprosy prevalence and detection rate in Tanzania 2000 – 2004.............................46
Figure 3.18 Treatment completion of PB leprosy cases notified in 2003 by region....................47
Figure 3.19 Treatment completion of MB leprosy cases notified in 2002 by region..................47
Figure 3.20 Leprosy treatment completion for both MB and PB 1994 – 2003...........................47
Figure 3.21 Distribution of reported AIDS cases by age and sex, Tanzania, ..............................50
......................................................................................................................................................51
Figure 3.21 Marital Status of reported AIDS cases for the year 2004....................................51
Figure 3.22 Possible source of infection for reported AIDS cases 2004...................................51
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Figure 3.22 Trend of reported AIDS cases, Tanzania Mainland:1983 to 2004...........................52
Figure 3.24 Prevalence of HIV and syphilis among ANC attendees by region:..........................53
Figure 3.25 Overall and location specific prevalence of HIV and syphilis ................................54
Figure 3.26 Age Specific Prevalence of HIV and syphilis .........................................................55
Figure 3.27 Prevalence of HIV and Syphilis among ANC attendees .........................................55
Figure 3.28 Prevalence of HIV and Syphilis among ANC attendees by education ...................56
Table3.29 Prevalence of HIV and syphilis among ANC attendees .............................................56
Figure 3.30 Age and sex specific trends of HIV infection, Tanzania Mainland: ........................58
Figure 4.1a Causes of neonatal deaths, Tanzania Mainland: 2000.............................................63
Figure 4.1b: Causes of neonatal d, Tanzania Mainland: 2001.....................................................63
Figure 4.1c Causes of neonatal deaths, Tanzania Mainland: 2002..............................................63
Figure 4.1d Causes of neonatal deaths, Tanzania mainland: 2003..............................................64
Figure 4.1e Causes of neonatal deaths, Tanzania Mainland: 2004..............................................64
Figure 4.3 Trend of Family Planning New Accepters, Tanzania Mainland: ...............................66
Figure 4. 5 Trend of Pregnant mothers registered for ANC, Tanzania Mainland:.......................70
Figure 4.6 Percentage of Pregnant Women Vaccinated TT2+, Tanzania Mainland: ..................72
Figure 4.7 Neonatal tetanus cases, Tanzania Mainland: 2000 – 2004 .......................................72
Figure 4.8 Immunization coverage for the under one year (BCG) : ...........................................73
Figure 4.9 Immunization coverage for the under one year (DPT3): 2004 for regions................74
Figure 4.10 Immunization coverage for the under one year (Polio 3):.......................................75
Figure 4.11 Immunization coverage for the under one year (Measles): .....................................75
Figure 4.12 Leading causes of maternal death, Tanzania Mainland: 2000 – 2004......................79
Figure 4.13 Percentage of students having undergone medical examination, ............................81
Figure 5.1 Distribution of Households with access to safe water sources ..................................83
Figure 5. 2 Households with appropriate latrines by Regions: 2004/05......................................84
Figure 5.3 Number of hospitals with De Mont Fort and De Mont Fort incinerators ..................85
Figure 5. 4 Periodic Medical Examination by municipality: 2004/05.........................................86
Figure 5. 5 Distribution of accidents in percent by occupation: 2004/05....................................86
Figure 5. 6 Distribution of safety gears in percent by occupation: 2004/05................................87
Figure 6.1 Broad Causes of the Burden of Disease in 2004 .......................................................89
Figure 6.2 More detailed main causes ........................................................................................89
Figure 6.3 Mortality by age group...............................................................................................90
Figure 6.4 Burden carried per capita (risk)..................................................................................90
Figure 6.5 District disease burden addressable by available cost effective ...............................91
Figure 6.6 District health services profile intervention addressable shares ................................91
Figure 6.7 Main causes of death for under-fives ........................................................................93
Figure 6.8 I MCI addressable conditions ....................................................................................93
Figure 6.9 Malaria addressable conditions .................................................................................94
Figure 6.10 STI addressable conditions - all ages ......................................................................95
Figure 6.10 SMI addressable conditions .....................................................................................95
Figure 6.11 SMI Perinatal Addressable Conditions ....................................................................96
Figure 6.12 SMI Maternal Addressable Conditions ...................................................................96
Figure 6.13 All Major EDP Addressable Conditions ..................................................................97
Figure 6.14 Other EDP Addressable Conditions ........................................................................97
Figure 6.15 EPI+Vit A Addressable Conditions - All Ages ........................................................98
Figure 6.16 TB DOTS and BCG Addressable Conditions .........................................................99
Figure 6.17 Injury Care Addressable Conditions ........................................................................99
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TABLES
Table 1.1 Distribution of hospitals and health centres by region and ownership .........................9
Table 1.2 Distribution of dispensaries and total health facilities by region ..................................9
Table 1.3 Number of beds in hospitals by type of ownership and region 2004/05......................12
Table 1.4 Health Facility Equipments by region for year 2005...................................................15
Table 1.5 Other measures of spending, MOF data FY01 – FY05...............................................19
Table 1.6 Total expenditure on health, Tanzania Mainland: Y2001/02 – FY2004/05 ................20
Table 1.7 Regional sub-vote budgets and expenditure, ..............................................................22
Table 1.8 Central government health subventions to local government, ...................................22
Table 1.9 Sector expenditure by level, Tanzania mainland: ........................................................23
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Table 3.1 Proportion of OPD attendances attributed to malaria by age groups ........................32
Table 3.2 Proportion of admissions due to malaria, Tanzania Mainland:..............................33
Table 3.4 Malaria Case Fatality Rate by regions in the year 2004..............................................37
Table 3.5 Ownership of Insecticide Treated Nets in households and their usage .......................37
Table 3.6 Tuberculosis cases notified by regions in Tanzania 2004............................................39
Table 3.7 Tuberculosis cases notified by category in Tanzania: 2000 - 2004..............................40
Table 3.8 Distribution of new smear positive TB cases notified in 2004 ...................................41
Table 3.9 Treatment outcome results of new smear positive TB cases notified in 2003.............42
Table 3.10 Distribution of reported AIDS cases by age and sex, Tanzania 2004.......................49
Table 3.11 Age–specific prevalence (in percentage) of HIV infection among male...................59
Table 3.12 Age–specific prevalence (in percentage) of HIV infection among female................59
Table 3.13 Prevalence of HIV infection (in percentage) among male blood donors...................60
Table 3.14 Prevalence of HIV infection (in percentage) among female blood donors ...............60
Table 4.1 Causes of neonatal deaths, Tanzania Mainland: 2000 – 2004......................................62
Table 4.2 Main causes of death for children age 0-28 days by region:.....................................65
Table 4.3 The number of family planning new acceptors, ..........................................................66
Table 4.4 Trend of family planning new acceptors For, Tanzania Mainland: .............................67
Table 4.5 Proportion of women of childbearing age using family planning ..............................68
Table 4.6 Pregnant mothers registered for ANC, Tanzania Mainland: 2000 -2004....................69
Table 4.7 Proportion of clients attending for the purpose of ANC ............................................70
Table 4 8 Proportion of clients attending for the purpose of delivery by region , ......................71
Table 4.9 Vaccination TT2+ for pregnant women and children born protected..........................72
Table 4.10 Proportion of Pregnant women attending ANC receiving TT+2 ..............................72
Table 4.11 Total attendance and nutritional status children age 0 – 1 years ...............................76
Table 4. 12 Proportion of the under one year with body weight less than 60% .........................77
Table 4.13 Number of Maternity Deaths reported for years 2000 – 2004...................................78
Table 4.14 Causes of maternal death, Tanzania Mainland: 2000 - 2004 ...................................78
Table 4.15 Percentage of risk factors among pregnancy mother registered for ANC, ...............79
Table 4.16 Percentage of primary schools visited for health education, ....................................80
Table 4.17 Percentage of schools with first aid kits, Tanzania Mainland: ..................................80
Table 4.18 Percentage of schools providing meals, Tanzania mainland: 2000-2004..................81
ACKNOWLEDGEMENTS
The primary aim of this report is to present statistics on the progress of performance of the
health sector on Tanzania Mainland. Most of the statistics presented are for the year 2004
however, in some chapters tables and figures reflect up to the year 2005.
This report has been prepared with assistance and in collaboration with many people in their
different capacities. While to all these say thank you. We would particularly like, at national
level, to thank all Directors at the Ministry of Health, Head of Sections, Programme Managers
and some members of Health Measurement and Performance Task Force. At regional and
district levels thank are due to the Regional Medical Officers (RMOs) and District Medical
Officers (DMOs) for providing the data on which this report is based.
vi
In this course of the preparation of this report the following assisted in collecting and editing
the report: Mr Josibert J. Rubona (HIR - MOH), Mr. Mdoe Robert Mdoe (HIMS - MOH), Dr.
Elias Kwesi (HSR - MOH), Dr. Leonard Mboera (DITC- NIMR), Mr. Emmanuel Makundi (HSR-
NIMR), Dr. Ahmed Hingora (HSPS – MOH), Ms Joyce Chitalika (HIMS – MOH), Mr. Wilfred
Yohana (NSS – MOH), Ms Lydia Mwaga (HMIS – MoH), Mr. T Mkoba (HMIS- MOH), Ms
Monica Masanja- Secretary. We hope that the cooperation provided will be also be provided
during the preparation of future reports.
PREFACE
vii
ABBREVIATIONS AND ACRONYMS
AIDS Acquired Immune Deficiency Syndrome

AMMP Adult Morbidity and Mortality Project
AMOs Assistant Medical Officers
DHS Demographic and Health Survey
DITC Directorate of Information Technology and Communication
DMOs District Medical Officers
HSPS Health Sector Programme Support
DPT Diphtheria Pertussis Tetanus
HMIS Health Management Information System
HIV Human Immunodeficiency Virus
HIR Health Information and Research
viii
HSR Health Systems Research
IMCI Integrated Management of Childhood Illnesses
IMR Infant Mortality Rate
ITNs Insecticide Treated Nets
MCH Mother and Child Health
MDGs Millennium Development Goals
MoH Ministry of Health
NACP National AIDS Control Programme
NIMR National Institute for Medical Research
NSS National Sentinel Sites
NTLP National Tuberculosis and Leprosy Programme
PMTCT Prevention of Mother to Child HIV Transmission
PPF Procaine Penicillin Fortified
RAS Regional Administrative Secretary
RMOs Regional Medical Officers
STIs Sexually Transmitted Infections
TBAs Traditional Birth Attendants
WHO World Health Organization
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CHAPTER 1: RESOURCE STATISTICS
1.0 Introduction
One of the major inputs into the delivery of quality health services is adequate resources like
human resources, infrastructure and financial resources. In order to evaluate the adequacy of
resources and see if there have been significant improvements over the years, some indicators
have been calculated and trend analyses have been done. This chapter, through staff ratio per
number of population highlights the actual workload for selected cadres of during the year
2004/05.
The infrastructure of the health delivery system is another aspect that has been considered in
this chapter. The information available shows the distribution of health facilities on Tanzania
Mainland as well as the ownership of those facilities. The distribution by ownership shows how
different stakeholders supplement government efforts in providing quality health services in
the country. The proportion of government health facilities in good state of repair can also be
used as proxy indicator for good quality services.
The importance of financing in the health sector cannot be overemphasized. Poor health
services in this country are due to under financing. However, in recent years some
improvements have been recorded due government efforts and development partners who
have put in more money than in previous years. Also, introduction of other sources for health
sector financing has helped to bridge financial gaps.
After independence, Tanzania had one financing source for the Health sector which was
through general taxation. However, due to the economic crisis facing the country, the
Government could not carry the burden for long. Hence the health sector was a good start for
reforms, which included among other things the financing reforms. The ministry worked out
other possible sources of funds in order to bridge the gap between the budget requirement and
the allocation from the central government. All these efforts, were geared towards the
achievement of our vision which is to improve the health and well being of all Tanzanians, with
a focus on those most at risk. To start with the government introduced user fees which is the
base for other complementary financing options. To date, apart from the government, other
sources of finance for the sector are external financing (donors), Community Health Financing
(CHF), User Fees, National Health Insurance Fund (NHIF), Tiba kwa Kadi (TIKA) etc.
1.1 Human Resource Statistics

In this country, government is a main employer of health workers. Through special agreements,
some of its employees are allocated to faith based health facilities. Figure 1.1 shows, the
majority of health staff about 74 percent work in the government health facilities, followed by
faith based facilities with a share of 22 percent. Private facilities employ about three percent and
parastatal owned facilities have one percent of total workforce in the health sector. This pattern
applies to all cadres although they differ in the magnitude in terms of percentages.
1
Figure 1.1 Health workers by type of employer Tanzania Mainland: 2004/05
Parastatal
1%
Private
Faith Based 3%
22%
Government
74%
Figure 1.2 shows the population per one medical doctor in each region. The available statistics
exclude medical doctors working in consultant, specialised hospitals and doctors working at the
Ministry of Health headquarters. This is because their particulars are not reported through
Regional Medical Officers. Even with missing information, the workload for medical doctors is
huge. This is due to high population growth rate and the small number of new recruited doctors
each year. Also, the turnover for this cadre is very high as the doctors migrate to other countries
to look a better pay. The number of people to be served by one doctor was found to be very
high in three regions namely Rukwa (309,000), Mwanza(308,000) and Shinyanga(306,000). The
regions with the lowest population per doctor were Arusha (39,000) and Coast (42,000). The
national average is 138,000 persons per doctor.
2
Figure 1.2 Population ratio per one medical doctor by region
Tanzania Mainland: 2004/05
Regions
Rukwa 309
Mwanz a 308
Shinyanga 306
Iringa 254
Dodoma 168
Mbeya 153
Manyara 145
Tabora 143
Morogoro 133
Lindi 119
Kilimanjaro 116
Mtwara 116
Kigoma 116
Kage ra 66
Tanga 61
Ruvuma 59
Mara 58
Dar es Salaam 50
Coast 42
Aru sha 39
Ave rage 138
0 50 100 150 200 250 300 350
Population (000)
Assistant Medical Officers (AMO) form another important cadre of health workers. Owing to
their larger number, they serve more people
than medical doctors. Although the current practice is for AMOs to be in charge of health
centres, the critical shortage of medical doctors has led to a situation where AMOs are often in
charge of district hospitals and some even serve as district medical officers.
Compared to the population the number of AMOs is small. Figure 1.2 shows the population per
one AMO by region. Shinyanga region has the highest population per assistant medical officer
(378,000) followed by Coast region (198,000). The regions with the lowest ratios are Mara
(20,000), Arusha (22,000) and Tanga (24,000). The national average is 67,000 persons per one
assistant medical officer.
3
Figure 1.3 Population per one assistant medical officers by region year 2004/05
Regions
Average 67
Mara 20
Arusha 22
Tanga 24
Kilimanjaro 25
Iringa 27
Ruvuma 30
Lindi 35
Dar e s Salaam 35
Rukwa 39
Kigoma 44
Mtwara 44
Mbe ya 48
Morogoro 51
Dodoma 54
Manyara 57
Tabora 57
Kagera 66
Mwanza 89
Coast 198
Shinyanga 378
0 50 100 150 200 250 300 350 400
Population (000)
After AMOs, clinical officer is another important cadre in the medical profession. Most of the
dispensaries and health centres in the country are managed by staff of this type. Since most of
the dispensaries and health centres are based in rural areas it can be concluded that the majority
of the people in this country, get their health services from clinic officers. Unfortunately, there is
no set standard in regard to the per one clinical officer. The workload for this cadre varies from
region to region. Figure 1.4 shows population per clinical officer in the country. A clinical officer
in Coast region serves most people at 57,000 per clinical officer. Shinyanga, and Dar es Salaam
regions follow in terms of the big populations being 37,000 for Shinyanga and 23,000 for Dar es
Salaam. Tanga and Arusha have the lowest figures. The national average is 14,000 people per
clinical officer .
4
Figure 1.4 Population per one clinical officer by region year 2004/05
Regions
Pwani 57
Shyinyanga 37
Dar es Salaam
23
Mtwara 13
Kigoma 13
Morogoro
12
Mwanza 12
Dodoma 11
Rukwa 11
Kagera 10
Manyara 8
Iringa 7
Kilimanjaro 7
Ruvuma 7
Mbeya 7
Mara 6
Lindi 6
Arusha 6
Tanga 6
Average 14
0 10 20 30 40 50 60
Population (000)
Quality services are also expected to be provided by well trained nurses. Nurses are the ones
work very closely with patients most of the time. Small population nurse ratios imply less
workload and this in turn allows for better services. Figure 1.5 shows population per nursing
officer in the regions. Morogoro and Mbeya regions have the highest population/nurse ratios at
13,000 and 12,000 persons per nurse. The lowest ratio is found in Shinyanga region 1,000
persons per one nurse. The national average is 5,000 persons per nurse.
5
Figure 1.5 Population per one nursing officer by region year 2004/05
Region
Morogoro 13
Mbe ya 12
Dar es Salaam 9
Mtwara 9
Kigoma 9
Dodoma 8
Kage ra 5
Mwanza 5
Pwani 5
Rukwa 4
Mara 4
Tabora 4
Manyara 4
Kilimanjaro 4
Tanga 3
Lindi 3
Aru sha 2
Ruvuma 2
Iringa 2
Shinyanga 1
Ave rage 5
0 2 4 6 8 10 12 14
Population (000)
Oral health care is becoming more and more important as currently the number of patients has
increased. Basically this is because people have changed their life style specifically the type of
food they consume. Unfortunately, the few resources set aside for this service are inadequate.
The population/dental surgeon ratios in the country are very high and unacceptable any
standard. As the result the quality of services leave a lot to be desired. Since there are few
professionals in this cadre, rapid method of health care (extraction) which is considered to be
more appropriate. It is ideally extraction should be the last option after other methods have
proved failure. Scarcity of Dental Surgeons is shown in Figure 1.6 whereby the
population/dental surgeon ratios are shown by region. Mwanza region has the highest
population 3,119,000 per dental surgeon followed by Shinyanga 2,806,000.
6
Figure 1.6 Population per dental surgeon by region year 2004 /05
Region
Mwanz a 3,119
Shinyanga 2,976
Morogoro 1,853
Kigoma 1,504
Tabora 1,480
Kilimanjaro 1,377
Rukwa 1,235
Mara 1,136
Kagera 1,073
Coast 928
Dodoma 889
Iringa 508
Tanga 424
Lindi 418
Ruvuma 392
Mbe ya 278
Aru sha 278
DSM 258
Mtwara 175
Manyara 128
Ave rage 1,021
0 500 1000 1500 2000 2500 3000 3500
Population (000)
Figure 1.7 below shows that the regional population/dental assistant officers ratios. All regions
have high ratios. Manyara has the lowest ratio at 64,000 persons per dental assistant while
Shinyanga at 992,000 persons per dental assistant has the highest ratio. The regional average is
356,000 persons per dental assistant.
7
Figure 1.7 Population per assistant dental officer by region year 2004/05
Region
Shinyanga 992
Rukwa 618
Kigoma 501
Mwanz a 446
Dodoma 444
Tabora 429
Lindi 413
Iringa 381
Tanga 339
DSM 339
Coast 309
Ruvuma 294
Kilimanjaro 286
Mara 284
Mtwara 246
Morogoro 232
Aru sha 231
Kagera 156
Mbe ya 119
Manyara 64
Ave rage 356
0 100 200 300 400 500 600 700 800 900 1000
Population (000)
1.2 Health Facilities in Tanzania

1.2.1 Distribution of health facilities by type, ownership and regions
The health care delivery system has been marked by reform and improvement. There has
been an expansion of health services to the rural areas facilitating greater access to the rural
population. By 1980, about 45 percent of the population lived within 1km of a health
facility, 72 percent within 5km and 93.1 percent within 10 km of a facility. Recently no
statistics have been collected to show how far the population need to travel to reach a
health facility. However, for many years, there has been a continuous increase in the
number of heath facilities in the country. It is therefore believed that the majority of the
population live within five kilometres from a health facility. However, there are still
geographical inequalities in access to health services.
Dispensaries serve a population of six to ten thousand people, a health centre fifty thousand
and a district hospital two hundred and fifty thousand people. The regional hospital serves
as a referral centre to between 4 and 5 district hospitals and the four consultant hospitals
serve several regional hospitals. However, the referral system is not functioning well due to
8
system failures. Tables 1.1 and 1.2 shows that by 2004/05 there were a total of 5,379 health
facilities in the country whereby hospitals were 219, health centres were 481 and dispensaries
are 4,679.
Table 1.1 Distribution of hospitals and health centres by region and ownership
year 2004/05
Region Hospitals Health Centres
Gvt Vol Par Prv Total Gvt Vol Par Prv Total
Dodoma 5 2 0 0 7 18 2 0 1 21
Manyara 4 2 0 0 6 4 7 0 0 11
Arusha 3 7 1 1 12 16 5 2 6 29
Kilimanjaro 5 9 1 3 18 21 4 1 6 32
Tanga 5 4 0 3 12 18 7 0 0 25
Morogoro 5 4 1 2 12 21 5 3 2 31
Coast 5 1 1 0 7 15 1 0 1 17
Dar es Salaam 4 2 2 19 27 5 7 2 9 23
Lindi 5 3 1 0 9 13 1 0 1 15
Mtwara 4 1 0 0 5 12 2 0 0 14
Ruvuma 3 5 0 0 8 8 3 0 0 11
Iringa 5 6 0 4 15 19 14 1 0 34
Singida 3 6 0 0 9 11 2 0 1 14
Mbeya 6 8 0 2 16 20 7 0 1 28
7 15
Tabora 4 3 0 0 12 2 0 1
3 28
Rukwa 2 1 0 0 20 8 0 0
5 18
Kigoma 3 2 0 0 13 4 1 0
8 26
Shinyanga 5 1 1 1 23 2 0 1
13 30
Kagera 2 10 0 1 17 11 0 2
13 39
Mwanza 6 6 0 1 32 3 0 4
7 20
Mara 3 4 0 0 13 4 0 3
Total 87 87 8 37 219 331 101 10 39 481
Gvt = Government, Vol = Voluntary Agencies, Par = Parastatal, Pvt = Private Health Facilities
Table 1.2 Distribution of dispensaries and total health facilities by region

and ownership year 2004/05
Region Dispensaries All Health facilities
Gvt Vol Par Prv Total Gvt Vol Par Prv Total
9
Dodoma 185 28 12 15 240 208 32 12 16 268
Manyara 75 36 1 11 123 83 45 1 11 140
Arusha 89 60 7 40 196 108 72 10 47 237
Kilimanjaro 149 63 7 113 332 175 76 9 122 382
Tanga 186 23 0 22 231 209 34 0 25 268
Morogoro 159 49 13 28 249 185 58 17 32 292
Coast 128 28 10 16 182 148 30 11 17 206
Dar es Salaam 71 28 11 230 340 80 38 15 258 390
Lindi 135 6 7 6 154 153 10 8 7 178
Mtwara 128 12 1 11 152 144 15 1 11 171
Ruvuma 127 31 3 13 174 138 39 3 13 193
Iringa 190 70 5 17 282 214 90 6 21 331
Singida 89 38 0 8 135 103 46 0 9 158
Mbeya 227 40 7 33 307 253 55 7 36 351
207 229
Tabora 156 22 2 27 172 27 2 28
184 215
Rukwa 156 11 0 17 178 20 0 17
196 219
Kigoma 164 17 7 8 180 23 8 8
216 250
Shinyanga 108 52 23 33 136 55 24 35
255 298
Kagera 142 99 4 10 161 120 4 13
336 388
Mwanza 243 25 16 52 281 34 16 57
188 215
Mara 131 25 9 23 147 33 9 26
Total 3038 763 145 733 4679 3456 952 163 809 5379
Gvt = Government, Vol = Voluntary Agencies, Par = Parastatal, Pvt = Private Health Facilities
Figure 1.8 shows the number of health facilities on Tanzania Mainland by ownership whereby the
government own 64.2 percent of all facilities. It is followed by voluntary agencies which own
around 17.7 percent. Parastatals, and private institutions had 3.0 percent and 15.0 percent, of the
facilities respectively.
Figure 1.8 The number of health facilities by ownership

, Tanzania Mainland:2004/05
10
Private
Parastatal
15.0%
3.0%
Government
Voluntary 64.2%
17.7%
Figure 1.9 shows ownership of hospitals on Tanzania Mainland whereby voluntary agencies
own 39.7 percent, while government owns 39.7 percent of all hospitals. The private sector owns
16.9 percent of these facilities, while parastatal organisations own 3.7 percent of facilities. It is
worthy noting that while the government owns 39.7 percent of all hospitals, other stakeholders
combined own 60.3 percent.
Figure 1.9 The number of hospitals by ownership, Tanzania Mainland: 2004/05

Private
16.9%
Gove rnme nt
Parastatal 39.7%
3.7%
Voluntary
39.7%
The majority of health centres (Figure 1.10) below are owned by the government (69
percent), while voluntary agencies own 21 percent of health centres. The private sector
own 8percent while parastatal organisations own 2 percent of health centres.
Figure 1.10 The number of health centres by ownership
11
Parastatal Private
Voluntary 8.1%
2.1%
21.0%
Gove rnme nt
68.8%
1.2.2 Health facility beds

The number proportion of beds in the government facilities is larger (18,581) is more than in the
voluntary agencies at (13,195). The highest number of beds per region is found in Mwanza
(3195) while the lowest is in Singida (527). Other regions with fewer number of beds include
Rukwa (943), Shinyanga (971) and Mbeya (974). Dar es Salaam figures have been much
affected by missing figures for Muhimbili and Ocean Road hospitals. There were a total of 33835
beds on Tanzania Mainland. Of these, 51.9 percent were in government health facilities,
followed by voluntary agencies (41.5 percent), private institutions (4.5 percent) and parastatal
organizations (2 percent).
Table 1.3 Number of beds in hospitals by type of ownership and region 2004/05
Region Government Voluntary Parastatals Private Total
Dodoma 1329 330 0 0 1659
Manyara 137 78 0 0 215
Arusha 642 618 30 12 1302
Kilimanjaro 873 1147 35 130 2185
Tanga 559 520 0 65 1144
Morogoro 527 790 135 73 1525
Coast 498 100 213 0 811
Dar es Salaam 522 66 0 606 1194
Lindi 530 397 24 0 951
Mtwara 877 300 0 0 1177
Ruvuma 524 630 0 0 1154
Iringa 745 961 40 85 1831
Singida 199 30 0 0 229
Mbeya 450 901 0 30 1381
Tabora 693 0 0 0 693
Rukwa 390 90 0 0 480
Kigoma 549 227 0 0 776
Shinyanga 490 50 0 0 540
Kagera 192 690 0 60 942
Mwanza 854 1693 0 20 2567
Mara 769 262 0 0 1031
Total National 12,349 9,880 477 1,081 23,S787
Table 1.3 (Cont’d) Number of beds in health centres by type of ownership and
region: 2004/05
12
Dodoma 373 97 0 22 492
Manyara 454 530 0 0 984
Arusha 132 268 8 70 478
Kilimanjaro 453 58 5 53 569
Tanga 497 201 0 13 711
Morogoro 297 30 29 0 356
Coast 216 15 0 16 247
Dar es Salaam 84 100 15 50 249
Lindi 167 33 0 6 206
Mtwara 255 110 0 0 365
Ruvuma 260 120 0 0 380
Iringa 294 614 0 21 929
Singida 180 108 0 10 298
Mbeya 414 157 0 29 600
Tabora 171 110 0 0 281
Rukwa 327 136 0 0 463
Kigoma 294 223 0 0 517
Shinyanga 371 60 0 0 431
Kagera 295 145 30 25 495
Mwanza 497 96 0 35 628
Mara 201 104 14 50 369
Total National 6,232 3027 101 390 8909
Table 1.3 ctd Number of beds in hospitals and health centres by type of ownership and
region for year 2004/05
Dodoma 1,702 427 0 22 2,151
Manyara 591 608 0 0 1,199
Arusha 774 886 38 82 1,780
Kilimanjaro 1,326 1,205 40 183 2,754
Tanga 1,056 721 0 78 1,855
Morogoro 824 820 164 73 1,881
Coast 714 115 213 16 1,058
Dar es Salaam 606 166 15 656 1,443
Lindi 697 430 24 6 1,157
Mtwara 1,132 410 0 0 1,542
Ruvuma 784 750 0 0 1,534
Iringa 1,039 1,575 40 106 2,760
Singida 379 138 0 10 527
Mbeya 864 1,058 0 59 1,981
Tabora 864 110 0 0 974
Rukwa 717 226 0 0 943
Kigoma 843 450 0 0 1,293
Shinyanga 861 110 0 0 971
Kagera 487 835 30 85 1,437
Mwanza 1,351 1,789 0 55 3,195
Mara 970 366 14 50 1,400
Total 18,581 13,195 548 1,481 33,835
Figure 1.11 Number of hospital beds by type of ownership

13
Private
Parastatal
5%
2%
Voluntary Age ncie s

41% Gove rnme nt
52%
1.2.3 Health Facility Equipment

Among many things which promote quality services is availability of medical equipment.
The most widely used equipment are shown in Table 1.4. Tanzania has a wide network of
equipment supply system through zonal offices. The network is within Medical stores
Department (MSD), a government agency that supplies essential drugs, equipment and
other medical and public supplies. However, despite its wider network, the MSD still lacks
efficiency as some essential medical equipment are sometimes missing. Equipment, such as
maternity beds and dental operating machines are often inadequate and sometimes not
available at all. The distribution of available supplies is sometimes delayed to reach the
zonal offices. Distribution of essential equipment in the country is inadequate and uneven.
Such situations are confirmed by information shown in Table 1.4. Another reason for poor
health delivery in the country is the inability to repair defective equipment. There are many
microscope which are not functioning. This implies that some of health facilities take a long
time without repairing or replacing essential equipment. In this respect the policy
guidelines on equipment repair and replacement need to me modified.
Table 1.4 shows that of the total 743 motor vehicles in the region, 19.5 percent are not working.
Regions with a large proportion of difective vehicles include Rukwa (54 percent) and
Kilimanjaro (45.3 percent). On average, 17.5 percent of all the microscope are difective. The
proportion of microscope that are not functioning is acute in Lindi (33.3 percent), Iringa (30.1
percent), Coast (21.1percent) and Manyara (23.9 percent). A total of 283 X-rays machine were
available in 2005. However, 18.0 percent were not functioning. The situation was more acute in
Tabora, where 42.9 percent of the X-rays were defective.
14
Table 1.4 Health Facility Equipments by region for year 2005
Number
Region Motor Vehicles Motor Cycles Microscopes
Functioning Defective Functioning Defectiv Functioning Defective
e
Dodoma 24 7 24 2 64 6
Manyara 21 9 5 1 51 16
Arusha 38 12 6 1 102 9
Kilimanjaro 29 24 9 0 192 32
Tanga 47 5 10 0 67 16
Morogoro 40 4 53 4 128 26
Coast 32 2 0 0 45 12
Dar es Salaam 29 2 22 1 75 16
Lindi 30 8 15 0 30 15
Mtwara 14 2 20 2 60 16
Ruvuma 15 1 2 0 29 1
Iringa 32 15 24 13 86 37
Singida 17 7 1 2 52 20
Mbeya 35 6 24 2 52 14
Tabora 30 2 19 4 61 18
Rukwa 23 27 4 0 23 21
Kigoma 33 2 16 0 92 12
Shinyanga 35 7 5 3 77 10
Kagera 25 3 14 2 176 27
Mwanza 26 0 30 4 111 15
Mara 23 0 10 1 107 18
Total 598 145 313 42 1,680 357
Table 1.4 (Contd) Health facilities wquipment by region, 2004/05

Region Number
Sterilizes Dental Units X-rays
Functionin Defective Functioning Defective Functionin Defective
g g
Dodoma 281 18 9 6 4 2
Manyara 24 5 5 1 5 0
Arusha 34 17 0 0 16 0
Kilimanjaro 382 52 9 5 19 4
Tanga 255 4 20 0 11 0
Morogoro 300 20 13 2 8 2
15
Coast 14 4 14 4 45 1
Dar es Salaam 199 27 15 10 7 2
Lindi 32 12 6 4 28 4
Mtwara 96 4 6 2 10 2
Ruvuma 521 0 0 0 6 4
Iringa 72 2 15 2 7 5
Singida 347 8 0 0 11 3
Mbeya 520 83 14 5 6 3
Tabora 18 14 17 3 8 6
Rukwa 86 53 4 0 8 3
Kigoma 11 5 6 4 5 2
Shinyanga 422 52 0 0 6 3
Kagera 235 36 7 1 4 0
Mwanza 84 24 15 5 10 4
Mara 14 0 6 3 8 1
Total 3,947 440 181 57 232 51
1.2.5 Proportion of health facilities in good state by type

There has been marked improvement in the state of health facilities over the period 1999 – 2003.
as shown in Figure 1.12 below. The data cover ten districts involving ten regions. These regions are
Kilimanjaro, Arusha, Mwanza, Tabora, Kagera, Coast, Morogoro, Iringa, Ruvuma and Kigoma.
Using the Ministry of Health physical state classification, the buildings were rated as good,
average or poor.
An upward trend of good state of repair can been observed from 1999 to 2003, with mean
increase of 10 percent, 25 percent and 30 percent of hospitals, health centres and dispensaries,
respectively. There was a general increase in the percentage of health facilities in good state of
repair.
Figure 1.12 Proportion of health facilities in good state of repair
90
80 80.8 80.8
75
72 72 72.22
70 70
% of health facilities in good state
61.67
60
54.83
50 49.02
48.33
42.74
40 40.27
36.5
30
25.45
20
10
0
1999 2000 2001 2002 2003
Year
Hospitals Health centres
16 Dispensaries
1.3 Health financing on Tanzania Mainland
Health financing can be categorised as on-budget which includes recurrent and development
spending the headquartes of the MOH, allocations by Prime Ministers Office Regional
Administration and Local Government (PMO-RALG) to Regional curative and preventive sub-
votes, and to local government sub-votes for curative, preventive, health centres and
dispensaries, together with the central PMO-RALG development budget related to Primary
Health Care rehabilitation. In addition, it includes the contribution from the Accountant-
General’s Office (AGO) to the National Health Insurance Fund (NHIF) on behalf of public
servants. Though finance data have been a problem for some time, still the ministry through
Public Expenditure Review (PER), has been able to compile information which has been used
for resource allocation and expenditure analysis. The trend so far has been steadily increasing
for the past decade. More analysis is given below here with.
1.3.1 Health in relation to the total Government of Tanzania (GOT) budget

Since health sector was identified as a priority sector within the first Poverty Reduction Strategy
(PRS), it was expected to benefit from increases in both the absolute level of government
funding, and in its share of the budget. Figure 1.13 below plots total spending on health as a
percentage of total government spending over the past five years, together with the budgeted
amount for the current financial year. Figures are shown both inclusive and exclusive of
spending on the Consolidated Fund Services (CFS)1.
Figure 1.13 shows that there has been a steady increase in the health sector’s share of
the budget for since FY 1999/00. As expected, the increase is greater when payments
for government debts are excluded. The share is highest in the 2001/02 when it was 11
percent. There was a drop in the health sector’s share during the financial year 2002/03
and 2003/04 such that by 2003/04 the share had dropped to 9.7 percent. However there
seems to be an increase to 10.1 percent in the FY 2004/05. This is encouraging, although
it should be noted that it still falls short of the share achieved in the earlier years of the
PRS, which according to Figure 1.13 had reached as high as 11 percent in FY 2001/02. It
also falls short of the 15 percent Abuja commitment.
Figure 1.13 Spending on the health sector as a proportion of the total

government spending, Tanzania mainland 1999/00 – 2004/05
1
CFS largely comprises debt and interest payments (both domestic and foreign) which have first claim on national
resources. The GOT budget excluding CFS is therefore used to define the ‘discretionary budget’ within which
government has more scope to articulate its spending priorities.
17
12
11
10.6 10.4
10 10.1
9.7
8.8 8.7 8.9 8.7
8.5
8 8
6.8
6
0
1999/00 actual
2003/04 actual
2000/01 actual
2001/02 actual
2002/03 actual
2004/05 Budgeted
He alth as % total GVT (incl CFS) He alth as % total GVT (ixncl CFS)
While the nominal value of Health sector spending has increased consistently, the rate of
growth has fluctuated in recent years, as shown in Figure 1.14 below. This increase appears to a
large extent to have been driven by an increase in the government expenditure share to health
and external spending in the sector.
Figure 1.14 Nominal government spending on health and its rate of growth,
Tanzania Mainland: FY 2000/01 – 2004/05
18
350.0 45%
40%
300.0 290.4
35%
250.0
218.2 30%
200.0
TSh bn 186.7
25%
Nominal bgt/expd
Year on year % growth
142.1 20%
150.0
100.7 15%
100.0
10%
FY 2004/05 budget
FY 2001/02 actual
FY 2003/04 actual
FY2000/01 actual
50.0
5%
-
0%
FY 2002/03 actual
1.3.2 Other measures of health spending

Table 1.5 below presents a number of other useful measures of health expenditure and budget.
Firstly, the equivalent figures in US dollar terms are given, in order to enable some comparison
with other countries. Secondly, the per capita figures are presented, in both Tanzanian shilling
and US dollar terms. Finally, by deflating by Consumer Price Index (CPI) in recent years, we
obtain a measure of real spending in the health sector, ie taking account of general inflation in
the country2. The allocation has therefore been re-valued in FY 2000/01 prices, and is shown
both in absolute and per capita terms. The data in Table 1.5 show a far more positive picture,
that is in per capita terms the trend has been positively increasing since FY 2000/01.
Surprisingly there is a jump in the FY 2004/05 from US$ 5.71 in FY 2003/04 to US$7.42 per
capita in FY 2004/05, an increase of 30 percent.
Table 1.5 Other measures of spending, MOF data FY01 – FY05

Item Actual Actual 2001/02 Actual 2002/03 Actual 2003/04 Actual 2004/05
2000/01
2
The official Tanzanian Consumer Price Index was re-weighted and re-based on 2001 prices.
19
Norminal (Tsh bn) 100.7 142.1 186.7 218.2 290.4
In US $ million 120.9 152.1 186.5 202.5 271.2
Per capita Tsh 3,109 4,256 5,424 6,150 7,939
Per capita US $ 3.73 4.56 5.42 5.71 7.42
In real terms (Tsh bn, FY 2000/01 100.7 135.6 170.6 192.0 245.3
prices 3,109 4,060 4,957 5,412 6,707
Per capita (Tsh, FY 2000/01 prices
CPI deflator 100.0 104.8 109.4 113.6 118.4

US$ exchange rate (Tsh/$) 833 934 1,001 1,078 1,071
Population 32,391,792 33,390,850 34,420,722 35,482,358 36,576,738
Note: break in series of CPI/inflation deflator from FY 2003/04
Table 1.6 shows up ward trend for the years in study. On the other hand the actual expenditure
has been going up and down. All in all, substantial jump in the total health sector resource
envelope for FY 2004/05 rising by 56 percent both in terms of year on year budget and 46
percent when compared with the actual outturn for FY 2005/04. PMO-RALG shows a
percentage increase of almost 100 percent, but from a very low base.
Table 1.6 Total expenditure on health, Tanzania Mainland: Y2001/02 – FY2004/05

(TSh billion)
Item 2001/02 2002/03 2003/04 2004/05
Budget Actual Budget Actual Budget Actual Budget
Recurrent
AGO 8.97 5.29 6.92 5.53 6.62 10.56 10.12
MOH 61.60 58.99 82.16 72.32 87.47 87.08 138.99
Region 7.06 6.58 7.86 7.82 12.06 11.90 9.68
Local Government 46.26 46.28 57.66 57.48 66.14 63.77 82.26
Total recurrent 123.89 117.15 154.60 143.14 172.28 173.31 241.04
Development
MOH 32.07 21.12 34.07 29.03 42.28 41.44 56.69
PMO-RALG - - - - 0.34 0.34 0.68
Regions 2.35 1.28 4.99 2.48 3.19 2.70 9.38
Local Government 1.70 1.45 1.75 1.70 2.31 2.32 5.02
Total Development 36.12 23.86 40.80 33.21 48.12 46.79 71.77
Total on budget 160.01 141.01 195.40 176.36 220.40 220.10 312.81

Off budget expenditure
Cost sharing - 1.24 - 1.67 1.67 7.48 7.48
Other foreign funds 66.14 79.37 49.25 59.11 68.99 82.79 132.86
Total off budget 66.14 80.61 49.25 60.77 70.66 90.27 140.33
Grand Total 226.16 221.62 244.66 237.13 291.06 310.37 453.15
Notes: AGO spending on NHIF

Figure 1.15 shows estimated budget by levels i.e Local Government at the appex followed by
regional level then Ministerial level. Regardless of the efforts of the government to decentralise
still central level has the lions share followed by the LGAs . More explanation could be due to
the central procurement system of drugs and other medical supplies, rehabilitation of facilities,
Vaccines, family planning goods being estimated in the central level though its consumption is
in the LGAs. The trend so far has been stable.
20
Figure 1.15 Distribution of the government budget for health by administrative
level, Tanzania Mainland: FY 2001/02 – 2004/05
100%
90%
30% 30% 28%
31%
80%
70% 6%
6% 7% 7%
60%
t
Local Gov
50%
Regions
40% Central
64% 66%
63% 62%
30%
20%
10%
FY2001/02
FY2003/04
FY2002/03
FY2004/05
0%
Note: On-budget only
1.3.3 Regional level trend

Figure 1.16 shows the allocation of funds for health purposes (OC) to regions in Tanzania
Mainland. As can be seen, Mwanza and Shinyanga had the largest shares of all. On the other
hand Lindi was allocated the least amount followed by Coast Region.
Figure 1.16 Allocation of funds for health purposes to regions

for financial year 2004/05
21
1,700,000,000
1,600,000,000
1,500,000,000
1,400,000,000
1,300,000,000
1,200,000,000
Annual Allocation
1,100,000,000
1,000,000,000
900,000,00 0
800,000,00 0
700,000,00 0
600,000,00 0
500,000,00 0
400,000,00 0
300,000,00 0
200,000,00 0
100,000,00 0
0
K/Njaro
Tabora
Moro.
Mtwara
Tanga
Kagera
Mara
DSM
Kigoma
Dodoma
Manyara
Mbeya
Coast
Iringa
Rukwa
Ruvuma
Mwanza
Lindi
Arusha
Singida
Shinyanga
Regions
Table 1.7 shows a substantial increase between the original estimates, and the approved
estimates amounting to TSh 2.65bn. Virtually the whole of this is due to the increase in the
preventive sub-vote, at TSh 2.55bn which is almost 800 percent. Both curative and preventive
estimates have little increase from year FY04 to FY05.
Table 1.7 Regional sub-vote budgets and expenditure,

FY 2003/04 – 2004/05 (TSh (mill.)
FY2003/04 FY2004/05
Approved
Estimates Estimates Actual expd Estimates
9,081 9,185 9,052 9,346
Curative
325 2,874 2,848 330
Preventive
9,406 12,059 11,900 9,676
Total regions
1.3.4 Local government trend

Personal emolument increased steadily for the three years. The increase is greater compared to
the increase in the other charges. For 2003/04 releases for other charges had a negative growth
of -2 percent. This means that there was a decrease from 13,594 million to 13,267 million.
However, the figure for 2004/05 shows an increase of 56 percent.
Table 1.8 Central government health subventions to local government,

Tanzania Mainland: FY2002/03 to FY2004/ 05 (TSh million)
22
Council 2002/03 2003/04 2004/05
PE OC Total PE OC Total PE OC Total
Urban 5,706 2,529 8,235 6,961 2,597 9,557 8,416 3,303 11,718
District 21,414 11,065 32,479 26,259 10,671 36,929 34,44 17,393 51,840
7
Total 27,120 13,594 40,714 33,219 13,267 46,487 20,695 63,558
42,86
2
Year of growth N/A N/A N/A 22% -2% 14% 29% 56% 37%
N/A = Not Available, PE = Personal Emolument, OC = Other Charges

Table 1.9 shows that the expenditure increased, though slowly, over a three years
period. However, the increase is greater at central level compared to regional and local
government levels. Considering the growth rate, that of regional level doubled from
7.87 billion in FY 2001/02 to 14.60 billion in FY2003/04. Expenditure of local
government level increased but slowly.
Table 1.9 Sector expenditure by level, Tanzania mainland:

FY2001/02 – FY2003/04 (TSh bn)
Level Financial Year Change, 2002/03 – 2003/04
2001/02 2002/03 2003/04 Value Percentage
Central 85.41 106.87 139.41 32.54 30%
Regions 7.87 10.31 14.60 4.29 42%
Local Government 47.74 59.18 66.08 6.90 12%
Total on-budget 141.01 176.36 220.10 43.75 25%
CHAPTER 2: MORBIDITY AND MORTALITY STATISTICS

Tanzania is among those developing countries with a high Burden of Disease (BOD). Malaria has
remains a major cause of morbidity and mortality both in rural and urban areas. In recent years
the malaria disease pattern has dramatically changed expanding into areas previously known to
23
be malaria free. Also there has been an increase in number of cases and deaths due to HIV/AIDS
and tuberculosis. The three diseases form a major threat to the health systems in Tanzania.
On the other hand, as in other developing countries, there is an emerging picture of a “Double
Burden of Disease” resulting from changing life styles, aging and growing elite of executives.
This phenomenon is manifested by the continuing presence of the usual communicable diseases
pattern with an increasing incidence of heart diseases, diabetes, cancers, mental conditions and
conditions resulting from trauma and accidents.
The Government of Tanzania recognizes the gross impact of diseases to the weak economy and
health systems. The country has therefore adopted several measures and/or strategies to combat
the the diseases. Such measures include strengthening the health systems through health sector
programme support and reforms and through its disease control programmes such as malaria,
tuberculosis/leprosy, HIV/AIDS, reproductive health, etc. Despite all these efforts, morbidity
and mortality due to communicable and non-communicable diseases remains a big problem.
2.1 Morbidity
Health statistic for 2004 indicate that malaria, acute respiratory infection, pneumonia and
diarrhoeal disease were the major causes for outpatient attendance in both population age under
5 and 5 years and above in Tanzania. Malaria accounted for 39 percent and 48 percent of all the
OPD attendances, Table 2.1 and 2.2 show that. Interestingly, 3 percent of the OPD in children age
under five years were ill-defined cases. The top ten leading causes of OPD attendance are similar
in both age groups.
Figure 2.1 Top ten OPD patients diagnoses age below five years,
Diagnosis
Ill Defined Conditions 2.0%

M inor Surgical Conditions 2.0%
Anaemia 2.5%
Skin Infections 3.4%
Eye Infections 3.9%
Intestinal Worms 4.6%
Diarrhoea Diseases 7.1%
Pneumonia 9.6%
ARI 16.5% 39.4%
M alaria
0% 5% 10% 15% 20% 25% 30% 35% 40%
ART: Acute Respiratory Infections
Figure 2.2 Top ten OPD diagnosis for patient age 5 years and above
for the year 2004/05
24
UT I 2%
Anaemia 2%
Eye Infections 2%
Minor Surgical Conditions 3%

Diagnosis
Ill Defined Conditions 3%

5%
Diarrhoea Diseases
Pneumonia 5%
Intestinal Worms 5%
ARI 11%
Malaria 48%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Figure 2.3 and 2.4 show the percentages of children less than five years of age and patients age five
years and above who were admitted at health centres and hospitals on Tanzania mainland for the
year 2004. The statistics excludes admissions to Referral hospitals.
Among inpatients, malaria was the leading cause of admission, 35 percent in children age less than
five years, followed by acute respiratory infections (ARI), diarrhoeral diseases and pneumonia.
Figure 2.4 shows that for the population age five years and above who got admission, 42 percent
were malaria cases. Other admissions in that age group were due to ARI, diarrhoeal disease and
intestinal worms . Tuberculosis and anaemia were also among the top ten leading causes of
admission in all age groups. HIV/AIDS ranked number eight as the cause of admission among
population age five years and above.
Figure 2.3 Top ten leading causes of admission for patients age below five years,
Tanzania Mainland 2004/05
25
Ill Defined Conditions 0.8%
T uberculosis 1.0%
Other Respiratory Diseases 1.6%
Anaemia 3.4%
Causes of admission

Pneumonia 5.5%
Malaria - Complicated 11.4%
ARI 22.1%
Malaria - Uncomplicated 33.4%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
Figure 2.4 Top ten leading causes of admission for patients age five and above
for year 2004/05
Ill Defined Symptoms 0.84%
Tuberculosis 0.99%
HIV/AIDS 1.1%
Causes of admission
Anaemia
2.2%
Pneumonia 3.4%
Severe Malaria
10.3%
ARI
13.3%
Malaria Uncomplicated 42.1%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%
26
2.2 Mortality
Figures 2.5 and 2.6 show the percent of children age under five years and population age five
years and above died at health facilities across Tanzania Mainland in 2004 with exclusion of
deaths from Referral hospitals.
Malaria is the leading cause of death in all age groups while HIV/AIDS is the second cause of
death among the adults, while for children below age five, it ranks sixth the among top ten
causes of deaths. Anaemia is the second important cause of death among children age below five
years. Non-communicable diseases including cardiac failure and neoplasms, are among the top-
ten killers among for the population age five years and above who were admitted at health
facilities on Tanzania Mainland. When compared to the past report, Health Statistical Abstract
2002, there is a change in disease pattern. While HIV/AIDS did not feature among top ten
leading causes of deaths across all age groups in 1994, it appeared as number two in 2004 for
those age five years and above. Death due to Tuberculosis declined from 14 percent of all causes
of deaths among patients in year 2000 to six percent in 2004. Death associated with pneumonia
also declined from 15 percent in 2000 to about nine percent in 2004 for uderfives year and from
14 percent to six percent in age group five years and above during the same period.
Figure 2.5 Top ten leading causes of deaths for patients age below five years,
ARI 1.0%
Other R espiratory Diseases 2.0%
Severe M alnutrition 3.0%
Cause of death
Perinatal C onditions 3.0%

HIV / AIDS 3.0%
Pneumonia 9.0%
A naemia 10.0%
M alaria - C omplicated 20.0%
M alaria - Uncoplicated 28.0%
0% 5% 10% 15% 20% 25% 30%
27
Figure 2.6 Top ten leading causes of deaths for patients age five years and above,
Cardiac Failure 2.6%

Neoplasms 2.8%
Dirrhoea Diseases 2.9%

5.0%
Cause of death
Anaemia
Tuberculosis 5.9%
Typhoid Diseases 6.2%
Pneumonia 6.4%
Uncomplicated M alaria 6.9%
HIV/AIDS 12.0%
Severe M alaria 19.0%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%
Figures 2.7 and 2.8 show Case Fatality Rates among top ten leading causes of deaths in health
facilities on Tanzania Mainland. Among children under-five years of age perinatal conditions
accounted for highest (15 percent) case fatality rates. This is followed by HIV/AIDS, severe
malnutrition, anaemia and malaria. In patients aged five years and above, higher case fatality
rates were observed among patients with neoplasm, cardiac failure and thyroid diseases . In
2004/05, HIV/AIDS was among the diseases with very high case fatality rates among children.
Figure 2.7 Case Fatality Rates for top ten leading causes of deaths for < 5 yrs
Perinatal Conditions 15%
HIV/AIDS 9%
Severe Malnutrition 6%
Anaemia 3%
Cause of death
Severe Malaria 3%
Pneumonia 3%
Other Respiratory Infections 3%
Uncomplicated Malaria 2%
Diarrhoea Diseases 1%
ARI 0%
0% 2% 4% 6% 8% 10% 12% 14% 16%
28
Figure 2.8 Case Fatality Rate for top ten leading causes of deaths for 5+ yrs
Neplasms 83.5%
C ardiac Failure 29.0%
Thyroid Diseases 27.1%
Couse of death
Tuberculosis 12.3%
HIV/ AIDS 5.6%
Pneumonia 3.9%
A naemia 2.5%
Severe M alaria 1.4%
Uncomplicated M alaria 0.9%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
2.3 Notifiable diseases

The ntifiable diseases that are being monitored by the health sector include Cholera, Measles,
Meningitis, Rabies, Acute flaccid paralysis, Animal rbid bites, Yellow fever, Dysentery,
Typhoid, Neonatal tetanus and Relapsing fever.
2.3.1 Cholera otbreak

Figure ows that the highest number of cholera cases were recorded during the month of March,
June and December.
Figure 2.9 Monthly cholera cases, Tanzania Mainland: 2005
800
700
600
Number of Cases
500
400
300
200
100
0
Jan Fe b Mar Apr May Jun Jul Aug Se pt O ct Nov De c
Month
Figure 2.10 below shows that out of cholera cases recorded during the year 2005. Forty percent
were from Tanga region 26 percent from Kigoma region and 17 percent from Rukwa region.
Figure 2.10 Distribution of reported cholera cases by region, Tanzania Mainland:

29
2005
Arusha
2.7%
DSM
4.5%
Kage ra
Tanga 0.8%
39.9% Kigoma
26.3%
Kilimanjaro
0.1%
Mbe ya
7.4%
Morogoro
Rukwa Pwani
0.4%
17.0% 0.7%
Figure 2.11 below shows that the highest number of measles cases were recorded during the
month of September at 120, otherwise the numbers of measles cases were on average below 40
cases per month. As regard to meningitis, the highest number of cases were recorded during the
period of May – September during which more that 100 cases per months were recorded. As for
Rabies less than 20m cases per month were recorded throughout the year 2005
Figure 2.11 Number of Measles, Meningitis and Rabies cases recorded,

Tanzania Mainland:2005
140
120
100
Number of cases
80
60
40
20
0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Measles CS Meningitis Rabies
The figure below shows that on average less that 10 cases of Acute Flaccid Paralysis were
being reported each month, while less that 5 cases were reported for Neonatal Tetanus.
Figure 2.12 Monthly Number of Neonatal Tetanus (NNT) and AFP

30
(Acute Flaccid Paralysis)cases Recorded Tanzania Mainland: 2005
12
10
Number of Cases
0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Months
NNT AFP
Figure 2.13 Monthly Figure 2.13 below shows that the average number of dysentery cases
were around 6000 cases per months throughout the year while the number rabid animal
bites and typhoid were below 2000 cases per month.
Figure 2.13 Number of Cases of Rabid Animal Bites, Dysentery and Typhoid Fever,
Tanzania Mainland: 2005
9000
8000
7000
Number of Cases
6000
5000
4000
3000
2000
1000
0
Jan Fe b Mar Apr May Jun Jul Aug Se pt O ct Nov De c
Months
Animal Bites Dysentery Typhoid
CHAPTER 3: DISEASES UNDER SPECIAL PROGRAMME
3.1 Malaria control programme

Malaria continues to burden the overstretched health services in Tanzania. It ranks number one
in inpatient and outpatient statistics. It is also a major cause of death for children age below five
years and inflicts a huge burden due to anaemia, especially in pregnant women. The
31
transmission is stable perennial to stable seasonal in over 80 percent of the region. About 25
districts representing up to 25 percent of the population are prone to malaria epidemics. These
areas constitute highland regions and semi -arid areas.
A major challenge in malaria control is the increase of resistance to cheap anti malarial drugs
such as chloroquine and sulfadoxine pyrimethamine. This has led to frequent change of malaria
treatment guidelines, more so to incredibly expensive Artemisinin based combination therapy.
The Ministry of Health through a five year National Malaria Medium Term Strategic Plan 2002
–2007, advocates four main strategies to fight against malaria; they include:
1. Improved malaria case management
2. Vector control through the use of ITNs
3. Prevention and control of malaria in pregnancy
4. Epidemic preparedness, prevention and control
The overall objective of the above Medium Term Strategic Plan is to prevent malaria related
mortality and reduce morbidity due to malaria in all 21 regions on Tanzania Mainland by 25
percent by year 2007 and by 50 percent by 2010. Targets to be achieved for each strategy by the
end of year 2007 have been set based on the 2001 baseline results from situation analysis.
Through Comprehensive Council Health Plans, all strategies are implemented at the district
level. Also various partners play key role in the implementation of malaria control at the
different levels.
3.1.1 Monitoring and evaluation

Sources of information for monitoring achievement of malaria control include: Health
Information System (HIS), periodic health facility and community surveys, population based
surveys and operational research. The validity of using hospital-derived data is severely limited
since in most rural areas a considerable proportion of deaths occur at home.
The following are achievements of the implementation of the National malaria Medium Term
Strategic Plan 2002 -2007 based on:
• health facility reports collected from over 95 percent of districts in the year 2003 and
2004,
• community surveys carried out by the National Malaria Control Programme in
collaboration with stakeholders in nine Roll Back Malaria sentinel districts in the years
2001, 2003 and 2005
Table 3.1 Proportion of OPD attendances attributed to malaria by age groups

Tanzania Mainland: 2003 and 2004
32
Year Number
Underfive Years Five years and above All ages
Total cases Malaria % Total cases Malaria % Total cases Malaria %
cases
2003 11,698,800 5,046,387 43.1 15,572,407 6,119,241 39.3 27,271,207 11,165,628 40.9
2004 12,604,668 5,405,208 42.9 15,399,899 5,813,137 37.7 28,004,567 11,218,345 40.1
Figure 3.1 All ages malaria cases versus other cases, Tanzania Mainland:
2003 and 2004
All ages OPD malaria cases Vs other
cases for year 2003
59% 41%
Malaria Cases Other Cases
All ages OPD malaria cases Vs other

cases for year 2004
40%
60%
Malaria C ase s O ther Cases
Table 3.2 Proportion of admissions due to malaria, Tanzania Mainland:

2003 and 2004
Year Number
Total Malaria % Total Malaria % Total Malaria %
admission admissions cases admission
s s
310,0 528,02
2003 706,665 93 43.9 683,608 217,929 31.9 1,390,273 2 38.0
2004 1,180,081 421,079 35.7 945,307 358,073 37.9 2,125,388 779,152 36.7
33
Figure 3.2 All ages IPD malaria admission versus other case, Tanzania Mainland:
2003 and 2004
All ages IPD malaria admissions Vs

other admissions for year 2003
38%
62%
Malaria Admissions O the r Admissions
All ages IPD malaria admissions Vs

other admissions for year 2004
37%
63%
Malaria Admissions Other Admissions
Table 3.3 Proportion of malaria deaths in health facilities, Tanzania Mainland:

2003 and 2004
Number
Year Total Malaria percent Total Malaria percent Total Malaria percent
deaths deaths cases deaths
2003 20,355 7,865 38.6 21,578 6,499 30.1 41,933 14,364 34.3
2004 26,721 10,718 40.1 21,240 7,162 33.7 49,116 17,880 36.4
34
Figure 3.3 All ages deaths due to malaria versus other cases, Tanzania Mainland:
2003 and 2004
All ages deaths due to malaria Vs All ages deaths due to malaria Vs
other causes for year 2003 other causes for year 2004
34%
66% 36%
64%
Malaria Deaths O the r C ause s Malaria de aths O the r Cause s
The burden of malaria at the OPD and Inpatient diseases remained high for all age groups
during the two years though there was a slight decrease from the year 2003 to 2004. Deaths
attributable to malaria increased from 34.3 in the year 2003 to 36.4 in the year 2004. Use of less
effective drugs, delayed health seeking and reliance on clinical judgment without laboratory
confirmation in most peripheral health facilities could be some of the contributing factors.
These are some of the main areas of focus for improvement. The problem of malaria at the
outpatient, admissions and deaths as reflected by each region is shown in the figures below.
Figure 3.4 Malaria cases as a proportion of all attending OPD by region

in the year 2004
Mara 49
Kagera 49
Singida 48
Ruvuma 46
Mwanza 46
Shinyanga 45
Lindi 44
Morogoro 43
Tabora 41
Rukwa 41
Region
Mtwara 41
Dodoma 41
Tanga 40
Manyara 39
Coast 39
Arusha 38
Dsm 37
Mbeya 35
Kigoma 31
Kilimanjaro 28
Iringa 26
0 5 10 15 20 25 30 35 40 45 50
Percent
Figure 3.5 Admissions due to malaria as proportion of all admissions by region
35
in the year 2004
Morogoro 64
Dodoma 62
Singida 51
Ruvuma 51
Mwanza 50
Mtwara 50
Kagera 48
Mara 45
Tanga 44
40
Regions
Rukwa
Kilimanjaro 40
Manyara 39
Kigoma 38
Coast 38
Tabora 31
Lindi 29
Iringa 29
Shinyanga 28
Dar es Salaam 25
Arusha 25
Mbeya 18
0 10 20 30 40 50 60 70
Percent
Figure 3.6 Deaths due to malaria as proportion of all deaths that occurred in HFs
( Health Facilities) by region in year 2004
Dodoma 54
Ruvuma 42
Singida 39
Mara 39
Morogoro 38
Manyara 38
Shinyanga 37
Mwanz a 36
Kage ra 36
Lindi 35
Regions
Kigoma 35
Tabora 34
Mtwara 33
Tanga 31
Mbeya 30
Rukwa 28
Kilimanjaro 28
Arusha 28
Dsm 25
Iringa 23
Coast 22
0 10 20 30 40 50 60
Percent
36
Table 3.4 Malaria Case Fatality Rate by regions in the year 2004
Region Rate (%)
Arusha 4.5
Coast 2.3
Dar es Salaam 4.9
Dodoma 3.1
Iringa 2.2
Kagera 2.6
Kigoma 5.1
Kilimanjaro 1.4
Lindi 3.7
Manyara 3.7
Mara 2.3
Mbeya 1.2
Morogoro 2.6
Mtwara 2.2
Mwanza 2.5
Rukwa 4.4
Ruvuma 1.9
Shinyanga 7.0
Singida 1.8
Tabora 2.9
Tanga 2.7
Tanzania Mainland 2.6
3.1.2 Scaling up use of insecticide treated nets (ITNs)

Scaling up use of insecticide treated nets (ITNs) is to increase access and use of ITNs to all
Tanzanians in particular for the vulnerable groups (pregnant mothers, children age below 5
years ) to have access to an ITNs. The target is: for 60 percent of pregnant women and 60
percent of children to sleep under treated mosquito nets by the end of the year 2007. Various
channels are used to increase accessibility of ITNs to the population including social marketing,
commercial sector, private sector, voucher scheme targeting pregnant mothers and infants. Data
from community surveys show that the coverage of households with at least one ITN and usage
by vulnerable groups increased between 2001 and 2003 as shown in the table below.
Table 3.5 Ownership of Insecticide Treated Nets in households and their usage
by vulnerable groups for the years 2001, 2003 and 2005
INDICATOR 2001 2003 2005
Proportion of household with 14% 50% 58%
at least one untreated net
Proportion of households 14% 25% -
with at least one Insecticide
Treated Net
Proportion of underfive 31% 21% 16%
children sleeping under
untreated net
Proportion of underfive 9% 18% 22%
children sleeping under
Insecticide treated net
37
Proportion of pregnant 28% 21% 20%
mothers sleeping under
untreated net
Proportion of Pregnant 8% 21% 27%
mothers sleeping under an
ITN
3.1.3 Use of intermittent preventive treatment by pregnant women

Intermittent Preventive Treatment (IPT) has been adopted in order to reduce effects of
malaria on the pregnant women and improve the outcome of pregnancy. Pregnant
women receive two doses of sulfadoxine/pyremethamine (SP) during pregnancy, first
dose during second trimester and second dose during third trimester. SP for IPT is
available and delivered through MCH clinics mainly under observation. The target is to
attain a coverage of 60 percent of pregnant women using the intervention by the end of
year 2007s. Health facility based reports from over 95 of districts show that 65.4 percent
and 47.3 percent of pregnant women newly attending antenatal clinic received first and
second dose of SP respectively in the year 2004. Late booking of pregnant women
remains a major challenge in achieving the set targets.
3.1.4 Prevention and containment of malaria epidemics

The burden of malaria is high during epidemics. System for early detection based at
health facilities is important for preparedness and timely containment of the epidemic.
Basing on retrospective malaria morbidity data thresholds have been established and
Malaria Monitoring Charts with Alert and Action lines developed for each health facility
in 19 out of 25 districts which are prone to malaria epidemics. Weekly cumulative
plotting of malaria cases enables health facility staff to monitor malaria trends and
institute appropriate responses as soon as the Alert or Action line is reached. Proper data
management, interpretation remains a big challenge
3.2 National Tuberculosis and Leprosy Control Programme (NTLP)
3.2.1 Tuberculosis case finding

The major strategy for case finding is passive whereby people with cough and other related
symptoms self-report to health facilities for further examination. Diagnosis of TB among
suspects was based on sputum smear microscopy and for those who are smear negative chest x-
ray examination is offered. Starting from November 2004, the programme started piloting a
partially active case finding approach involving the community in seven regions under FIDELIS
project financed by IUATLD. Overall, 65,665 cases of tuberculosis (all forms) were notified in
2004, which is an increase of 11,223(20.6percent) cases compared with year 2000 when 54,442
cases were notified. The number of new smear positive cases was 25,823 or 39.3 percent of all
cases notified. The proportion of new smear positive cases increased by 7.4 percent compared
with year 2000.
Figure 3.7 Tuberculosis cases (all forms) by region notified in 2004
38
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
Pwani
Lindi Mara Rukwa Tabora Tanga
Singida
Ilala II Iringa Mbeya Mwanza Ruvuma
Arusha Kagera
Kigoma Mtwara
Morogoro
D Dodoma Shinyanga
Dar Ilala I D'Salaam Kilimanjaro
ar
Te
Dar Kinondoni
me
ke
Table 3.6 Tuberculosis cases notified by regions in Tanzania 2004

Region AFBP AFBN Extra Relapse Failure Return Other Total
Pulmonar
y
Dar es Salaam 5,587 6,102 2,274 392 25 54 1,370 15,804
Arusha 1,590 1,580 1,372 110 2 35 129 4,818
Dodoma 916 624 509 61 2 15 85 2,212
Iringa 1,496 1,466 1,292 107 3 4 67 4,435
Kagera 951 783 193 69 9 10 88 2,103
Kigoma 476 318 221 22 2 3 39 1,081
Kilimanjaro 1,130 884 371 96 40 9 135 2,665
Lindi 660 397 183 47 8 12 58 1,365
Mara 856 420 681 73 6 8 37 2,081
Mbeya 1,594 795 1,503 55 2 5 116 4,070
Morogoro 1,242 1,238 1,019 78 6 8 109 3,700
Mtwara 1,347 311 482 94 5 14 78 2,331
Mwanza 2,152 1,651 730 143 8 10 155 4,849
Pwani 1,115 526 312 72 5 7 9 2,046
Rukwa 359 227 246 25 0 3 18 878
Ruvuma 427 544 481 28 10 0 43 1,533
Shinyanga 1,397 683 448 109 8 12 59 2,716
Singida 556 605 240 62 2 5 35 1,505
Tabora 517 322 228 33 0 7 17 1,124
Tanga 1,234 2,064 479 91 12 9 111 4,000
39
Mainland 25,602 21,540 13,264 1,767 155 230 2,758 65,316
Figure 3.8 Tuberculosis notification rate (smear positive per 100,000)

populations by region: 2004
Table 3.7 Tuberculosis cases notified by category in Tanzania: 2000 - 2004
Category 2000 2001 2002 2003 2004

AFBP 24,049 24,685 24,136 24,902 25,823
AFBN 17,624 20,705 21,959 21,910 21,591
Extra-Pulmonary 10,997 12,324 12,508 12,959 13,320
Relapse 1,772 1,807 1,703 1,810 1,778
Failure - - - 128 161
Return - - - 250 231
Other - 2,082 2,742 2,708 2,761
Total 54,442 61,603 63,048 64,667 65,665
Figure 3.9 Tuberculosis cases notified by category in Tanzania: 2000 – 2004
40
70,000
60,000
number
50,000
40,000
30,000
20,000
10,000
0
2000 2001 2002 2003 2004
Year
AFBP AFBN Extra-Pulmonary Relapse Failure Return Other
Table 3.8 Distribution of new smear positive TB cases notified in 2004

by age and sex, Tanzania
Age Groups (Years)
0–
Sex 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+ Total
Male 208 2,217 5,204 3,888 2,251 1,271 1,129 16,168
Female 280 1,998 3,537 1,960 1,012 543 329 9,659
Total 488 4,215 8,741 5,848 3,263 1,814 1,458 25,827
Perc.of Total 1.89 16.32 33.84 22.64 12.63 7.02 5.65 100.00
Perc.of Male 1.29 13.71 32.19 24.05 13.92 7.86 6.98 100.00
Perc.of
Female 2.90 20.69 36.62 20.29 10.48 5.62 3.41 100.00
Figure 3.10 Distribution of New smear positive TB cases notified in 2004

by age and sex, Tanzania Mainland
41
6,000
Male
5,000 Male
4,000
number
3,000
2,000
1,000
0
0 -14 15 - 24 25 -34 35 - 44 45 -54 55 - 64 65+
age group
3.2.2 Tuberculosis treatment outcome results

The overall treatment success rate was 80.9 percent for Tanzania Mainland (cured 77.2 percent
and completed treatment 3.7 percent) for cohort notified in 2003. Figure 3.11 shows that there
was much variation in treatment success among regions – the highest is 95.4 percent in Mtwara
and the lowest is 69.8 percent in Kilimanjaro. Figure 3.12 shows the cohort notified in 2003. A
total of 2,580 (10.5 percent) patients died while on TB treatment. The highest number of deaths
was reported in Iringa (23.3 percent), followed by Ruvuma (19.1 percent) and Mbeya (18.4
percent) while the lowest rate was reported by Mtwara (3.5 percent) and Tanga (6.2 percent).
Table 3.9 Treatment outcome results of new smear positive TB cases notified in 2003
by region
42
Region Cured Treatment Failur Died Out of Transfe Total Notifie percent Treatment
completed e Control rred Treated d case Success
2003 holding
Dares Salaam 4,218 100 16 376 242 340 5,292 5,293 100.0 81.6
Arusha 941 142 1 110 130 77 1,401 1,402 99.9 77.2
Dodoma 734 2 1 136 34 33 940 940 100.0 78.3
Iringa 969 28 3 321 25 32 1,378 1,378 100.0 72.4
Kagera 765 13 5 74 25 22 904 894 101.1 87.0
Kigoma 335 45 5 31 34 29 479 480 99.8 79.2
K’njaro 691 52 10 111 108 90 1,062 1,065 99.7 69.8
Lindi 504 11 5 68 26 14 628 628 100.0 82.0
Mara 714 7 5 58 29 34 847 843 100.5 85.5
Mbeya 1,143 117 3 295 20 23 1,601 1,601 100.0 78.7
Morogoro 769 83 1 96 48 47 1,044 1,045 99.9 81.5
Mtwara 1,201 14 2 45 10 17 1,289 1,274 101.2 95.4
Mwanza 1,668 67 4 206 106 90 2,141 2,155 99.4 80.5
Pwani 893 0 5 130 21 37 1,086 1,086 100.0 82.2
Rukwa 307 11 0 58 17 8 401 401 100.0 79.3
Ruvuma 356 10 8 93 0 14 481 487 98.8 75.2
Shinyanga 900 109 7 180 35 59 1,290 1,290 100.0 78.2
Singida 384 34 0 51 23 22 514 519 99.0 80.5
Tabora 340 35 1 54 25 27 482 482 100.0 77.8
Tanga 1,205 41 1 87 31 33 1,398 1,398 100.0 89.1
Mainland 19,037 921 83 2,580 989 1,048 24,658 24,661 100.0 80.9
Figure 3.11 Treatment success rate for cohort notified in 2003 by region
Mtwara 95.4
Tanga 89.1
87.0
Kage ra
85.5
Mara
82.2
Pwani
Li ndi 82.0
Dar e s Sal aam 81.6

81.5
Morogoro
80.5
Singi da
80.5
Region
Mwanz a
Rukwa 79.3
Ki goma
79.2
78.7
Mbe ya
78.3
Dodoma
Shi nyanga 78.2
Tabora 77.8
Arusha 77.2
Ruvuma 75.2
Iri nga 72.4

Ki li manjaro 69.8
Mainl and 80.9
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Percentage
Figure 3.12 Death among smear positive cases notified in 2003 by regions
43
25.00 23.3
19.3
20.00 18.4
14.0 14.514.5
Percentage
15.00
11.212.0
10.5 10.5 10.8
9.6 9.9
9.2
10.00 7.9 8.2
6.2 6.5 6.8 7.1
5.00 3.5
0.00
Ruvuma
Rukwa
Tabora
Mtwara
Arusha
Dodoma
Lindi
Pwani
Mbeya
Mara
Morogoro
Mwanza
Tanga
Iringa
Kigoma
Mainland
Kagera
Shinyanga
Singida
Kilimanjaro
Dar es Salaam
Regions
Figure 3.13 Treatment outcome results of new smear positive TB cases notified,
Tanzania Mainland: 1999 - 2003
90
ge 80
70
ta
en
rc 60
pe
50
40
30
20
10
0
1999 2000 2001 2002 2003

year
Cured/Rx Compl. Failure Died Absc./Transferred
Absc = Absconded
In 2003, a total of 4,437 (99.8 percent) of the 4,445 category II patients notified were put on re-
treatment regimen. The category II patients were distributed as follows, relapses (1,703), failures
(137), return to control (238) and others (2367). Overall, 3,419 cases (77.0 percent) were treated
successfully; The other, outcomes is that 631 patients (14.2 percent) died; failures 20 (0.5
percent). out of control 197(4.4 percent); transferred out 170 (3.8 percent). However, further
analysis by each category shows that the best treatment success results were among the relapses
and others, 79.2 percent and 76.7 percent respectively. The failure and return to control
categories had treatment success of 67.7 percent and 68.0 percent respectively. Figure 3.14 below
summarises the outcome for each category retreated.
Figure 3.14 The outcome for each category retreated, Tanzania Mainland: 2003
44
Treat.Success Died
90.0
Failure O.Control/T.Out
80.0
76.9 76.9
70.0 67.7 68.0
60.0
50.0
Percentage
40.0
30.0
20.0 18.2
15.4 14.1
12.9 13.1 13.4
10.0 9.0 8.4
3.9
1.3 0.4 0.6
0.0
Relapse Failure Returns Others
Category
3.3 Leprosy control services
3.3.1 Case finding

A total of 5,437 leprosy cases (all forms) were notified in 2004, of which 5,066 (93.2
percent) were new cases and 371 (6.8 percent) were relapse cases. The total number of
cases detected in 2004 were 8.8 percent more than those notified in 2000. The regions in
the western and eastern parts of the country had the highest case detection rates; more
than 2.0 per 10,000 population. The high detection rates in Rukwa and Tabora were
attributed to the Leprosy Elimination Campaign (LEC) conducted in 2004 suggesting that
there are still substantial numbers of hidden cases in the community. Figures and tables
below summarises the distribution of the cases and detection rates by regions in 2004 and
2000.
Figure 3.15 Leprosy detection rate per 10,000 of the population by region: 2004
Figure 3.16 Leprosy case detected by category, Tanzania Mainland: 2000 – 2004
45
4,000
3,500
3,000
number
2,500
2,000
1,500
1,000
500
0
2000 2001 2002 2003 2004
yea r
New PB New MB
3.3.2 Registered prevalence

There were 4,838 leprosy case in 2004 thus the prevalence rate was 1.3 per 10,000 population,
which is above WHO leprosy elimination target of less than 1per 10,000 population by the end
of 2005. Ten regions of Tanzania Mainland and Zanzibar reached the National goal of
elimination of leprosy as a public health problem by the end of 2004. However, 12 other regions
in the Mainland have not yet reached the set target. Inadequate community awareness, poor
service coverage in some regions, re-registration and over-diagnosis may together interplay
with each other to influence the prevalence rates in these regions. This may need further follow-
up to ascertain factors influencing the prevalence by conducting Leprosy Elimination
Monitoring (LEM) exercises.
Figure 3.17 Leprosy prevalence and detection rate in Tanzania 2000 – 2004
2.0
1.8
1.5
Rate/10,000
1.3
1.0
0.8
0.5
0.3
0.0
2000 2001 2002 2003 2004
Year
Prevalence Detection
3.3.3 Disability grading and proportion of children notified
The treatment completion rates of leprosy patients have significantly improved since the
introduction of WHO-MDT. Among the 1,880 PB cases (all forms) notified in 2003, treatment
outcome results were available for 1,871 cases (99.5 percent). Of the latter, 1,790 (95.7 percent)
cases completed treatment, 9 (0.4 percent) cases died during treatment, 10 (0.5percent) cases
were transferred out and 62 (3.3 percent) cases were out of control. The MB cases notified in
2002 were 4157 treatment outcome results were available for 4,175 (100.4percent) cases. There
were more results for 18 (0.5 percent) cases. Cohort results for those analysed shows that 3,801
(91.4percent) cases completed treatment, 57 died, and 78 were transferred out while 239 were
out of control. Further analysis needs to be done to determine risk factors leading to default
among PB and MB cohorts put on treatment
46
Figure 3.18 Treatment completion of PB leprosy cases notified in 2003 by region
100.0
90.0
80.0
70.0
60.0
percentage
50.0
40.0
30.0
20.0
10.0
0.0
Ir Mara
Lindi MbeyaMtwaraPwani
Rukwa
ArushaD in
Kagera
Kigoma T Tanga
Mwanza RuvumaSingida Zanzibar
Tanzania
D'Salaam o g Morogoro abo
d a Kilimanjaro Shinyangara
Dar Ilala II o region
Dar IlalaDar
I Temeke m
Dar Kinondoni a
Figure 3.19 Treatment completion of MB leprosy cases notified in 2002 by region
100.0
90.0
80.0
70.0
60.0
percentage
50.0
40.0
30.0
20.0
10.0
0.0
Iringa
K
LindiMara
Mtwara RukwaR
Pwani Tabora
Tanga
Dodo
Arusha Kigoma Mwanza u Singida Zanzibar
Dar Ilala I ma ager Morogoro v
D'Salaam M Tanzania
a Kilimanjaro Shinyanga
u
Dar Ilala II
Dar Temeke b
Dar Kinondoni regioney m
a a
Figure 3.20 Leprosy treatment completion for both MB and PB 1994 – 2003
47
98
96
94
92
Percent
90
88
86 MB PB
84
1999 2000 2001 2002 2003
year
3.4 HIV/AIDS/STIS
This section summarizes the magnitude and trend of HIV/AIDS/STIs on Tanzania Mainland
for the annual year January to December 2004.
A total of 16,430 AIDS cases were reported to the NACP from the 21 regions during the year
2004. This resulted into a cumulative total of 192,532 reported cases since 1983 when the first 3
cases were identified in the country. About 3 percent (540) of the AIDS cases reported in 2004
were below 15 years of age and most of these are likely to have acquired infection through
mother to child transmission. The age group 20-49 years remained the most affected for both
sexes, an observation that has remained consistent for several years since the beginning of the
epidemic in the country. The observed clustering of cases in the age group 20-49 indicates that
the majority of infections occur during the age of maximum sexual activity. The predominant
mode of HIV transmission has remained heterosexual constituting up to 78.1 percent of all
reported AIDS cases during 2004. Mother to child transmission constituted 4.6 percent and
blood transfusion 0.5 percent. In about 17 percent of the cases, the mode of acquisition of
infection was not stated. Of all AIDS cases reported during year 2004, 55.6 percent were
married, while 23.2 percent were single. The marital status of the remaining cases were;
divorced (3.5 percent), separated (2.0 percent), cohabiting (3.5 percent) and widowed (0.6
percent). In about 11.7 percent of cases, the marital status was not stated. However, it is wrong
to interpret the data as 55.6 percent of married couples in Tanzania are HIV positive. They do
not represent the proportion of AIDS cases among married couples in Tanzania; rather they
reflect the proportion of cases among the different marital categories of patients with AIDS.
A total of 154,045 individuals donated blood during the year 2004. The majority of blood
donors were males constituting 83.7 percent of all donors and the rest were females. Most blood
donors were relatives of patients (88.9 percent) and the rest were institutional, paid donors and
volunteers (5.5 percent), (4.8 percent) and (0.1 percent) respectively.
The overall prevalence of HIV infection among blood donors during 2004 was 7.7 percent. This
is a decrease of 1.1 percent compared to the 2003 prevalence of 8.8 percent. This is the third year
running a decrease in prevalence is noted among blood donors. A decrease was first noted in
2002. The sex specific prevalence was higher among females at 10.7 percent compared to
that of 7.2 percent among males. Using estimations and projections package (EPP) and the
spectrum model developed by WHO, it is estimated that, in the year 2004, 1,840,000 people
48
were living with HIV (860,000 males and 980,000 females) on Tanzania Mainland. On the basis
of estimations that only 1 in 14 AIDS cases are reported, a total of 188,140 cases are likely to
have occurred in year 2004 alone, females being 97,690 and males 90,450. Assuming total
absence of antiretroviral (ARV) drugs, the estimated annual AIDS deaths in Tanzania Mainland
for the year 2004 was 187,350 (89,315 males and 98,040 females). This corresponds to findings
from studies which observed that, from the time a person develops AIDS symptoms to his/her
death, it takes about one to two years in the absence of ARV drugs. During the year 2004, a total
of 208,384 STI episodes were reported throughout the STI clinics. Of these, 94,366 (45.3 percent)
were genital discharge syndromes, 40,408 (19.4 percent) were genital ulcer diseases, 49,605 (23.8
percent) were pelvic inflammatory diseases and other syndromes constituted 24,005 (11.5
percent). Regions reporting the highest number of episodes include Dar es Salaam, Mwanza,
Mbeya, Shinyanga and Tanga in decreasing order. The least number of episodes were reported
from Lindi, Kagera, Singida and Tabora. Overall, the number of STI episodes especially syphilis
was higher among females than in males. This observation may not be due to a true higher
incidence of STI among females, rather it reflects differences in health seeking between females
and males. The most affected age groups in both sexes were those of 20-29 years, followed 30
years and above.
In conclusion, the spread of HIV infection continued as in previous years. Data obtained from
various surveys indicate high risk of HIV infection among youth and higher vulnerability to
infection among women.
3.5 Surveillance of AIDS cases
3.5.1 Distribution of AIDS cases

Between 1st January and 31st December 2004, a total of 16,430 cases were reported to the NACP
from the 21 regions of Tanzania Mainland. This resulted into a cumulative total of 192,532 cases
since 1983 when the first AIDS cases were reported in Tanzania. The number of cases reported
in 2004 (16,430) were fewer than those reported in 2003 (18,929). Table 3.10 and Figure 3.21
show the age and sex distribution of the reported AIDS cases for the year 2004. About 540 (3
percent) of the AIDS cases with known age and sex reported in 2004 were below 15 years of age
and most of these are likely to have acquired infection through mother to child transmission.
The age group 20-49 years remained the most affected for both sexes, an observation that has
remained consistent for several years since the beginning of the epidemic. The observed
clustering of cases in the age group 20-49 years indicates that the majority of infections occur
during the age of maximum sexual activity. It is evident that there were more female AIDS
cases than males in the age group 20-39. The predominance of female cases was particularly striking
for age groups 20-24 and 25-29 where female cases were almost twice as many as for males. The age and
sex specific cumulative case rates from 1987-2004 shows that males generally have a higher case rate
than females particularly for the age group 30 years and above. High case rates for both sexes are in the
age group 25-44 years.
Table 3.10 Distribution of reported AIDS cases by age and sex, Tanzania 2004
Age group Male Female Unknown Total
Number percent N umber percent N umber percent N umber percent
49
0–4 154 3.8 122 2.7 8 0.1 284 1.7
5–9 83 2.1 68 1.5 3 0.0 154 0.9
10 – 14 41 1.0 55 1.2 6 0.1 102 0.6
15 – 19 52 1.3 150 3.3 4 0.1 206 1.3
20 – 24 227 5.7 562 12.3 14 0.2 803 4.9
25 – 29 507 12.7 928 20.3 22 0.3 1,457 8.9
30 – 34 825 20.6 1005 22 35 0.4 1,865 11.4
35 – 39 620 15.5 635 13.9 22 0.3 1,277 7.8
40 – 44 581 14.5 459 10 10 0.1 1,050 6.4
45 – 49 349 8.7 252 5.5 11 0.1 612 3.7
50 – 54 225 5.6 156 3.4 12 0.2 393 2.4
55 – 59 117 2.9 59 1.3 3 0.0 179 1.1
60 – 64 93 2.3 38 0.8 2 0.0 133 0.8
65+ 96 2.4 33 0.7 2 0.0 131 0.8
Unknown 35 0.9 48 1.1 7,701 98.0 7,784 47.4
Total 4,005 100 4,570 100 7,855 100.0 16,430 100.0
Figure 3.21 Distribution of reported AIDS cases by age and sex, Tanzania,
January-December 2004
1200
1000
Male
800
Number of cases
Female
600
400
200
0
n
19
24
34
49
14
29
39
44
54
59
64
4
w
65
–
no
–
–
–
–
0
15
20
30
45
10
25
35
40
50
55
60
nk
U
Age-group in years
Marital status and possible sources of infection for the reported AIDS cases during the year 2004
were analyzed. These findings are presented in Figures 3.22 and 3.23. As for previous years, the
predominant mode of HIV transmission has remained heterosexual constituting up to 78.1
percent of all infections during 2004. Mother to child transmission constituted 4.6 percent and
blood transfusion 0.5 percent. In a significant proportion of cases (16.0 percent), the mode of
acquisition of infection was not stated, an observation that calls for the need to strengthen AIDS
case reporting. The reported figure of 0.5 percent of infections resulting from transmission
through blood transfusion has remained constant for several years. This figure is still
50
unacceptably high given that all donor blood in the country is screened for HIV since 1987. It is
likely that this category also contains cases that are misclassified, such as cases resulting from
handling blood in other ways other than blood transfusion.
Figures 3.22, 55.6 percent of reported AIDS cases reported in 2004, were married. One should be
circumspect in interpreting these data. They do not represent the proportion of AIDS cases
among married couples in Tanzania; rather they reflect the proportion of cases among the
different marital categories of patients with AIDS.
Figure 3.21 Marital Status of reported AIDS cases for the year 2004
Cohabiting Divorced
Widowed 3.5% 3.5%
0.6%
Single
23.2%
Separated
2.0%
Not mentioned
11.7%
Married
55.6%
Figure 3.22 Possible source of infection for reported AIDS cases 2004
51
Blood transfusion
Not stated 0.5%
16.5%
Other
0.3%
Mother to child
4.6%
Heterosexual
78.1%
Annex 4 shows the cumulative number of AIDS cases by region since the first detection of cas
es in Tanzania two decades ago (1993-2004). The distribution of AIDS cases by region is based
on where the diagnosis was made and does not necessarily reflect the place of usual residence
of the diagnosed case. The NACP estimates that only 1 out of 14 AIDS cases are reported due to
underutilization of health services, under-diagnosis, under-reporting and delays in reporting.
Despite these limitations, if the error of underreporting is consistent, the data is believed to
reflect the trend of AIDS cases in the country. Figure 3.24 depicts the trend of reported AIDS
cases in Tanzania from 1983-2004.
Figure 3.22 Trend of reported AIDS cases, Tanzania Mainland:1983 to 2004
52
20,000
18,000
16,000
14,000
12,000
(Number of Cases)
10,000
8,000
6,000
4,000
2,000
-
19
19
19
19
19
19
19
19
19
19
20
20
20
20
19
19
19
19
19
19 7
1
201
99
83
85
87
89
95
99
00
88
91
93
03
04
94
96
84
90
86
98
0
2
2
(Year)
In 2004 the three leading regions with high number of AIDS cases in descending order were
Mbeya, Dar es Salaam and Kilimanjaro. Mbeya and Dar es Salaam have consistently ranked
high in the number of AIDS cases for the past several years. Population based findings from the
Tanzania Health Indicator Survey (THIS) carried out in 2003/2004 also showed that the three
leading regions in HIV prevalence in descending order were Mbeya, Iringa and Dar es Salaam3.
The first four regions which reported lowest numbers of AIDS cases in 2004 were Morogoro,
Iringa, Arusha and Kigoma in descending order. Interestingly, in the population based study
done in 2003/2004, the four regions with lowest HIV prevalence were Kigoma, Manyara,
Singida and Mara. From the NACP AIDS case reporting and These findings there appears to be
a concordance in the pattern of HIV morbidity emphasizing that despite its limitations,
surveillance data based on AIDS case reporting is still useful for tracking the trend of
HIV/AIDS in the country.
3.5.2 HIV prevalence among pregnant women attending ANC

A total of 17,813 antenatal clinic attendees were enrolled in the 57 ANC serosurveillance clinics
located in 10 regions of Tanzania between October 27th 2003 and January 23rd 2004. The number
of enrolled women regionally ranged from 1,135 in Lindi to 3,018 in Dar es Salaam. A total of
1,545 women tested HIV positive resulting in an overall HIV prevalence in this population of
8.7 percent. HIV infection prevalence ranged from a low of 4.7 percent in Kagera region to a
high of 15.7 percent in Mbeya region (Figure 3.24).
Figure 3.24 Prevalence of HIV and syphilis among ANC attendees by region:
2004/05
3
2003 – 04 Tanzania HIV/AIDS Indicator Survey
53
18
15.7
16 14.9
HIV
14
12 Syphilis
12 10.8
9 9.1 9.2
10 8.7 8.4
7.3 7.8
8
6.3 7.1 7.1
(Prevalence (percent))
6.2
5.7
6 5.1 5.1 5.1
4.7
4 3.3
2.1
2
m
ro
aa
o
or
ja
al
a
a
a
an
g
ya
m
ll
sS
ar
om
a
er
ro
A
ng
o
be
tw
od
ag
e
o
ig
Ta
nd
ili
M
ar
M
D
K
D
Li
(Regions)
HIV prevalence is also presented at the clinic level (Annex 3). Of the 57 ANC sites included in
the surveillance, 13 (22.8 percent) were found to have a prevalence of HIV infection of 10
percent or more. These high prevalence sites consisted of one clinic in Dodoma (urban), three
urban clinics in Dar es Salaam, two clinics in Lindi (urban), one in Morogoro (urban), one in
Tanga (urban) and five in Mbeya (2 urban, 1 rural, 1 border and 1 road side).
Figure 3.24 shows that the HIV prevalence differed according to residence ranging between 3.7
percent for rural clinics, 4.7 percent for semi-urban, 9.1 percent for road side, 11.2 percent for
urban and 15.3 percent for border clinics.
Figure 3.25 Overall and location specific prevalence of HIV and syphilis
Among ANC attendees 2003/04
54
18
16.0 15.8
16
14
12 11.2
10.5 HIV
10 8.7 9.1 Syphilis
8
Prevalence (percentage) 7.3 7.0
6.8
5.8
6 4.7
3.7
4
0
Rural
Overall Road side Urban Semi Border
(Urban)
In all regions, HIV prevalence was highest among women aged 25 – 34 years.
Magnitudes were similar among the youngest and oldest age groups (Figure 3.26).
Figure 3.26 Age Specific Prevalence of HIV and syphilis

Among attendees 2003/04
12
11
10.4
10
8.7
7.8
8 7.3 7.4
6.5 6.7
6
Prevalence (percent)
HIV
4 Syphilis
Overall 15 - 24 25 - 34 35+
Age group
Figure 3.27 shows that HIV prevalence among single women (9.7 percent) was slightly higher
but not statistically different from that of married women (8.6 percent)
Figure 3.27 Prevalence of HIV and Syphilis among ANC attendees

by marital status 2003/04
55
12
9.7
10
8.7 8.6
7.8
8 7.3 7.3
nt)
(perce
lence 6
Preva HIV
4 Syphilis
0
Overall Married Single
Marital status
HIV prevalence increased with level of education from 5.2 percent among women with no
education to 9.3 percent among those with some primary education or more (Figure 3.28).
Figure 3.28 Prevalence of HIV and Syphilis among ANC attendees by education
status: 2003/04
12
9.8
10 9.3
8.7
8 7.3
6.8
6
Prevalence (percent) 5.2
HIV
4
Syphilis
2
Overall No education Some

Education
Education level
Table3.29 Prevalence of HIV and syphilis among ANC attendees

by number of previous pregnancies 2003/04
56
14
12.5
12
ent) 10.2
10
(perc 9.4
e 8.7 8.6
8
alenc
Prev 7.3 7 7.3
6 5.4
5.2
4 HIV
Syphilis
2
0
0
Overall 1-2 3-4 5+
Number of previous pregnancies
3.5.3 Syphilis prevalence

A total of 17,323 ANC attendees were tested for syphilis during the study period. A
total of 1,265 women tested positive, an overall syphilis prevalence of 7.3 percent.
Syphilis infection prevalence ranged from as low as 2.1 percent in Kigoma region to as
high as 14.9 percent in Kagera region where interestingly, the HIV prevalence was
found to be very low (Figure 3.25) The prevalence of syphilis was highest among
attendees from roadside clinics (16.0 percent) than those from rural clinics 10.5 percent
and lowest among urban clinic attendees (5.8 percent) Women living in rural areas had
higher prevalence than those in urban areas (Figure 3.25). Marital status did not appear
to influence the prevalence of syphilis (Figure 3.27). The age specific prevalence of
syphilis were 6.5 percent for age group 15-24, 7.8 percent for age group 25-34 and 10.4
percent for age group 35+ (Figure 3.26). The observed differences in age-specific
prevalence were statistically significant, suggesting that there was a higher likelihood of
having syphilis for women aged >34 years compared with those less than 34 years of
age. As in previous years, in contrast to women with HIV, women with no education
were more likely to be infected with syphilis than were women with some education
(Figure 3.28). Overall, 130/17,813 (0.7 percent) of clinic attendees were infected with
both syphilis and HIV.
57
3.5.4 Trends of HIV infection among blood donors
From a total of 154,045 blood donors during 2004, 11,861 individuals were found to be HIV
positive resulting into an overall prevalence of 7.7 percent. This is a decrease of 1.1 percent
compared to the 2003 estimate of 8.8 percent. This is the third year running since 2002; when a
decrease in prevalence was first noted among blood donors. The decrease in prevalence may
reflect the decrease in the epidemic or it may be due to alternative explanations that include
deaths, migration and self exclusion for the HIV infected. In the era of ARV delivery one would
expect a constant or even a rise in prevalence of HIV infection if incidence remains constant, but
in case of blood donors this may not apply because individuals who know that they are HIV
positive and may be on ARVs and are unlikely to donate blood.
The sex specific prevalence as in the previous year was higher among females at 10.7 percent
compared to that of 7.2 percent among males. There was a statistically significant decrease in
the sex specific prevalence estimates when the figures for 2004 were compared to those of 2003.
Prevalence among females decreased from 11.9 percent in 2003 to 10.7 percent in 2004 the
corresponding decrease among males was from 8.2 percent in 2003 to 7. 2 percent in 2004,
Figure 3.31 below details the trends over a seven year period. Prevalence varied by donor type.
It was highest among relative donors at 7.7 percent (N=152,435) followed by institutional
donors at 6.5 percent (N=847) and was lowest among paid donors at 5.2 percent (N=747).
Prevalence among volunteer donors did not make any meaningful interpretation due to small
numbers in this group (N=16).
3.5.5 Age and sex specific HIV infection trends

The following line graph illustrates trends in the age and sex specific prevalence of HIV
infection among the blood donor population for the years 1996 to 2004.
Figure 3.30 Age and sex specific trends of HIV infection, Tanzania Mainland:
1996 - 2004
17
16
15
14
13
12
11 Females 15-24 yrs
10
Prevalence (Percent)
9 Males 15-24 yrs
8 Females 25-34 yrs

7 Males 25-34 yrs
6 Females 35 yrs plus
5 Males 35 yrs plus
4
3
2
1
0
1996 1997 1998 1999 2000 2001 2002 2003 2004

Year
58
Between 2003 and 2004, prevalence in all age groups showed a decreasing trend except among
females in the age group 15-24 years whose prevalence virtually remained constant. The
aberrant trend in this age group calls for further investigation to establish whether the rate of
new infections in this age group is on the increase compared to other age groups and especially
males of a similar age. (Note: prevalence in the younger age groups may approximate
incidence) Figure 3.30 gives further details regarding these trends. To keep track of the exact age
and sex specific prevalence figures, the following tables (3.12 and 3.13 are added in for this
purpose. Similar information however may better be interpreted in the preceding graphs.
Table 3.11 Age–specific prevalence (in percentage) of HIV infection among male
blood donors, Tanzania, 1991 – 2004
Age 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
15 – 19 3.2 3.7 3.9 2.4 5.3 4.4 4.5 5.2 5.4 6.0 5.9 4.9 4.8 4.7
20 – 24 5.0 4.9 5.8 2.4 5.8 5.9 4.9 6.8 7.0 7.2 8.5 7.5 6.3 5.7
25 – 29 6.7 6.0 6.1 5.8 7.2 7.4 7.2 8.5 8.8 9.6 10.4 9.1 8.2 7.0
30 – 34 6.4 5.8 6.2 5.4 7.7 7.9 7.3 10.1 10.0 10.4 11.2 10.5 9.5 8.2
35 – 39 6.1 5.6 6.5 9.8 7.8 7.7 7.4 9.8 9.9 10.9 12.3 10.4 9.9 8.5
40 – 44 4.8 3.9 5.1 0.0 5.9 6.3 6.6 9.1 9.9 9.2 11.2 9.9 9.3 8.0
45 – 49 4.5 4.2 4.9 7.4 5.8 5.7 5.8 8.4 8.5 9.3 10.6 9.2 8.6 6.9
50 – 54 4.4 2.6 4.3 0.0 3.5 5.6 4.8 7.1 7.7 9.1 9.3 7.9 7.2 6.1
55+ 4.0 2.3 5.2 12.5 2.5 4.4 5.9 8.2 5.5 6.8 7.6 6.3 6.7 6.8
Overall 5.8 5.3 5.9 4.8 6.7 6.9 6.0 8.5 8.7 9.2 10.3 9.1 8.2 7.2
Table 3.12 Age–specific prevalence (in percentage) of HIV infection among female
blood donors, Tanzania 1991 – 2004
Age 1 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
991
15 – 19 4.9 4.2 2.9 5.6 5.3 6.3 6.7 8.8 7.8 8.2 9.2 7.9 6.2 7.6
20 – 24 7.7 7.2 7.5 5.4 9.4 9.8 10.2 11.3 12.2 11.9 13.3 10.9 10.3 9.7
25 – 29 8.7 6.6 7.2 7.1 11.6 10.1 11.0 13 14.5 16.8 15.7 14.9 14.3 13.0
30 – 34 6.5 5.7 6.6 6.9 10.0 9.3 11.0 13.2 14.2 13.6 15.0 14.4 14.4 12.0
35 – 39 4.8 5.7 6.7 10.1 8.8 9.3 12.1 12.5 14.9 15.2 13.2 13.0 13.1 11.0
40 – 44 6.3 3.6 1.7 5.4 7.6 6.0 9.6 10.3 10.0 11.1 12.9 11.6 11.4 9.0
45 – 49 3.4 4.4 3.7 7.5 4.8 5.5 8.2 9.8 10.2 13.6 12.0 9.7 9.0 10.1
50 – 54 5.6 5.4 5.9 6.2 *6.3 5.6 11.2 8.8 7.0 9.5 11.3 6.9 10.3 6.5
55+ 6.7 4.2 5.3 3.3 *16.7 7.1 7.6 7.8 8.8 9.7 10.3 5.2 9.1 3.3
Overal 7.2 5.9 6.3 6.9 9.2 8.7 9.7 11.8 12.6 13.3 13.6 12.3 11.9 10.7
l
3.5.6 HIV infection trends by regions and districts

The prevalence of HIV infection varies between regions and districts. To enable geographical
assessment of the trend of the epidemic, data is presented in Annex 4 by region and by district.
There has been a change in the region with the highest prevalence when 2003 data is compared
to that of 2004. HIV prevalence rose in Rukwa region from the former prevalence of 17.9
percent in 2003 to 19.5 percent in 2004 resulting into the region with the highest prevalence
during 2004. The other regions in decreasing prevalence of HIV infection include: Kagera 18.2
percent, Mbeya 13.3 percent, Arusha 12.9 percent and Iringa 12.1 percent. Muleba district
continued to have the highest prevalence of HIV infection at 33.7 percent followed by Nkasi at
32.1percent, Ludewa 26.5 percent, Kinondoni 18.8 percent and Chunya 17.7 percent. Muleba,
Nkasi and Kinondoni exhibited a rising trend compared to the previous years while Chunya
showed a decrease in prevalence. No information was available for Ludewa district during 2003.
59
Table 3.13 Prevalence of HIV infection (in percentage) among male blood donors
by region, Tanzania Mainland: 1992 2004
Region 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Arusha 2.6 2.6 2.7 6.1 3 2.8 4.2 21.3 13.4 17.2 8.7 9.4 11.7
Coast 4.1 5.9 6.6 5.5 9.4 8.2 7.7 7.5 10.1 8 8.3 5.9 5.7
Dodoma 2.8 1.7 0 0 4.9 7.9 4.9 5 3.7 7.8 7.6 6.9 5.7
DSM 8.5 - - 4.9 17.2 19.8 12.5 23.8 8.3 18.2 11.2 9.5 7.5
Iringa 11.1 13.2 7.7 13 14.2 14.2 14.8 14.7 13.7 17.9 14.1 14.9 11.8
Kagera 10.9 5.8 7.9 10.8 8 8.6 14.8 17.3 19.5 22.3 18.6 21.0 18.5
Kigoma 1.9 7 3.4 4.9 5.6 2.8 3.8 6.3 3.9 4.8 3.2 4.3 3.0
Kilimanjaro 2.4 3.4 1.5 10.7 4.1 4.1 4.8 4.7 6.2 5.8 6.9 4.1 4.1
Lindi 3.7 2.5 - 3 3.7 3 3.3 3.3 3.9 3.2 3 3.1 3.3
Manyara - - - - - - - - - - 17.5 10.6 5.2
Mara 6.9 5 3.7 5.8 7.6 8 7.6 8.6 8.7 7.8 8.7 7.4 4.9
Mbeya 15.1 0 - 9 11.1 12.6 13 13.6 15.4 14.4 11.6 13.5 11.1
Morogoro 4.6 5.7 - - 4.1 5.5 7.4 10.3 15.2 16.2 8.2 7.6 7.8
Mtwara 5.2 9.5 15.2 10.1 9.7 4.5 8 7 7.3 7.2 6.5 5.8 4.7
Mwanza 5.1 4 2.9 12.5 7.6 9.5 6.9 6.2 7.2 7.7 7.2 8.3 8.2
Rukwa 6.7 - - - 8 7.9 - - 11.5 11 9.7 17.8 20.0
Ruvuma 6.2 7.3 2 3.3 8.1 7.7 7.4 9.8 9.5 10.3 10.3 9.9 7.3
Shinyanga 6.1 6.4 14.7 11.7 8.5 8.5 8 7.7 9 8 7.9 6.6 7.0
Singida 2.7 2.8 0 - 5.6 3.6 6.2 7.7 7.5 11.6 11.1 7.0 4.9
Tabora 2.8 4.4 2.5 6.2 3.2 6.1 5.9 6.8 6.8 7.3 6.2 7.6 5.8
Tanga 7.1 4.4 - 10.4 5.5 8 7.3 7.9 8.7 8.6 9.8 7.2 6.5
Tanzania
Mainland 5.3 5.9 6.9 7.8 6.8 7.6 8.5 8.7 9.2 10.4 9.1 8.2 7.2
Table 3.14 Prevalence of HIV infection (in percentage) among female blood donors
by region, Tanzania Mainland: 1992 - 2004
Region 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Arusha 2.2 3.9 - 15.6 4.4 6 7.6 25.2 15.1 20.4 10.2 18.1 17.1
Coast 5 10.2 11.8 9.2 - 8 13.1 15.8 25.1 21.2 17 11.9 10.0
Dodoma 4.8 - - 0 - 9.2 6.2 6.7 5.3 8.7 7.8 7.8 6.1
DSM 7.7 - - 6.7 - 40.6 32.1 55 14.9 31.4 18.9 14.8 17.4
Iringa 8.1 17.6 20 7.8 12.4 16.4 15.1 14.4 20.8 21.4 18.4 18.2 14.1
Kagera 11 8.6 8.3 14.3 7.4 11.3 14.3 19 19.5 20.5 15.9 19.2 16.6
Kigoma 4.1 5.8 5.1 0 6.1 2.6 2.6 6.6 3.6 5.1 3.4 6.5 4.1
Kilimanjaro 2.2 1.8 2.9 0 5.9 8.1 8.1 6.6 11.4 6.9 6.7 12.0 10.7
Lindi 2.3 1.9 - 1.6 3.6 4.9 5.2 4.3 5.8 6.7 7.1 8.3 5.3
Manyara - - - - - - - - - - 19.8 18.0 12.7
Mara 8.2 2.9 10 9.4 10.1 13.1 7.7 10.2 10.7 11.1 13.3 8.7 8.0
Mbeya 20.3 - - 11.4 13.8 14.4 15.1 19.3 20.9 21 15.5 18.0 18.8
Morogoro 5.7 10.8 - - 6 9.1 8.8 16 24.2 22.3 10.8 12.7 9.6
Mtwara 10.5 5.7 0 5.6 10.5 - 23 21.3 25.2 14.9 13.2 20.4 7.3
Mwanza 5.7 8 5 0 8.5 11.8 9.5 10.6 9.5 9.3 9.4 10.3 11.6
Rukwa 0 - - - 8.8 - - - 16 8.8 11.1 19.1 16.9
Ruvuma 6.4 6.7 2.1 6.1 10.5 12.7 12.2 11.8 12.7 14.1 13.1 11.6 10.8
Shinyanga 10 21.6 33.3 0 14.9 14.9 14.6 12.9 13.6 11.8 11.6 9.5 9.7
Singida 4.5 4.6 0 - 5.8 5.2 7 9.4 10.4 12.1 14.9 10.3 9.4
Tabora 2.7 5.8 0 12.9 3.2 7.7 9.5 8.8 9.3 8.9 7.9 11.8 10.7
Tanga 7 5.9 - 20.8 7 13.6 11.9 14 11.2 8.6 8 10.7 11.2
Total 5.9 6.2 4.8 9.4 8.2 11.6 11.8 12.6 13.3 13.7 12.3 11.9 10.7
60
The sex specific prevalence by region are shown in Tables 3.13 for males and 3.14 for females.
The regions with the highest prevalence of HIV infection among males in descending order
were Rukwa 20.0 percent, Kagera 18.5 percent, Iringa 11.8 percent, Arusha 11.7 percent and
Mbeya 11.1 percent. All the mentioned regions showed a decrease in prevalence compared to
previous year except Arusha and Rukwa.
Prevalence among females was highest in Mbeya region at 18.8percent followed by Dar es
Salaam at 17.4 percent, Arusha at 17.1 percent, Rukwa 16.9 percent and Kagera at 16.6 percent
in this descending order. The magnitude of infection rose in Dar es Salaam from 14.8 percent in
2003 to 17.4 percent in 2004. The rest of the mentioned regions had stable or decreasing
prevalence.
61
CHAPTER 4: REPRODUCTIVE AND HEALTH STATISTICS
4.1 Introduction
The goal of Reproductive and Child Health Section (RCHS) of the Ministry of
Health is to reduce morbidity and mortality among men, women, adolescent’s
and children resulting from reproductive and child health problems by provision
of quality RCH interventions at all levels of service delivery.
The general objectives are to: -
(i) Improve antenatal services;
(ii) Increase use of family planning methods;
(iii) Improved vaccinations and nutritional status among pregnant women
and children;
(iv) Improve maternal care during prenatal, interpartum and postpartum
periods.
In light of above general objectives, the analysis of the RCH performance
indicators based on the data collected starting from 2000 to 2004 was done and
the subsequent results on performance of
reproductive health service delivery in Tanzania for stated years are discussed
below.
4.2 Clinical
Clinical treatment for the children and particularity neonates contributes to positive
outcome for the healthy of a child. Health facilities in the country collect information on
the causes of neonatal deaths so as to monitor the level of the quality of services and the
probability of children age 0 – 28 days dying within first month of life. In the last five
years of the facility based data collection in the country, birth asphyxia and prematurely are
leading causes of neonatal deaths and have consistently remained at an average of 20
and 28 percent respectively. Table 4.1 shows fluctuating trends for both causes since
year 2000. However, in 2004, both causes were higher than average. That is birth
asphyxia had 30 percent and 35 percent was due to prematurely deaths. There are
remarkabley regional variations for the number of neonatal deaths. Health facilities in
Morogoro region are least likely to report death due to birth asphyxia, prematurely and
low birth weight. Health facilities in Dar es Salaam and Mwanza regions lead in the
number of cases of children dying due to neonatal causes. Table 4.2
Table 4.1 Causes of neonatal deaths, Tanzania Mainland: 2000 – 2004

Year Birth Hypothermia Low Birth Prematurely Tetanus Infection Congenital
Asphyxia Weight Septicemias Abnormality
2000 1,033 203 356 1,131 45 304 175
2001 985 167 268 1,810 43 586 202
2002 1,522 466 809 1,760 35 407 346
2003 1,213 256 339 1,473 17 669 271
2004 1,392 250 406 1,646 - 356 247
62
Figure 4.1a Causes of neonatal deaths, Tanzania Mainland: 2000
Infe ction Se ptice mias
9.7%
Conge nital
Tetanus Abnormality Births Asphyxia
1.4% 5.6% 32.8%
Hypothe rmia
6.5%
Pre mature ly
35.9%
Low Birth We ight
8.1%
Figure 4.1b: Causes of neonatal d, Tanzania Mainland: 2001
Births Asphyxia
Conge nital
Infe ction Se ptice mias 24.3%
Abnormality
Te tanus 14.4% 5.0%
1.1%
Hypothe rmia
4.1%
Prematurely Low Birth W eight

44.6% 6.6%
Figure 4.1c Causes of neonatal deaths, Tanzania Mainland: 2002
63
Infe ction Se ptice mias
7.6% Conge nital
Tetanus Births Asphyxia
Abnormality
0.7% 28.5%
6.5%
Hypothe rmia
8.7%
Pre mature ly Low Birth We ight

32.9% 15.1%
Figure 4.1d Causes of neonatal deaths, Tanzania mainland: 2003

Infection Septice mias
15.8% Conge nital
Births Asphyxia
Abnormality
28.6%
Te tanus 6.4%
0.4%
Hypothermia
6.0%
Pre mature ly Low Birth We ight

34.8% 8.0%
Figure 4.1e Causes of neonatal deaths, Tanzania Mainland: 2004
64
Congenital
Infection Septice mias Abnormality Births Asphyxia
8.3% 5.7% 32.4%
Hypothermia
5.8%
Pre mature ly Low Birth Weight

38.3% 9.4%
Table 4.2 Main causes of death for children age 0-28 days by region:
2003 and 2004
Region 2003 2004

Birth Low birth Prematurely Birth Low birth Prematurely
Asphyxia weight Asphyxia weight
Arusha 40 20 50 42 17 96
Coast 15 6 19 18 9 32
Dar es Salaam 276 10 355 401 32 394
Dodoma 48 8 31 38 18 23
Iringa 98 14 73 105 30 108
Kagera 79 6 67 73 7 73
Kigoma 40 5 64 36 5 42
Kilimanjaro 62 15 83 84 37 80
Lindi 31 14 38 40 16 41
Manyara 41 26 42 44 17 45
Mara 20 15 19 26 18 22
Mbeya 51 30 109 61 26 135
Morogoro 5 6 10 9 11 13
Mtwara 14 15 20 17 10 24
Mwanza 70 52 201 133 63 234
Rukwa 10 12 38 15 11 46
Ruvuma 36 17 66 35 21 73
Shinyanga 70 13 40 70 13 48
Singida 82 19 60 25 11 16
Tabora 66 26 45 74 22 47
Tanga 39 10 43 46 12 54
TOTAL 1,213 339S 1,473 1,392 406 1,646
A desirable outcome of a pregnancy mother is to have a clean, safe delivery and bear a
healthy child. Survey findings reports that children below five years of age are most
vulnerable in terms of health, nutrition and social development (TDHS, 1996; TRCHS,
1999, TDHS 2005). Immunzable and communicable diseases such as malaria, diarrhoea
and respiratory tract infections contribute to morbidity and mortality for children. For
65
the last three years, reports from health facilities indicate that malaria, anemia and
respiratory track infections are on average the leading causes of under-five mortality.
4.3 Family planning

Knowledge of contraceptive methods and where they can be obtained are necessary for
attracting new clients for contraceptive methods. Health facilities collect two types of
data (new clients and continuous clients). Both data are important in measuring the
acceptance rates. For the last five years, the analyzed data indicates that trends for new
acceptors has gone down substantially from 31 percent 2000 to 19 percent in 2004 as
Table 4.3 shows. Pills and injectable are reported to be the favored methods of choice at
an average of 35 and 40 percent respectively though both indicate a slight decline since
year 2000. (Table 4.4 and Figure 4.4). After pills and injectables, condoms follows as a
favored method of contraception. And it is only this method which shows an increasing
pattern from 15 percent in 2000 to 27 percent in 2004. In addition to IUCD being the least
favored method it also shows a declining trend.
Table 4.3 The number of family planning new acceptors,

Year Target New Percent
Accepters
2000 5,808,664 1,776,883 31
2001 6,873,042 1,571,842 23
2002 6,519,779 1,192,175 18
2003 6,443,611 1,347,999 21
2004 7,086,679 1,342,270 19
Figure 4.3 Trend of Family Planning New Accepters, Tanzania Mainland:

2000 – 2004
66
35
30
25
20
(Percent)
15
10
5
0
2000 2001 2002 2003 2004
(Year)
Table 4.4 Trend of family planning new acceptors For, Tanzania Mainland:
2000 - 2004
Year New Pills Injectabl IUCDs Norplan Condom BTL NM Other
acceptors e t
2000 1,776,883 45% 37% 1.0% 0.5% 15% 0.4% 0.1% 0.4%
2001 1,571,842 35% 39% 1.1% 0.3% 24% 1.0% 0.4% 0.1%
2002 1,192,164 32% 44% 1.0% 0.4% 21% 1.0% 0.3% 0.2%
2003 1,347,999 32% 40% 1.0% 1.0% 22% 1.0% 0.3% 1.0%
2004 1,342,270 31% 38% 0.1% 1.0% 27% 1.0% 0.4% 0.7%
Figure 4.4 Trends of family planning new acceptors by type of method,

67
50
45
40
35
30
Percent
25
20
15
10
5
0
2000 2001 2002 2003 2004
Year
Pills Injectable Condom IUCD
Table 4.5 shows the percentage of women of childbearing age using family planning
methods by region. It indicates the continuous users “acceptance rate. In general, the
acceptance rate declined possibly as a result of declining trend of new acceptors. There
are substantial region differences. For example in 2004, Kagera Region had 13 percent of
mothers in childbearing age compared with Coast Region which had 57 percent. Also
unstable acceptance is noted for the rest of the regions regarding family planning use.
Table 4.5 Proportion of women of childbearing age using family planning

methods by region: 2002 - 2004
(Percentage)
68
Region 2002 2003 2004
Arusha 37 38 30
Coast 59 53 57
Dar es Salaam 37 37 46
Dodoma 32 27 27
Iringa 37 37 52
Kagera 15 18 13
Kigoma 25 28 31
Kilimanjaro 21 17 25
Lindi 40 31 30
Manyara 26 22 14
Mara 25 45 41
Mbeya 41 43 30
Morogoro 26 26 31
Mtwara 19 22 21
Mwanza 30 31 22
Rukwa 31 30 28
Ruvuma 26 27 28
Shinyanga 27 20 19
Singida 46 43 42
Tabora 28 28 23
Tanga 42 29 29
Mean (National 32% 31% 30%
figure)
4.4 Antenatal care

Antenatal care from trained provider is important in order to monitor the pregnancy
and reduce the risks for the mother and child during pregnancy and delivery. The health
delivery system keeps records for all mothers who attend for the purpose of ANC, and
within that classify those mothers who attend ANC before 20 weeks. This is important
because initial baseline pregnancy status of a mother is recorded. Generally, the
percentage of pregnant mother registered for ANC is is above 90 percent (Table 4.6), and
as it is noted in Table 4.8 the trends of pregnant mother who attend for the purpose of
ANC is also increasing having increased from 87 percent in 2002 to 89 percent in 2004.
Arusha and Manyara regions are more likely than others (above 100 percent) regions
especially in years 2002 and 2003 to recruit more clients who attend for the purpose of
ANC. It is not yet well understood as to why Dar es Salaam region (which is mainly
urban) is least likely to register pregnant mother who attend for the purpose of ANC.
Although in the last five years the percentage of pregnant mothers who attended for
ANC before 20 weeks has substantially increased, it is still below 50 percent.
Table 4.6 Pregnant mothers registered for ANC, Tanzania Mainland: 2000 -2004
Year Targets Registered Performance
69
2000 2,569,300 2,411,580 93 %
2001 1,650,000 1,481,997 90 %
2002 1,962,204 1,838,652 93 %
2003 1,594,076 1,401,745 88 %
2004 1,358,743 1,383,164 102 %
Figure 4. 5 Trend of Pregnant mothers registered for ANC, Tanzania Mainland:

2000 - 2004
105
100
(Percent)
95
90
85
80
2000 2001 2002 2003 2004
(Year)
Table 4.7 Proportion of clients attending for the purpose of ANC

By region: 2002 - 2003
Region 2002 2003 2004
Arusha 157 150 89
Coast 76 78 80
Dodoma 84 87 86
Iringa 84 85 88
Kagera 90 91 97
Kigoma 75 73 76
Lindi 62 82 89
Manyara 131 114 92
Mara 90 87 90
Mbeya 89 90 90
Morogoro 88 90 98
Mtwara 77 75 77
Mwanza 75 69 99
Rukwa 98 101 103
Ruvuma 86 88 85
Shinyanga 82 85 101
Singida 97 88 97
Tabora 92 76 95
Tanga 79 71 87
Mean 87% 86% 88%

4.4 Deliveries
The Health Policy put much emphasis in encouraging the pregnant mothers to deliver at
the health facilities in order to be attended by the trained service providers. This was
intended to reduce the risks of complications and infections that can cause the deaths or
serious illness for the mother and or a baby. Data to affirm that strategy are collected at
70
all health facilities in the country. Table 4.8 shows a substantial increase of deliveries
that are taking place at health facilities from 55 percent in 2002 to 62 percent in 2003 in
2004. In Dar es Salaam Region about 83 percent of mothers do deliver at health facilities.
However, less than 50 percent of pregnant mothers in Shinyanga, Singida, Tabora,
Manyara, Mbeya, kagera and Tanga are reported to deliver at health facilities. Trends for
other regions seem fluctuate.
Table 4 8 Proportion of clients attending for the purpose of delivery by region ,

Region 2002 2003 2004
Arusha 51 75 52
Coast 73 76 64
Dodoma 38 70 68
Iringa 64 68 71
Kagera 60 57 44
Kigoma 51 60 57
Lindi 60 62 54
Manyara 41 49 38
Mara 79 79 81
Mbeya 41 48 48
Morogoro 57 63 60
Mtwara 58 66 68
Mwanza 66 66 67
Rukwa 55 66 72
Ruvuma 73 80 84
Shinyanga 41 39 45
Singida 44 47 49
Tabora 41 47 42
Tanga 40 46 38
Mean (National figure) 55% 62% 60%
4.5 Vaccination
Vaccination of children below one year against tuberculosis, diphtheria, pertusis and
tetanus are important for the health of children.In the last three years reports from all
facilities in the country indicate an outstanding trend of vaccination of children below
one year. Almost both antigens coverage are above 70 percent.
4.5.1 Tetanus Vaccination

Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, an
important cause of infant deaths. Generally, reports from health facilities reveal that
percentage of pregnant women vaccinated TT+ has substantially increased from 75
percent in 2000 to about 85 percent in the year 2004 see Table 4.9 and Figure 4.6. Again
Table 4.10 and Figure 4.7 show a significant change in the number of neonatal tetanus
cases in 2000 from 41 to 19 neonatal cases in year 2004. In the last three years the trends
observed at various health facilities shows that the proportion of pregnant women
attending ANC for the purpose of receiving TT+2 immunization increased from 87
percent in year 2002 to 95 percent in 2004. This has led to decrease in neonatal tetanus
cases to date. Regional differences are remarkable. For instance, health facilities from
Dar es Salaam , Mara, Mwanza and Musoma regions show the highest rates (above 100
percent) for the pregnant women receiving TT+2. Pregnant women from Morogoro
region are least likely than others to attend at health facilities in order to receive TT+2.
71
Table 4.9 Vaccination TT2+ for pregnant women and children born protected
against tetanus and neonatal tetanus cases, Tanzania Mainland:
2000 - 2004
Year 1st ANC Vaccinated U1 1st Visit Children Born Alive NNT Cases Rate per
TT2+ Protected 1000
2000 1,385,650 1,045,967 113,958 900,868 789,678 41 0.05
(75%) (86%)
2001 1,484,113 1,117,857 1,191,372 941,885 801,781 43 0.05
(75%) (84%)
2002 1,420,485 1,166,103 1,246,698 1,103,401 733,304 36 0.05
(82%) (97%)
2003 1,334,120 1,155,332 1,278,664 1,033,716 895,426 32 0.04
(87%) (90%)
2004 1,393,460 1,183,594 1,290,502 1,119,520 898,706 19 0.02
(85%) (95%)
Figure 4.6 Percentage of Pregnant Women Vaccinated TT2+, Tanzania Mainland:

2000 – 2004
90
85
(Percentage)
80
75
87 85
82
70 75 75
65
2000 2001 2002 2003 2004
(Year)
Figure 4.7 Neonatal tetanus cases, Tanzania Mainland: 2000 – 2004
50 41 43
40 36
32
(Percentage)
30
19
20
10
0
2000 2001 2002 2003 2004
(Ye ar)
Table 4.10 Proportion of Pregnant women attending ANC receiving TT+2

immunization by region, Tanzania Mainland: 2000 - 2004
(Percentage)
Region 2002 2003 2004
72
Arusha 80 56 81
Coast 91 83 96
Dodoma 87 84 93
Iringa 94 79 78
Kagera 92 93 91
Kigoma 80 120 138
Lindi 123 90 77
Manyara 55 77 77
Mara 100 100 96
Mbeya 84 75 84
Morogoro 61 60 68
Mtwara 100 88 99
Mwanza 118 134 90
Rukwa 96 96 87
Ruvuma 100 109 100
Shinyanga 93 90 140
Singida 87 80 75
Tabora 72 98 100
Tanga 89 118 58
Mean (National figure) 87% 93% 95%
4.5.2 BCG Vaccination

Figure 4.8 shows vaccination coverage of BCG for regions and national average for the
period 2002 – 2004. During 2004 vaccination coverage for BCG are highest in Lindi,
Mwanza, Tanga and Mbeya regions. For regions which performed below national
average, the coverage range between 90.5 to 98.6 percent. In general the performance
meet MTUHA target. The national average is almost 100.0 percent since 2001 up to 2004.
Figure 4.8 Immunization coverage for the under one year (BCG) :
2004 for regions
73
131
127
140
119
120
100.0
98.4
99
99
98
97
97
96
90.1
97
93.8
95
96
95
94
Percentage
92
94
92
90
100
86
89
83
80
60
40
20
Kilimanjaro
Total 2002
Total 2004
Total 2001
Total 2003
Morogoro
Shinyanga
Manyara
Dodoma
Mtwara
Tabora
Mwanza
Ruvuma
Kigoma
Kagera
Mbeya
Tanga
Rukwa
Arusha
Singida
Mara
Iringa
0
Coast
DSM
Lindi
Regions and National Average
4.5.3 DPT3 vaccination

Figure 4.9 shows immunization coverage for under one year (DPT3) in all regions on
Tanzania Mainland. The Kilimanjaro region shows the highest rate (109 percent) of
vaccination which is above the national average at 88.0 percent for year 2004.
Performance of remaining regions is below national average ranging from 83.0 to 95.9
percent. The trend pattern since 2001 to 2004 shows a fluctuating pattern.
Figure 4.9 Immunization coverage for the under one year (DPT3): 2004 for regions
95
94.8
96
93
92
92
100
92
91
91
91
90
89
84.2
87.1
90
90
85.8
87
84
83
83
90
80
83
82
80
70
Percentage
55
60
50
40
30
20
10
Total 2002
Total 2001
Total 2003
Total 2004
0
Morogoro
Kilimanjaro
Manyara
Tabora
Mtwara
Dodoma
Kagera
Kigoma
Ruvuma
Mwanza
Shinyanga
Tanga
Mbeya
Mara
Rukwa
Arusha
DSM
Iringa
Singida
Coast
Lindi
4.5.4 Polio Vaccination

Figure 4.10 shows immunization coverage for Polio. The performance for Kilimanjaro,
Lindi, Mwanza, Mara, Dar es Salaam, Tanga and Kagera were above the national
average (93.1 percent). For the remaining regions immunization coverage was between
74
83 and 93 percent. Nationally there was substantial improvement from 49 percent in
2001 to 93.1 percent in 2004.
Figure 4.10 Immunization coverage for the under one year (Polio 3):
2004 for regions
120
110
105
96
95
94
92
92
92
100
92
88.0
86.2
88.7
91
88
87
88
85
85
81
82
79
76
78
74
Percentage
80
60
49.0
40
20
Total 2003
Total 2004
Total 2001
Total 2002
0
Morogoro
Kilimanjaro
Manyara
Tabora
Mtwara
Dodoma
Kagera
Ruvuma
Kigoma
Shinyanga
Mwanza
Tanga
Mbeya
Rukwa
Mara
Arusha
DSM
Singida
Iringa
Coast
Lindi
4.5.5 Measles vaccination

Measles vaccination performance is shown in Figure 4.11. Lindi, Tanga, Mwanza,
Kilimanjaro, Dar es Salaam, Rukwa and Mara regions performed above national average
(95.2 percnt) for year 2004. For the remaining regions, vaccination covarege is below
national average. The national level there is an increasing trend from 88.1 percent in
2001 to 95.2 percent in 2004.
Figure 4.11 Immunization coverage for the under one year (Measles):
75
2004 for regions
115
120
102
97
96
95
94
100
91
90
90
89
88
86.0
88.1
90
86.4
89.0
88
87
86
87
86
84
80
82
80
Percentage
60
52
40
20
Total 2001
Total 2002
Total 2003
Total 2004
Morogoro
Tabora
Kagera
Mtwara
Manyara
Dodoma
Kigoma
Tanga
Mara
DSM
Mbeya
Mwanza
Ruvuma
Kilimanjaro
Rukwa
Iringa
Coast
Arusha
Lindi
Shinyanga
Singida
Regions and national Average
4.6 Nutrition
Poor nutrition places children at increased risk of morbidity and mortality and has been shown
to impaired mental development. Data from health facilities indicate that since 2001 there are no
significant variations for children age 0 -1 year who weighed below 60 percent for the last five
years. Proportion of children age 0-1 year who weighed above 60 percent is dropping, while the
proportion of children age 0-1 year who weighed 60 – 80 percent has substantially increased
from 24 percent in 2000 to 33 percent in 2004 according to Table 12 number of below one year
with body weighs less than 60 percent from year 2002 to 2004 is shown in Table 13.
Progressively the number of children who weigh below 60 percent is increasing. Singida and
Kilimanjaro health facilities are reported the least number of children who weighed less than 60
percent.
Table 4.11 Total attendance and nutritional status children age 0 – 1 years
2001 – 2004, Tanzania Mainland: 2001 - 2004
Year Expected Attended Weight below Weight Weight
age 0 -1 age 0 - 1 60% 60% - 80% 80% - 100%
2001 1,376,439 1,306,692 3% 24% 73%
2002 1,319,634 1,234,601 4% 29% 67%
2003 1,372,661 1,279,885 3% 25% 72%
2004 1,417,541 1,019,766 3% 33% 64%
76
Table 4. 12 Proportion of the under one year with body weight less than 60%
by Region, Tanzania mainland: 2000 - 2004
Region 2002 2003 2004
Arusha 1,100 1,000 857
Coast 912 726 814
Dar es Salaam 4,567 4,174 4,698
Dodoma 2,144 2,929 1,914
Iringa 1,342 1,234 1,502
Kagera 986 1,113 1004
Kigoma 2,293 2,954 2,839
Lindi 1,600 3,152 2,912
Manyara 768 933 1,149
Mara 1,285 931 1,211
Mbeya 1,267 1341 1,350
Morogoro 874 649 754
Mtwara 1,305 1,507 914
Mwanza 3,451 3,186 2,272
Rukwa 1,986 2,567 2,966
Ruvuma 1,896 2,375 2,599
Shinyanga 1,929 2,264 2,599
Singida 758 642 432
Tabora 1,993 2,870 2,425
Tanga 2,441 3,099 2,940
TOTAL 35,189 39964 38,469
4.5.7 Maternal care

The maintenance of ill health across generation results from a complex interplay of
social, economic, cultural and biological factors (Wallace, 1990). As suggested by
McCarthy, (1997) and UNFPA (2002) efforts to address maternal health are those
pronged to (1) reduce the likelihood that a woman becomes pregnant; (2) reduce the
likelihood that a pregnant women experiences a serious complication of pregnancy or
childbirth (3) improve the outcome for women with complications. All facilities collects
data on the number of maternal deaths, associated causes, and risk factors among
pregnant mothers registered for ANC, which, in totality provide the necessary
information to assess the extent of maternal care and quality of service delivery. Since
year 2000, facility based data shows that maternal mortality rate substantially declined
from 229 per 100,000 live births to 214 per 100,000 live births. PPH, sepsis ruptured
uterus and anemia are the leading causes of maternal deaths at the health facilities with
an average of 16, 12, 8 and 13 percent of maternal deaths respectively. Pregnant mothers
age below 20 years, above 35 years and those with multiple pregnancies were reported
to have high risks of pregnancy related complications as indicated in Table 4.15.
Pregnant mothers who had many pregnancies are more likely than others to suffer from
pregnancy complications.
77
Table 4.13 Number of Maternity Deaths reported for years 2000 – 2004
Year Live births Number of Maternal
Maternal Mortality Rate
Deaths Per 100,000
reported live births
2000 789,678 1,800 229
2001 801,781 1,946 243
2002 733,334 2,111 288
2003 895,426 2,082 235
2004 898,706 1,923 214
Table 4.14 Causes of maternal death, Tanzania Mainland: 2000 - 2004

Year
Total Delivery
Born Alive
Maternal Death Reported
Ruptured Uterus
PPH
APH
Sepsis
EPH Gestosis
Enclampsia
Anemia
Obstructed Labour
Malaria
HIV/AIDS
Abortion
Other
2000 724,790 789,678 1,809 9% 16% 4% 12% 3% 10% 12% 3% 5% 6% 0.2% 13%
2001 774,920 801.781 1,946 8% 17% 3% 13% 4% 8% 12% 4% 9% 7% 0.5% 12%
2002 858,153 733.334 2,111 7% 17% 3% 12% 4% 8% 13% 4% 8% 7% 1.2% 13%
2003 937,569 895.426 2,082 7% 13% 3% 10% 3% 9% 16% 4% 8% 7% 4% 17%
2004 905,280 898,706 1923 6% 15% 3% 11% 2% 12% 13% 4% 9% 7% 2% 14%
78
Figure 4.12 Leading causes of maternal death, Tanzania Mainland: 2000 – 2004
14
17
Other 12 13
13
1 2
Abortion 1.2
0.5
0.2
77
HIV/AIDS 7
7
6
9
8 8
Malaria
9
5
1
44
Obstracted labour 4
3
13
16
Anaemia 13
12
12
12
8 9
Enclampia 8
10
2
4
EPH Gestosis 4
4
3
11
10
Sepsis 12
13
12
3
3
APH 3 3
4
15
13 17
PPH 17
16
6
7
Ruptured Uterus 7 8
9
0 2 4 6 8 10 12 14 16 18
Percent
2000 2001 2002 2003 2004
Table 4.15 Percentage of risk factors among pregnancy mother registered for ANC,
79
Risk Factors Year
2 2 2 2 2004
000 001 002 003
Under 20 Years 2% 2% 3% 3% 8%
Above 35 Years 4% 6% 7% 7% 6%
> 5 Pregnancy 9% 12% 15% 15% 13%
Anaemia 1% 1% 1% 1% 2%
Other 2% 3% 5% 5% 3%
4.6 School health programme

The government of Tanzania put much emphasis on good academic performance. One of the
promoting factors in this area is good health of a student. In this respect, through the Ministry
of Health the government usually undertakes visits to assess health education provided at the
primary school level. During the period under review, a number of issues are examined
including number of schools visited for health education, schools with first aid kits, schools
providing meals and number of students having undergone medical investigations. There are
many factors which promote health status of a student but these few indicators are considered
to be basic for a student to perform well.
4.6.2 Primary School Visit

Table 4.16 shows an increase in terms of percentage of schools visited for health education over
a period of 5 years from 55 percent in the year 2000 to 92 percent in the year 2004. Explanation
for this sharp increase is due to the strengthening of effectiveness in the implementation of
school health programme in 2004.
Table 4.16 Percentage of primary schools visited for health education,

Tanzania Mainland: 2000 – 2004.
Year Number ofNumber of P/Schools Percentage
P/Schools Visited
2000 11,740 6,480 55%
2001 11,875 7,541 63%
2002 12,273 7,726 62%
2003 13,032 8,923 68%
2004 13,553 12,500 92%
Table 4.17 shows the percentage of schools with first aid kits. The general situation indicate that
most of pupils attending primary school in Tanzania Mainland are at risk in case of any medical
problem while they are at school. This is because for the past five years most of the school had
no first aid kits. The Table shows that all the time during the past five years little progresses
were made in years 2002 and 2003 thereafter there was a sharp decline in 2004.
Table 4.17 Percentage of schools with first aid kits, Tanzania Mainland:
2000 – 2004
80
Year Number Number of Number of Percentage
of P/Schools P/Schools Visited P/Schools with
1st Aids Kit
2000 11,740 6,480 1,012 16%
2001 11,875 7,541 1,191 16%
2002 12,273 7,726 1,844 23%
2003 13,032 8,923 2,548 29%
2004 13,553 12,500 2,001 16%
One of the factor which contribute to good academic performance is food intake by primary
pupils while attending school. In this respect, the government encourages school administration
to ensure that pupils are provided with food while are at schools. This intended to ensure that
all pupils attend their classes while they are free from hunger. Unfortunately, Table 4.18 shows
that most of the pupils do not get something to eat while attending classes. The situation
deteriorated further in 2004 whereby only 13 percent of schools on Tanzania Mainland
managed to provide food to their pupils.
Table 4.18 Percentage of schools providing meals, Tanzania mainland: 2000-2004.

Year Number of Number of Number of Percentage
P/Schools P/Schools Visited P/Schools
Providing meal
2000 11,740 6,480 1,625 25%
2001 11,875 7,541 1,928 26%
2002 12,273 7,726 2,071 27%
2003 13,032 8,923 2,088 23%
2004 13,553 12,500 1,596 13%
It was recommended that students should undergo medical check-up from time to time. The
purposes of this undertaking is to detect any health problem that could be treated at early stage.
Despite the importance of such exercise, the progress over the past five years is not encouraging
as the majority of students are not examined time to time. Data on the students having
undergone medical examinations increased slightly from year 2000 to 2001 and decreased up to
19 percent in 2004.
Figure 4.13 Percentage of students having undergone medical examination,

25 24
22
20 19
15
Percent
12
10
0
2000 2001 2003 2004
81
CHAPTER 5: ENVIRONMENTAL HEALTH AND SANITATION
STATISTICS.
5.1 Introduction
Environmental health is a broad discipline referring to those measures taken to reduce harmful effects to
man’s health and his environment. Essentially it is a milestone in diseases prevention and
encompasses measures related to sanitation, hygiene, occupational health, water, and port
health. The main objective of environmental health is to contribute to the attainment of
significant reduction in morbidity and mortality of environmental health related diseases.
Majority of diseases found in developing countries including Tanzania are caused by poor
environmental health condition. Diseases like Malaria, Diarrhoea, Tuberculosis, worm infection
and skin disease rank higher among the top ten diseases. These diseases are directly linked
with poor environmental health.
Unfortunately there is a lack of a single comprehensive public health legislation as the

existing are scattered under different authorities and are out-dated for present times and
standards for the protection of the environment as well as control of human health hazards.
Furthermore, there is inadequate enforcement of the existing legislation, due to the lack of
legal background amongst personnel. Failure to prosecute those responsible for violation of
health legislation, this means there is deterioration in environmental health and sanitation
services, causing easy spread of communicable disease and poor living standards from high
prevalence of nuisances and pollutants. The Ministry of Health initiative on health
legislation review which commenced in 2002 has progressed slowly.
In an effort to improve environmental health in Tanzania, the Ministry of Health is now

finalizing the National Environmental Health, Hygiene and Sanitation Strategy to streamline
the implementation of environmental health activities in the country. The strategy is
supplemented by guidelines namely, national environmental health implementation guidelines,
waste management guidelines, participatory hygiene and sanitation transformation training
guidelines and occupational health and safety guidelines. Moreover, enactments of laws like
Public Health Act, Tanzania Food, Drugs and Cosmetic Act, 2003 and other existing laws and
bye laws related to environmental health reinforces the efforts to boost the process of improving
environmental health in the country.
The inclusion of environmental health parameters into the Health Statistical Abstract paves the
way for concerned stakeholders to perceive the challenge ahead of the sector. Apart from
disseminating the information pertaining to environmental health status and related services, it
further give feedback to key actors in the sector.
5.1 Water and sanitation
5.1.1 Water .
Due to socio-economic, geographical and demographic conditions most of the water
supplies can be categorised as unsafe. About 20 and 68 percent of people living in urban
and rural areas, respectively, do not have access to clean water according to the WHO
Department of Health Action in Crisis. The National Water Policy of 1991 states that safe
water should be available within a radius of 400 meters from each home. A single water
point should serve safe water to 250 people with an average consumption of 40 litres per
person per day. There are many problems affecting the provision of safe water to
communities, as highlighted by National Environmental Health and Sanitation Policy
82
Guidelines (April 2002). This include inadequate operation and maintenance, unplanned
settlements, pollution, contamination of water sources and a high leakage rate (50 percent).
According to the Household Budget Survey 2000/01 sanitation service levels were gauged
at 90 percent but hygiene practices such as population washing hands after toilet visit were
poor (33 percent).
Table 5.1 shows accessibility to safe water in the regions. Kagera, Dodoma, Rukwa and
Arusha regions have high percentage of population that access safe water and it ranges
from 62.8 percent to 84.2 percent. Manyara, Mtwara, Singida and Kigoma regions are
most deprived with only 32.8 percent to 39 percent of households having access to safe
water sources. At National level, the coverage stands at 53 percent.
Figure 5.1 Distribution of Households with access to safe water sources

by region: 2004/05
Kage ra 84.2
76.0
Dodoma
Rukwa 64.1
62.8
Arusha
Ruvuma 60.8
60.8
Pwani
Tanga 59.0
Iringa 56.4
54.3
Mwanz a
Mbe ya 54.0
Lindi 53.0
Regions
Mara 47.4
Shinyanga 43.8
Kilimanjaro 43.1
Morogoro 39.2
Tabora 39.0
Manyara 39.0
Mtwara 35.9
Singida 33.7
Kigoma 32.8
51.0
Ave rage 2001
52.0
Ave rage 2002
54.0
Ave rage 2003
Ave rage 2004 53.0
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0
Percent
83
5.1.2 Sanitation
Shelter in urban and rural settlements varies widely, but for the majority of people, housing
is inadequate which has lead to non-sanitary situations that threaten the health and
productivity of inhabitants. A vivid demonstration of inequality in the country is the
pattern and quality of housing along the socio-economic stratification of Tanzanian society.
Overall the emerging picture here is that of poorly organised and hence deteriorating
environmental health sub-sector calling for concerted and more determined reform.
One indicator which can be used to evaluate sanitary problem is by assessing coverage
of appropriate sanitary latrines on Tanzania Mainland. Figure 5.2 shows that on
average availability of appropriate sanitary latrines stands at 64.8 percent. High
coverage is demonstrated by Shinyanga, Dar es Salaam and Iringa regions which ranges
between 80 and 84.4 percent, whereas Tabora and Manyara have the lowest coverage
(37 – 42 percent). Generally, there is a slight increase of latrine coverage countrywide; it
is estimated to be one percent for the period of 2001 to 2004.
Figure 5. 2 Households with appropriate latrines by Regions: 2004/05
Sh i n yanga 84.4
80.8
Dar e s Sal aam
Iri n ga 80.0
77.3
Tanga
Dodoma 77.0
76.2
Aru sh a
Ru vum a 75.3
Mwanz a 71.5
69.0
Mbe ya
Si ngi da 67.8
66.2
Regions
Mtwara
Morogoro 65.1
Ki gom a 63.7
Li ndi 62.7
Pwan i 62.0
Ru kwa 61.6
Ki l i m anjaro 55.8
Mara 54.0
Manyara 42.0
Tabora 37.0
63.0
Ave rage 2001
63.0
Ave rage 2002
65.0
Ave rage 2003
Ave rage 2004 64.8
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0
Pe rce nt
Few industries and other working places including hospitals are associated with sewage
system and other protective measures. For example, industries as well as hospitals are
expected to have a pre-treatment plant, but again this is rarely the case. Some industries
discharge wastewater and even products directly into rivers or leave them to percolate
underground. Public health hazards caused by these malpractices need systematic
documentation to inform programatised responding. To this effect there is a need to revisit
84
the effectiveness of occupational health vis a vis protection of public health in the country.
For example figure 5.3 shows that in hospitals the coverage of De Mont Fort incinerators
used to safely dispose health care waste is still low. Dodoma, Morogoro and Shinyanga
regions are better of with five incinerators in place each. Majority of the regions have
the incinerators under construction.
Figure 5.3 Number of hospitals with De Mont Fort and De Mont Fort incinerators
under construction by region: 2004/05
4
Number
0
Dar es Salaam
Dodoma
Iringa
Tanga
Morogoro
Kigoma
Mwanza
Musoma
Pwani
Tabora
Shinyanga
Mtwara
Lindi
Mbeya
Ruvuma
Rukwa
Under Construction With De Mont Fort Incenerator
5.3 Occupational health and safety

Occupation health is another area which need more attention. This is because some of
the health problems are caused by the type of occupation someone is engaged in. The
problems associated with environmental health have been attributed to many factors, such
as inadequate resources, poor public awareness and participation, lack of strategies and
integrated plans on waste management, inadequate policies governing waste disposal and
hazardous chemicals, inadequate laws and regulations and weak enforcement of existing
laws. However, there is a need to have a policy in place, which considers periodic
examination of workers to enable early detection of health problems due to occupation.
There is inadequate legislation protecting public health and the environment from
chemicals that have otherwise either been banned or are strictly regulated in developed
countries. Registration of industrial and consumer chemicals is not yet in place in Tanzania,
and the amount of such chemicals that are imported for local use and those manufactured
locally is unknown. The parliament has passed an Act to protect the public from chemicals
that have been banned elsewhere.
From few selected municipalities, evaluation was made to determine the extent workers are
exposed to medical check-up on regular periods. Percent distribution of periodic Medical
examination of Estate farm workers by municipality is shown in Figure 5.4. The extent
of periodic medical examination conducted for workers in estate farms is generally
85
poor, ranging between 13.6 to 50 percent. Moshi municipality exhibits the highest level
at 50 percent while Arusha and Tanga have the lowest at 13.6 percent.
Figure 5. 4 Periodic Medical Examination by municipality: 2004/05
50
50
45
40
35
30
25 22.8
20
13.6 13.6
15
10
5
0
Arusha Iringa Moshi Tanga
Despite the fact that there are so many occupational health problems that exists, unfortunately
such information is rarely available in this country. Few available information show a need of
having in place a system that will collected environmental data including occupational health
statistics. For example Figure 5.5 shows distribution of accidents in percent by occupation.
Construction work accounts for the highest level of accidents among the three categorized
occupations. About 55 percent of workers were injured in construction work while
manufacturing had the lowest prevalence of 22 percent. It should be noted that 23 percent of
accidents in Agriculture refers to cases reported on Estate farms among the workers, excluding
the peasants.
Figure 5. 5 Distribution of accidents in percent by occupation: 2004/05
Manufacturing Agriculture
22% 23%
Construction
55%
86
Information on the availability of safety gears by occupation. This is very important because all
the time workers especially those working in more hazardous areas need to be protected. Table
5.6 shows the distribution of safety gears to workers in the three categories of work namely
manufactures, agriculture and construction. Comparatively, 38 percent of safety gears are
obtained in manufacturing sector followed by Agriculture (estate farms) 37 percent and 25
percent in construction works.
Figure 5. 6 Distribution of safety gears in percent by occupation: 2004/05
Agriculture
Manufacturing
37%
38%
Construction
25%
87
CHAPTER 6: DEMOGRAPHIC DATA FROM SELECTED
SENTINEL SITES
6.1 Introduction
The purpose of this chapter is to simplify, package, and communicate complex information on
vital statistics and the local burden of disease in a practical, accessible format for district health
planning. Few sentinel sites for the coastal zone of Coast, Lindi, Mtwara and Tanga Regions are
presented. Other sentinel sites are not documented here since its data is not yet analyzed. This
includes sites which are in Ilala, Temeke, Morogoro Rural, Igunga, Kigoma urban and Hai
district.
Coastal zones and other parts of Tanzania having socio-economic, cultural, and ecologic
circumstances broadly similar to those of the rural coast. This information should be considered
as part of the situation analysis for the annual District Health Planning cycle. All information is
provided in a graphical format with short explanatory captions and minimum text to provide
"pictures" of the current demography and disease burden.
The data source is the Tanzania Ministry of Health and Social Welfare's National Sentinel
Surveillance System (NSS). The specific data in this profile comes from the Coastal Sentinel
Demographic Surveillance System located in Rufiji District for the year 2004. This sentinel
profile is updated annually. In the year 2004, the Rufiji Demographic Surveillance System
monitored a population of 86,164 people; recording 78,133 person-years lived in 18,330
households. This sample is very much larger than the DHS and other national household
surveys. In the year 2004, the system documented 2,905 births and 903 deaths, including the
causes, rates and trends of these deaths.
Health reforms in Tanzania expect Districts to go beyond just managing diseases, to managing
health systems from a perspective of health equity. It is difficult for health systems to target the
poor accurately. However in all societies, the poor carry the heaviest burden of disease and it is
possible to target major components of the Burden of Disease (BOD), thus increasing equity in
resource allocation with more emphasis on the poor. For districts, this means a greater focus on
cost-effective interventions that address the largest shares of the burden of disease. In Africa,
80percent of the burden 1 comes from premature mortality. The causes of this mortality also
cause most of the disability that makes up the remaining 20percent. Therefore we can use cause-
specific mortality burden as a guide to setting priorities. Since most mortality occurs at home or
outside of health facilities, we cannot rely on conventional, health facility-based, Health
Management Information Systems' attendance data as the source of information on the burden
experienced by communities and households. Instead we can use household derived
demographic surveillance data from the National Sentinel Surveillance System for
understanding the real burden and its trends in various parts of the country.
6.2 Intervention Addressable Burden of Disease Graphics Broad Causes
6.2.1 Broad causes of burden of diseases

In Figure 6.1 above, the total burden of disease in the Coastal Sentinel is divided into three
broad groups of causes. Group I (red) contains all communicable, maternal, perinatal and
nutritional causes. In the Coastal Sentinel district, these account for 78percent of the total
burden. Group II (green) represents the non-communicable diseases and accounts for 11
percent of the total burden. Group III (blue) is all external causes such as injuries and contains
about 4percent of the burden. The remaining 7percent of the burden is undetermined by
available methods (yellow). This overall pattern indicates that the health transition towards
88
non-communicable and life style diseases is not yet very advanced in coastal regions of
Tanzania and that there is a large unfinished agenda of preventable conditions to address. The
Coastal pattern is similar to the rest of Africa, except that the proportion due to injuries is much
less. This is due to the current heavy burden of injury inflicted by war and civil conflicts in
several African countries, which does not occur in Tanzania.
Figure 6.1 Broad Causes of the Burden of Disease in 2004

Undete rmine d, 7% Injuries, 4%
Noncommunicable
, 11%
Communicable,
Mate rnal &
Nutritional, 79%
6.2.2 Main causes

In figure 6.2 (below), Group I (red) is further sub-divided into its components to show the
communicable, perinatal, maternal and nutritional shares for the Coastal Sentinel district.
Communicable diseases dominate the pattern and contribute over 49 percent of the total
burden. Malnutrition as a direct cause of mortality is relatively uncommon in Tanzania, but it
should be appreciated that malnutrition is a common underlying cause of other mortality and
deserves more attention than this picture might suggest. The relatively large share (15percent)
of the burden of disease due to perinatal mortality is a cause of concern and emphasizes the
importance of the Safe Motherhood Initiative and Control of Sexually Transmitted Infections.
Figure 6.2 More detailed main causes

Undete rmine d, 7.0%
Maternal 0.7%
Injurie s, 4.0%
C ommunicable ,
49.0%
Perinatal, 15.0%
Non-communicable,
Nutritional &
11.0%
Anemia, 13.0%
89
Figure 6.3 below shows that much of the total population's mortality is still experienced during
the first five years of life. This is due to preventable child illnesses. A second preventable peak
occurs in young adults and is largely due to the effects of HIV/AIDS and TB.
Figure 6.3 Mortality by age group
300 290
250
210
Number of Deaths
200
150
102 102
100
70 68
48
50
20
0
0-4 '5 - 14 15 - 29 30 - 44 45 - 49 60 -69 70 -79 80+
Age group
Figure 6.4 Burden carried per capita (risk)
800
700
600
500
400
300
200
100
0
< 5 Yrs 5 Yrs and Above Maternal Mortality
Mortality
Figure 6.3 and 6.4 illustrate the disproportionately high risk of disease burden carried by
children. Figure 4 shows the relative burden of disease (risk) on a per capita basis for each of the
three categories. This graph adjusts for the fact that age categories are unequal in size. The
under-fives represent a 5 year age class and contain only 17 percent of the population, yet carry
about 49percent of the mortality (YLL) burden. The 5-year and older age group spans over 80
years and includes 83percent of the population but carries only 51 percent of the burden.
Included in this group is the maternal age group that spans 35 years and includes 21percent of
the total population and suffers a loss of 0.7 percent of total life years due to maternal mortality.
The per capita shares represent the relative risk of burden of disease for those in each age
90
80%
60%
40% Under-five mortality clearly demands

category. East high priority. (Maternal mortality is also part of
the 5-year
20% and older mortality).
0%
Figure 6.5 District disease burden addressable by available cost effective
Available
Interventions
interventions
No Intervensions,
6%
Available
Intervensions, 94%
Figure 6.5 Shows District Disease Burden Addressable by Available Cost-Effective Interventions
Although it is not possible to prevent all premature mortality, the above graph shows the good
news that 94 percent of the year 2004 remaining disease burden is amenable to health care and
addressable by cost-effective interventions available through Council Health Plans. As new
cost-effective interventions become available for the non-addressed 6percent of the burden,
these can eventually be considered for inclusion in the National Package of Essential Health
Interventions for rural districts.
Figure 6.6 District health services profile intervention addressable shares
30% 28% 27%
25% 22%
20% 16%
15% 12%
10% 7% 7% 6%
4%
5%
0%
AFI
HIV?STI
TB Dots
AMCI
Motherhood
Control
Injury Care
Essential
All Other (15

Immunization
Drugs
causes)
Safe
EPI+
91
Figure 6.6 shows intervention addressable shares of the burden of Disease. The above graph
shows how much of the total burden of disease is addressed by each individual cost-effective
essential health intervention strategy currently available at District level. This core package
includes all interventions that address at least 2 percent of the burden of disease and which are
considered cost-effective. Together these represent a minimum package for such districts and
include: Integrated Management of Childhood Illnesses (IMCI); Case management and
prevention for acute febrile illnesses (AFI) including malaria; Insecticide Treated Nets (ITNs) for
prevention of malaria; Intermittent Preventive Therapy (IPT) for Malaria in Pregnancy, STD
Syndromic Management; Safe Motherhood Initiative (SMI); EDP; EPI; TB DOTS; and Injury
Care. Since some diseases are addressed by more than one intervention package, these shares
add to more than 100 percent. The category labeled All Other (6percent) is all remaining disease
burden not yet addressable by any of the listed cost-effective essential health interventions.
The causes of death (15) that make up the 6 percent share that is currently not yet addressable
by cost-effective essential health interventions at rural level. Most of these causes individually
constitute less than 1 percent of the total burden of disease in the population and will be
difficult to address cost-effectively without high opportunity costs. These causes are :-
Acute Abnormal Conditions

Renal disorders
Diabetes
All other specified non-communicable diseases
Liver cirrhosis
All other specified acute abdominal conditions
Carcinoma cervix or uterus
Carcinoma breast
Carcinoma of gastrointestinal disorders
Specified renal disorders
Unspecified cardiovascular disorder
Hypertension unspecified non-communicable
Causes unspecified neoplasm all other
specified cardiovMcular disorders All other
Specified neoplasm
92
Figure 6.7 Main causes of death for under-fives
Non-Communicable Meningitis Diarrhoea
Causes Injury 0.4% 0.3% Malaria
Malnutrition
2% 2% 43%
4% Measles
HIV 0.1%
Other Communicable
3%
7%
Anemia
9%
Pneumonia Perinatal
11% 19%
Figure 6.7 shows the main causes of death in children under five. Given the high burden of
preventable mortality in children under-five, we show here the proportions for the main causes
of death across this age group. Malaria dominates, followed by conditions in the perinatal and
neonatal period. Diarrhoea and measles are now well controlled and at relatively low
proportion. Interventions for neonatal, child and maternal causes are critical to address this
largely preventable burden. These interventions are described in the following graphics. Note
that cause of deaths exclude still births.
Figure 6.8 I MCI addressable conditions
Diarrhoea, 0.40%
Malnutrition, 5% Measles, 0.20%
Anemia, 13%
Acute Febrile illness(incl

Pneumonia, 17%
malaria), 65%
93
Figure 6.8 shows the Integrated Management of Childhood Illness (IMCI) addressable
conditions. Children under the age of five carry the highest per capita share of the total burden.
The above graph shows that if Integrated Management of Childhood Illness (IMCI), an
integrated, cost-effective essential health strategy targeted to under-fives, was the only
intervention offered, it would address over one quarter of the total population burden of
disease. No other single intervention addresses such a large portion of the remaining burden of
disease, thus this package merits intensive support to reach high levels of coverage. The total
share of the burden addressable by IMCI has decreased from 41.3percent in 1999 to 27 percent
in 2004, possibly as a response to the wide access to IMCI that was achieved since 1999 in Rufiji
District. Similar gains might be expected in other districts achieving similar coverage through
use of Council Health Basket Funding as done in Rufiji. The above graph illustrates the relative
contribution of the individual component conditions addressed by IMC!. Acute febrile illness
including malaria constitutes about 65 percent of the under-five burden and emphasizes the
importance of providing efficacious preventive and curative interventions for malaria. The
transition from chloroquine to SP has improved the effectiveness of IMCI. IMCI Addressable
Causes are 27.2 percent of Total Burden.
Figure 6.9 Malaria addressable conditions
Malaria AFI all

othe rs, 32%
Malaria/AFI Wome n
Malaria/AFI Unde r 5,
15 - 49, 5%
63%
Figure 6.9 shows malaria and acute febrile illness addressable conditions. 28 percent of the total
burden of disease of the population is driven by acute febrile illness, predominantly malaria
(down from 37 percent in 1999). Of this, about 63 percent is suffered by children under-five
(also counted in IMCI). The other important risk group is pregnant women. Women 15-49 are 21
percent of the population and carry about 5 percent of the malaria burden. This risk increases
during pregnancy. This illustrates the importance of prompt and effective Malaria Case
Management with SP (or ACT) according to the new National Guidelines, and preventive
interventions such as Insecticide Treated Nets (ITNs), especially for mothers and young
children via the Tanzania National Voucher Scheme, and Intermittent Preventive Treatment
(IPT) during pregnancy at ANC. Malaria Addressable Causes are 27.9 percent of Total Burden.
94
Figure 6.10 STI addressable conditions - all ages
AIDS
Still birth 29%
33%
Unspe cified TB/AIDS

Low birth weight
Maternal conditions 12%
16%
3%
Figure 6.10 shows Sexually Transmitted Infection (STI) Addressable Conditions. Sexually
Transmitted Infections (STls), including HIV/AIDs, constitute about 23 percent of the total
disease burden in 2004 (up from 14 percent in 1999). They are the third largest addressable
component of the burden of disease. HIV/AID8 causes about half of the mortality due to STls,
either directly or through increasing the risk of TS. Other major contributors are stillbirths
(mainly associated with syphilis), low birth weight, and maternal conditions (possibly
associated with chlamydia and gonorrhoea). STls can be partially addressed by carefully
selected Reproductive Health interventions such as STD Syndromic Management, RPR
Screening in Pregnancy, Family Planning, Condom Promotion, Strengthening Blood
Transfusion Safety, School Health and Youth Interventions, Voluntary Testing and Counseling,
Prevention of Mother-to-Child Transmission of HIV, Anti-Retroviral Therapy, SMI, etc.
Figure 6.10 SMI addressable conditions
O the r pe rinatal Maternal

49% 4%
Still births
47%
95
Figure 6.10 shows Safe Motherhood (SMI) Addressable Conditions. The above graph illustrates
the portions of the burden of disease addressed by the Safe Motherhood Initiative that
collectively addresses the fourth largest portion of the burden of disease (16 percent). This is
composed of maternal mortality at 4 percent, stillbirth, at 47 percent, and other perinatal causes
at 49 percent of total burden respectively. The next two graphs show the actual component
causes within the maternal and perinatal burdens separately.
Figure 6.11 SMI Perinatal Addressable Conditions
Birth injury and/or

asphyxia, 16% Conjenital
abnomalities, 5% Still births, 49.00%
Prematulity and/or
low birth we ight,
24.00%
Figure 6.11 shows Safe Motherhood (SMI) Perinatal addressable conditions. Perinatal causes
are 15.2 percent of total burden. The above graph shows perinatal mortality within SMI.
Stillbirths are the largest share, followed by prematurity or low birth weight, birth injury or
asphyxia, and congenital abnormalities. Stillbirths can be partially addressed by RPR Screening
for Syphilis during pregnancy. Neonatal tetanus was not observed, suggesting that EPI is
performing well. Low birth weight demands further attention on both maternal nutrition and
on malaria prevention in pregnancy (IPT). Birth injury demands more attention on quality
obstetrical care. This graph illustrates the growing importance for dealing with neonatal
mortality now that IMCI has made such good progress in reducing post-neonatal under-five
mortality.
Figure 6.12 SMI Maternal Addressable Conditions

96
Unspe c. Direct
mate rnal cause s
Ante lpostpartam
11%
hae morrhage Eclampsia
22% 38%
Puerpe ral sepsis

29%
Figure 6.12 shows Safe Motherhood Initiatives (SMI) maternal addressable conditions. The
above graph shows the causes for the 0.7 percent of total burden due to maternal mortality.
These are usually sepsis, eclampsia, haemorrhage, and obstructed labour. Malaria, anemia and
HIV/AIDS are also indirect causes. These can be addressed by Life Saving Skills, Family
Planning, Antenatal Care, IPT for Malaria, STD Syndromic Management, Postpartum Care,
Post-abortion Care and Quality Emergency Obstetric Care including essential obstetric drugs
(e.g. oxytocins), equipment (e.g. resuscitation), and supplies (e.g. oxygen and blood) and TBA
Training.
Figure 6.13 All Major EDP Addressable Conditions

Mate rnal
O the r Epilepsy
Condition Diarrhoe a
Communicable C ere brovascular 1%
1% 1%
Diseases Disease s AFI Malaria
5% 3% 40%
Conjestive Cardiac
Anaemia failure
9% Injury Care 1%
6%
ARI
Pernatal C ondition
12%
21%
Figure 6.14 Other EDP Addressable Conditions

97
C onje stive cardiac Epilepsy O ther spe cified AFI
failure 5% Diarrhoea for for population age
8% population age 5+ 5+
2% 1% Pne umonia and
ARI for population
Chronic obstractive age 5+
pulmonary disease s 31%
6%
O the r spe cifie d

Ce re brwascular communicable
disease s dise ase s
19% 28%
Figure 6.13. shows essential drug program (EDP Lists for Kit or Indent) addressable
conditions.Here we show two graphs for essential drug lists to emphasize the profound
importance of maintaining adequate supplies. The EDP list for Tanzania has been well designed
for the existing burden of disease and addresses 71 percent of the total burden (top graph).
Most essential drugs are delivered through essential health interventions already listed in this
document, but some have no specific package. This remainder of the EDP kit contains drugs
and materials useful for additional care aimed at morbidity reduction and mortality. These
additional causes amount to about 12 percent of the total burden of disease (Figure 6.14) and
include diarrhoea, pneumonia and ARI in people five years and older as well as a number of
communicable and non-communicable diseases such has helminthic infections, epilepsy,
hypertension and cardiovascular conditions. These considerations are important to bear in
mind for those districts converting to the Indent system for essential drugs.
Figure 6.15 EPI+Vit A Addressable Conditions - All Ages
Tetanus
Diarrhoea 1.0%
population age <5
years Measle s
1.6% 0.8%
He patitis
3.0%
TB
93.6%
98
Figure 6.15 shows expanded program on immunization Plus (EPI+) addressable conditions. The
above graph illustrates the success of EPI+ as an essential health intervention. The current high
coverage of EPI+ has reduced a previously high burden to only 7 percent of the total burden.
Remaining causes are tetanus, measles and hepatitis, however T8 is rising due to HIV. This
illustrates the importance of maintaining EPI+ at high coverage and supporting additional
interventions for measles (e.g. IMCI), Tetanus (e.g. SMI), T8 (e.g. TB DOTS) and EPI+ with
Vitamin A Supplementation for diarrhoea and measles mortality reduction in under-fives.
Figure 6.16 TB DOTS and BCG Addressable Conditions
Pulmonary
Unspecified tube rculosis
TB?AIDS 33.0%
40.2%
All othe r forms Tube rculosis/AIDS

tube rculosis 24.8%
2.0%
Figure 6.16 shows TB directly observed treatment - short course (TB DOTs) addressable
conditions T8 accounts for about 7percent of the burden of disease in 2004, up from 5percent in
1999. HIV is believed to increase the risk of T8 mortality. This illustrates the importance of
increasing the coverage and integration of TB DOTS and STD Syndromic Management as well
as maintaining high BCG immunization coverage in newborns.
Figure 6.17 Injury Care Addressable Conditions

99
Suicidal injuries Unspe cifie d
2.0% unintentional
Falls injuries
Burns 6.0% 1.0%
9.0%
Road traffic
acci dents
Homicid injuries 38.0%
11.0%
Drowning
O the r specifie d 18.0%
uninte ntional
injurie s
15.0%
Figure 6.17 shows injury care Addressable conditions. The above graph illustrates the relatively
low (4 percent) but important burden of disease that can be addressed through life-saving
interventions for injuries through adequate risk avoidance and injury care. This shows the
importance of maintaining a regular supply of Essential Drug Kits and other supplies that
include materials for injury care. It also suggests the need for appropriate Intersectoral
Interventions, e.g. to address the rising risk of road traffic accidents. The pattern of injuries will
vary greatly between districts depending on the nature of roads, which affects road traffic
accidents, and the proximity to wild life, which determines risk of animal attacks. Drowning is a
common cause of fatal injury in the Coastal Sentinel. School Health Programs should consider
rescue, first aid, and swimming instruction at primary school level. There were no fatal animal
attacks in the DSS area this year. Previous years saw snakebite mortality. Adequate stocks of
anti-venom should be kept available at dispensaries. In districts where suicide or homicide are
occurring, health planners may need to consider mental health interventions.
ANNEXES
100
Annex 1 OPD attendances, Tanzania Mainland: 2004
Age < 5 years Age 5 years and above
Type of disease Type of disease
Malaria 5,046,387 Malaria 5,813,137
ARI 2,097945 ARI 1,906,217
Diarrhoeal Disease 811,912 Diarrhoeal Disease 882,255
Intestinal Worms 528,152 Intestinal Worms 876,930
Pneumonia 1,202,287 Pneumonia 390,435
Eye Infections 502,223 Eye Infections 185,217
Ear Infections 175,432 Ear Infections 50,008
Skin Infections 439660 Skin Infections 35,063
Bronchial Asthma 78,676 Non-skin Fungal Infections 151,510
Cardiovascular Diseases 59,094 Bronchial Asthma 94,920
STI 17,194 Cardiovascular Hypertension 40,607
UTI 156,462 Other Cardiovascular Diseases 131,927
Anaemia 334764 Genital Discharge Syndrome 180,338
Schistosomiasis 37,616 Genital Ulcer Diseases 324,922
Protein Energy Malnutrition 43,952 Urinary Tract Infections 147,722
Other Nutritional Disorders 30,678 Pelvic Inflammatory Disease 348,070
Epilepsy 8,713 Anaemia 132,806
Burns 34,597 Schistosomiasis 44,561
Poisoning 7,534 Neuroses 23,912
Minor surgical Conditions 278248 Psychoses 14,729
Tuberculosis 4,753 Protein Energy Malnutrition 18,016
HIV/AIDS 1,466 Nutritional Disorders 81,118
Non-Infectious Skin Disease 83,166 Epilepsy 191,100
Vitamin A Def Xerophthalmia 6,485 Non-infectious Gastro-intest Disease 42,360
Non-Infectious Eye Dis (ukitoa Vit A def.) 28,825 Burns 10,397
Joint Disorders 1,736 Poisoning 479,202
Dental Caries 20,375 Minor surgical Conditions 86,337
Other oral disorders 25,859 Tuberculosis 7,843
Ill Defined Symptoms (No diagnosis) 226,489 Leprosy 38,368
Others 319988 HIV/AIDS 20,857
Diabetes Mellitus 14,085
Thyroid Diseases 57,805
Non-Infectious Skin Disease 1,580
Vitamin A Def/ Xerophthalmia 43,933
Non Infectious Eye Disease 18,368
Peptic Ulcer 17,958
Rheumatoid and Joint Disorders 125,787
Dental Caries 11,312
Periodontal disease 30,147
Other Oral disorders 580,270
Ill defined symptoms 740,891
Others 821096
Total 12604668 15,399,899
101
Annex 2 Admissions, Tanzania Mainland: 2004
Type of disease Age <5 years
Admission Deaths
Acute Respiratory Infections 159,613 286
Diarrhoeal Diseases 709,143 1,158
Intestinal Worms 41,786 59
Malaria- Severe, Complicated 149,901 5,823
Malaria- Uncomplicated 271,190 6,261
Schistosomiasis 5,009 115
Tuberculosis 9,286 178
Severe Protein Ernegy Malnut. 5,307 389
Other Nutritional Disorders (Excl. PEM) 2,108 121
Sickle cell Disease 4,043 84
Anaemia 55,057 2,969
Epilepsy 7,094 399
Ear Infections 1,552 4
Eye Infections 1,579 31
Other Eye Diseases 826 22
Vitamin A Defc/Xerophthalmia 359 51
Cardiac Failure 1,716 40
Other Cardiovascular 230 15
Rheumatic Fever 2,354 95
Bronchial Asthma 1,550 313
Pneumonia 61,481 1,777
Respiratory Disease (Nyinginezo) 22,676 693
Non-Inf. Gastrointestinal Diseases (Others) 4,101 111
Urinary tract Infections (UTI) 4,540 37
Non-Inf. Kidney Diseases 2,451 3
Skin Infections 3,960 20
Skin Diseases Non-Infectious 506 26
Joint Disorders 420 -
Peri-natal Conditions 2,804 522
Snake and Insect Bites 865 14
Burns 3,352 146
Poisoning 2,104 76
HIV/AIDS 3,111 497
Neoplasms 539 27
Haematological Diseases (less anaemia) 210 30
Osteomyelitis 2,416 48
Congenital Diseases 342 65
Fractures/Dislocation 2,596 18
Ill Defined Symtoms, no Diagnosis 6,486 213
Others 337,282 644
Total 1,891,945 23,380
102
Annex 2 (Cont,d) Admissions, Tanzania Mainland: 2004
Type of disease Age 5 and above years
Admission Deaths
Acute Respiratory Infections 122,483 211
Diarrhoeal Diseases 75,403 547
Hepatitis 701 54
Intestinal Worms 35,640 233
Leprosy 352 273
Malaria- Severe, Complicated 106,067 3,996
Malaria- Uncomplicated 268,240 1,490
Schistosomiasis 4,329 118
Tuberculosis 12,500 1,382
GDS 2,557 223
GUD 1,248 6
Other Sex Tras. Dis (toa GDS & GUD) 1,374 1
Severe Protein Ernegy Malnut. 969 62
Nutritional Disorders (toa PEM) 540 23
Sickle Disease 2,028 211
Anaemia 23,544 1,097
Neuroses 1,242 32
Psychoses 2,019 19
Epilepsy 1,534 36
Ear Infections 1,326 5
Eye Infections 2,193 3
Cataract 1,977 9
Other Eye Diseases Non-Inf. 1,425 15
Vitamin A Defc/Xerophthalmia 295 41
Cardiac Failure 4,534 569
Hypertension 4,469 397
Other Cardiovascular Diseases 1,020 121
Rheumatic Fever 599 13
Bronchial Asthma 5,527 289
Pneumonia 36,369 1,286
Respiratory Disease (Nyinginezo) 6,656 214
Peptic Ulcers 3,426 85
Non-Infectious Gastrointestinal Diseases 4,428 144
(Others) 7,351 84
Urinary tract Infections (UTI) 5,138 128
Skin Infections 1,551 14
Skin Diseases Non-Infectious 767 5
Rheumatoid or Joint Diseases 2,195 38
Peri-neonatal Conditions 875 54
Snake and Insect Bites 2,335 84
Burns 1,662 119
Poisoning 9,117 2,190
HIV/AIDS 4,903 1,172
Neoplasms 3,303 1,042
Thyroid Diseases 1,887 122
Diabetes Mellitus 777 84
Hematological Diseases 4,897 200
Osteomyelitis 609 104
Congenital Diseases 4,699 89
Fractures/Dislocation 8,512 182
Ill Defined Symptoms, no Diagnosis 7,152 176
Non infectious kidney diseases 140,563 1,507
Others (Taja)
Total 945,307 20,599
103
Annex 3 Cumulative number of reported AIDS cases by region,
Tanzania, 1993 – 2004.
Region
1993 1994 1995 1996 1997 1998
Arusha 2,185 2,368 2,615 2,787 3,244 3,567
Coast 2,740 3,023 3,268 3,559 3,796 4,266
Dar es Salaam 10,406 11,050 11,302 12,983 13,899 14,517
Dodoma 1,028 1,294 1,608 1,938 2,517 2,641
Iringa 4,462 4,674 4,785 4,883 5,008 5,031
Kagera 6,646 7,064 7,223 7,426 7,671 7,881
Kigoma 1,920 2,070 2,257 2,280 2,426 2,481
Kilimanjaro 4,699 5,119 5,513 5,991 6,618 7,375
Lindi 1,691 1,966 2,173 2,480 2,712 3,074
Mara 1,304 1,393 1,486 1,486 1,486 1,515
Mbeya 11,439 12,214 12,371 14,685 16,835 19,949
Morogoro 4,328 4,575 4,903 5,189 5,438 5,534
Mtwara 2,090 2,201 2,267 2,444 2,569 2,843
Mwanza 5,349 5,731 5,974 6,365 7,006 7,384
Rukwa 715 777 801 882 1,227 1,359
Ruvuma 2,480 2,847 3,087 3,345 3,752 4,260
Shinyanga 2,624 3,062 3,361 3,824 4,217 4,515
Singida 1,472 1,688 1,908 2,135 2,167 2,262
Tabora 2,786 3,075 3,428 3,805 4,278 4,733
Tanga 3,207 3,475 3,793 4,062 4,278 4,632
Manyara
Unspecified 1 2 44 44 44 44
TOTAL 73,572 79,668 84,167 92,593 101,188 109,863
Region
1999 2000 2001 2002 2003 2004
Arusha 3,948 4,196 4,688 4,785 6,476 6,569
Coast 4,375 5,348 5,580 5,737 5,884 7,904
Dar es Salaam 14,643 16,053 18,627 24,501 26,818 28,474
Dodoma 2,748 2,941 3,170 3,565 4,306 4,746
Iringa 5,076 5,179 5,298 5,318 6,079 6,167
Kagera 8,310 8,529 8,976 9,072 12,034 12,234
Kigoma 2,613 2,732 2,815 2,860 4,040 4,180
Kilimanjaro 7,766 8,088 9,097 10,042 11,909 12,791
Lindi 3,559 4,155 4,710 5,008 5,267 5,430
Mara 1,634 2,021 2,229 2,345 2,920 5,356
Mbeya 23,688 26,952 30,320 31,172 32,705 33,520
Morogoro 5,863 6,388 6,820 7,073 7,467 7,491
Mtwara 3,000 3,262 3,638 3,886 4,130 4,331
Mwanza 7,884 8,338 8,752 9,194 9,676 12,359
Rukwa 1,621 1,997 2,382 2,706 3,246 3,650
Ruvuma 4,760 5,406 6,381 7,080 7,743 8,655
Shinyanga 4,861 5,440 6,310 7,174 7,972 8,687
Singida 2,329 2,396 2,692 2,872 3,040 3,383
Tabora 5,199 5,946 6,349 6,810 7,323 7,720
Tanga 4,792 4,975 5,620 5,819 6,711 8,352
Manyara 110 312 489
Unspecified 44 44 44 44 44 44
TOTAL 118,713 130,386 144,498 157,173 176,102 192,532
104
Annex 4 Prevalence of HIV and syphilis infection by ANC sites,
RPR HIV
Site Total Positive percent Total Positive percent
prevalence prevalence
Dar es salaam 2959 151 5.1 3018 325 10.8
c
Buguruni 879 11 1.3 884 107 12.1
c
Kasorobo 446 46 10.3 450 43 9.6
c
Kigamboni 386 4 1.0 389 36 9.3
c
Oysterbay 466 37 7.9 478 50 10.5
c
Kimara 361 10 2.8 384 35 9.1
c
Kiwalani 421 43 10.2 433 54 12.5
Dodoma 1597 134 8.4 1621 126 7.8

a
Bahi 176 6 3.4 181 8 4.4
a
Handali 228 64 28.1 228 1 0.4
e
Kibaigwa 203 5 2.5 203 18 8.9
c
Makole 331 4 1.2 339 31 9.1
b
Mpwapwa 308 29 9.4 319 19 5.9
c
Wajenzi 351 26 7.4 351 49 13.9
Kagera 1814 270 14.9 1826 87 4.7

c
Bukoba 409 21 5.1 410 39 9.5
b
Katoro 244 64 26.2 245 6 2.4
a
Kimeya 235 51 21.7 241 2 0.8
a
Nkwenda 451 86 19.1 452 7 1.5
b
Nyamiaga 180 27 15.0 182 4 2.2
c
Rwamishenye 295 21 7.1 296 29 9.8
Kilimanjaro 1405 89 6.3 1429 81 5.7

e
Hedaru 219 84 38.4 221 5 2.3
c
Majengo 323 1 0.3 323 22 6.8
a
Masama 266 0 0 268 17 6.3
a
Umbwe 103 0 0 103 3 2.9
b
Huruma 187 2 1.1 323 26 8.1
c
Pasua 307 2 0.7 191 8 4.2
Mbeya 2386 149 6.2 2442 384 15.7

e
Chimala 249 18 7.2 249 38 15.3
a
Ilembo 178 13 7.3 188 15 8.0
c
Kiwanjampaka 724 29 4.0 726 137 18.9
d
Kyela 315 22 7.0 323 51 15.8
a
Igamba 195 29 14.9 228 24 10.5
c
Ruanda 725 38 5.2 728 116 15.9
Mtwara 1262 115 9.1 1279 66 5.1

c
Ligula 388 29 7.5 389 37 9.5
b
Mangaka 264 21 8.0 267 13 4.9
a
Nanyamba 173 9 5.2 176 6 3.4
b
Tandahimba 146 8 5.5 147 1 0.7
c
Likombe 165 29 17.6 165 7 4.2
a
Mkunya 126 19 15.1 135 2 1.5
105
Annex 4 Contd) Prevalence of HIV and syphilis infection by ANC sites,
Kigoma 1246 26 2.1 1349 69 5.1

b
Kibondo 204 0 0.0 217 7 3.2
b
Kiganamo 293 5 1.7 326 11 3.4
c
Kigoma 296 6 2.0 301 21 7.0
a
Nyakitonto 113 2 1.8 163 6 3.7
c
Ujiji 340 13 2.8 342 24 7.0
Lindi 1112 79 7.1 1135 80 7.1
a
Chumo 132 4 3.0 141 4 2.8
b
Liwale 296 7 2.4 307 8 2.7
b
Nachingwea 227 32 14.1 227 22 9.7
a
Nyangao 231 20 8.7 233 12 5.2
c
Sokoine 117 7 6.0 119 16 13.5
c
Town clinic 109 9 8.3 113 18 15.9
Morogoro 1556 187 12.0 1630 147 9.0

a
Hembeti 81 9 11.1 99 2 2.1
a
Mkuyuni 154 5 3.3 173 3 1.7
c
Morogoro 550 54 9.8 559 64 11.5
c
Uhuru 771 119 15.4 799 78 9.8
Tanga 1986 65 3.3 2084 191 9.2

b
Handeni 380 8 2.1 403 32 7.9
a
Kwamkono 158 16 10.1 168 8 4.7
b
Lushoto 237 1 0.4 246 13 5.3
a
Magoma 171 7 4.1 175 2 1.1
c
Makorola 518 8 1.5 545 36 6.6
c
Ngamiani 522 25 4.8 547 100 18.3
Key: arural, bsemi-urban, curban, dborder, eroadside
106
Annex 5 Prevalence of HIV infection among blood donors by region and district,
Tanzania 1999- 2004
Year 1999 Year 2000 Year 2001 Year 2002 Year 2003 Year 2004
Regio Total percen Total percent Total percen Total percent Total percen Total percen
n District donors t prev donors prev donors t prev donors prev donors t prev donors t prev
Arusha 3,030 22 7,223 13.8 6,827 17.8 - - 2,095 11.1 2072 12.9
Arumeru - - - - 72 - - - - - 132 1.5
Arusha
municipality - - 1,372 9.1 1,825 11.2 1,456 8.9 1,608 12.7 1505 16.6
Karatu - - - - - - - - 292 3.1 343 2.3
Monduli 112 0 152 11.8 119 10.1 165 10.9 138 12.3 92 8.7
Ngorongoro - - - - - - - - 57 5.3
Manyanra - - - - - - - - 4,780 12 4450 6.3
Babati 2,095 30.4 4,132 19.1 2,428 33.9 3,676 23.7 2,224 18.6 1419 4.7
Hanang - - - - 223 18 279 13.6 210 14.3 335 15.2
Kiteto - - 64 10.9 266 11.7 537 10.6 579 10.5 858 3.7
Mbulu 809 3.6 1,503 3.7 1,892 7.5 1,601 7.8 1,767 4 1938 2.9
Coast 3,510 8.9 3,160 12.5 3,240 10.4 4,470 9.6 4,688 7 3351 6.4
Bagamoyo 320 5.9 463 7.8 236 13.6 282 14.2 692 3.3 658 9.4
Kibaha 1,730 10.6 664 11.9 1,147 9.1 2,286 8.9 2,113 7 782 5.8
Kisarawe 112 9.8 452 19 281 8.2 - - 145 11
Mafia 256 8.2 249 8 292 5.8 384 4.7 249 1.6 381 3.1
Rufiji 1,092 7.1 1,318 13.1 1,284 12.5 1,518 11.1 1,489 9.3 1530 6.3
DSM 694 33.1 1,739 8.6 1,956 18.8 3,547 12 4,923 10 2572 7.9
Ilala 428 45.1 1,005 9.7 1,351 14.7 1,536 6.3 2,125 6.9 2348 6.9
Kinondoni 162 12.4 658 5.5 153 33.3 1,295 15.1 1,833 10.3 224 18.8
Temeke - - - - 452 25.9 716 18.4 965 16.3
Dodoma 2,269 5.1 3,001 3.9 8,984 7.9 4,351 7.6 3,933 7 4390 5.7
Dodoma
municipality 1,364 4.8 1,129 5.6 4,249 13.2 2,280 6.9 2,251 4.6 1125 5.2
Kondoa - - 797 4.9 1,122 4.4 855 3.7 785 6.6 1034 6.2
Kongwa - - - - 441 7.3 1,216 11.7 897 13.3 1004 7.6
Mpwapwa 905 5.4 1,075 1.5 3,172 2.3 - - - - 1227 4.4
Iringa 4,258 14.7 2,393 14.6 5,104 18.7 3,450 14.8 2,115 15.4 2163 12.1
Iringa
municipality 2,643 14.3 1,008 14.7 3,057 21.4 1,911 16.6 1,431 14.2 1453 9.7
Ludewa 280 22.1 415 15.2 534 18.4 165 17.6 - - 298 26.5
Mafinga - - - - 96 10.4 - - 181 14.9
Mufindi 297 8.1 301 8.9 62 3.2 318 6.6 83 3.6 412 10.2
Njombe 1,038 15.7 669 16.6 1,355 13.9 1,056 13.7 420 22.1
Kagera 4,572 17.7 3,827 19.5 5,753 22 5,965 18 4,699 20.7 6060 18.2
Biharamulo 428 19.6 413 8.5 350 10.6 947 6.7 729 11.8 852 15.5
Bukoba 1,615 20.7 650 12.2 1,577 12.7 1,501 13.1 836 13 309 12
Karagwe 638 20.8 998 19.5 1,183 17.4 1,585 19.2 871 24.8 2732 17.6
Muleba 1,159 15.5 1,472 24.6 1,843 33.7 1,403 31.1 1,246 29.3 858 33.7
Ngara 732 10.4 294 25.8 800 25.4 529 14 1,017 19.2 1309 12.3
107
Annex 5 (Cont’d) Prevalence of HIV infection among blood donors by region and district,
Tanzania 1999- 2004
Kigoma 6,860 6.4 6,772 3.8 7,412 4.9 3,935 3.2 8,124 4.8 9049 3.1
Kasulu 4,935 6.8 3,503 3.5 3,918 3.7 3,200 3 3,029 2.7 3841 2.8
Kibondo 752 4.5 530 6.2 543 4.6 142 0 1,135 1.4 945 2.6
Kigoma 1,173 5.7 2,739 3.8 2,951 6.5 593 4.9 3,960 7.4 4263 3.6
Kilimanjaro 5,218 4.8 4,435 6.7 4,823 5.9 4,125 6.8 3,334 4.8 3499 4.5
Hai - - 416 10.1 310 1.6 15 - - -
Moshi 3,233 5.4 2,221 6.4 2,948 5.6 2,792 7.4 2,041 4.2 2466 4.3
Mwanga 277 3.6 115 7 162 10.5 202 3 166 5.4 169 7.1
Rombo 305 2.9 222 3.3 302 2.6 372 2.4 238 4.2 97 2.1
Same 1,369 4.2 1,461 6.8 1,101 8 744 8.2 889 6.3 767 4.8
Lindi 7,083 3.4 5,092 4.2 6,046 3.8 5,856 3.6 5,308 3.8 5645 3.6
Kilwa 879 5.6 478 3.1 656 5 673 4.2 812 5.5 1021 3.6
Lindi 2,788 5.1 2,175 4.5 2,159 4 2,367 3 1,858 4.7 2041 4
Liwale 986 1.3 931 3.6 837 3.9 638 3.9 787 2.7 879 3.1
Nachingwea 2,430 1.6 1,508 4.4 2,394 3.3 2,069 2.8 1,587 2.4 1269 3.4
Rwangwa - - - - - - - - 264 4.9 435 4.1
Mara 5,151 9.2 10,676 9.4 9,277 9 10,709 10.3 8,108 7.8 11732 5.9
Bunda 262 9.9 2,416 10.7 2,495 9 2,391 9.1 584 16.3 3889 4.7
Musoma 2,835 8 4,230 7.6 4,670 7.5 2,943 9.5 4,994 8.5 4846 6.3
Serengeti 988 6.3 1,335 2.9 1,042 2.1 1,567 2.7 1,657 2.5 1641 3.3
Tarime 1,066 14.7 2,695 14.3 1,070 22.2 3,794 14.9 873 8.6 1356 11.1
Mbeya 6,691 15.2 7,338 17 10,618 16.4 7,462 12.7 7,957 14.8 7144 13.3
Chunya 865 17.8 868 19.9 1,938 20 1,207 17.9 1,688 26.5 1707 17.7
Ileje 218 13.8 211 11.9 190 11.6 125 2.4 138 5.8 80 6.3
Kyela 750 13.6 1,110 16.4 1,671 15.7 1,388 17 1,408 14.1 1675 16.4
Mbarali 1,470 18.3 1,683 25.4 1,868 20.3 946 14.4 1,033 15.8 925 14.7
Mbeya 1,254 16.3 1,153 18.3 1,390 13.3 1,093 7.5 1,368 5.6 1134 3
Mbozi 635 16.4 566 11.1 934 11.7 741 16.3 974 17.4 837 13.3
Rungwe 1,499 10.5 1,747 9.6 2,627 15.1 1,962 7.9 1,348 8.3 786 10.7
Morogoro 12,389 11.3 7,606 16.6 12,755 17.2 9,764 8.6 10,140 8.3 12387 8
Kilombero 2,697 18.1 1,671 35.3 3,334 34.6 2,346 11.5 2,867 14.4 4039 10.2
Kilosa 4,435 11.7 1,309 6.9 3,581 8.7 3,173 6.1 2,265 3.7 2969 4.9
Mahenge - - - - - - - - 14 0
Morogoro 4,440 8.2 4,072 12.1 4,964 13.5 2,887 10.4 1,685 7.1 1905 6.7
Mvomero - - - - - - - - 1,763 12 1753 16.2
Ulanga 805 3.7 540 15.4 876 6.4 849 1.9 1,546 1 1721 1.5
Mtwara 3,030 7.8 8,665 8.2 5,767 7.5 6,476 6.8 4,833 6.5 3541 4.7
Mtwara urban 739 4.5 139 7.2 1,994 4.6 1,971 5.3 1,522 5.4 618 2.9
Masasi 2,291 8.9 3,725 10.1 2,955 9.8 2,981 8.3 2,497 7.7 2721 5.3
Mtwara rural - - 3,182 7.2 - - - - - -
Newala - - 1,619 5.7 818 6.2 1,493 6 650 5.5
Tandahimba - - - - - - - - 164 1.8 202 2.5
108
Annex 5 (Cont’d) Prevalence of HIV infection among blood donors by region and district,
Tanzania 1999- 2004
Mwanza 10,373 7 9,858 7.6 12,526 8 16,672 7.7 15,235 8.7 11,151 8.9
Geita 832 8.8 1,173 7 1,942 6.2 2,228 7.2 2,289 7.3 2,238 8.3
Kwimba 1,977 4.9 1,171 4.4 1,293 7.8 2,685 7.1 2,714 7.4 2,784 6.4
Magu 1,436 9.5 1,243 12.6 1,539 13 2,214 12.2 2,571 14.6 3,544 10.8
Misungwi 372 3.2 444 5.6 491 6.3 1,111 5.2 1,124 5.1 222 12.2
Mwanza 2,561 5.8 2,377 8.2 3,061 7.6 3,544 6.3 4,148 5.4 813 11.8
Sengerema 2,518 7.5 2,868 6.5 3,406 7.2 3,400 6.1 235 8.5
Ukerewe 677 10.6 558 10 772 10 1,490 11.3 2,154 13.2 1,550 7.9
Rukwa - - 3,277 11.8 531 10.7 1,829 9.8 1,749 17.9 2381 19.5
Mpanda - - 565 12.2 341 8.8 375 7.5 - - 1854 9.8
Nkasi - - 652 15.6 - - 927 9.9 1,355 18.4 1427 32.1
Sumbawanga - - 2,045 10.6 190 14.2 527 11.4 394 16.2
Ruvuma 8,301 9.8 9,813 10.2 12,187 11.2 14,965 10.9 12,318 10.3 13127 8.1
Mbinga 3,502 7.5 3,618 9.4 3,646 11.4 5,370 10.1 3,950 8.8 4155 8.8
Songea 3,460 13.8 4,605 12.4 5,678 14.3 6,919 13.7 6,003 13.5 5965 9.4
Tunduru 1,339 5.3 1,590 6 2,863 4.8 2,663 5.3 2,365 4.4 3007 4.4
Shinyanga 8,654 8.2 9,332 9.4 12,316 8.4 15,603 8.3 19,748 7 19267 7.3
Bariadi 2,676 4.2 1,580 4.8 2,569 6.2 4,045 6.1 9,754 4.9 5037 3.9
Kahama 2,534 10.2 2,344 9.6 3,754 8.6 5,632 7.8 4,743 9.4 6400 8.5
Maswa 690 9.3 908 9 1,239 10.1 1,800 9 1,059 6.6 1813 8.3
Meatu 426 10.3 307 10.1 569 12 799 8.1 436 12.4
Shinyanga 2,328 9.9 4,185 11.1 4,185 8.6 3,327 11.5 3,756 9 6017 8.6
Singida 4,187 8.1 5,326 8 6,785 11.8 5,896 10.9 4,962 7.6 5213 5.7
Iramba 181 5.5 1,095 12 710 5.2 737 14.2 537 8.6 875 6.4
Kiomboi - - - - 14 7.1 - - - -
Manyoni 877 7.1 1,864 7.4 2,024 8.3 2,335 6.6 2,042 5.5 2604 4.9
Singida urban 3,129 8.6 2,367 6.8 3,557 13 2,269 14.9 2,383 9.2 1734 6.7
Singida rural - - - - 480 27.5 552 8.3 - -
Tabora 11,335 7.1 9,084 7.2 9,628 7.6 7,973 6.6 9,052 8.4 12314 6.5
Igunga 4,120 7 2,359 7.6 2,427 8.2 3,379 7.3 3,137 8.8 2520 9.2
Nzega 1,812 6.4 1,604 5.4 3,156 5.7 2,172 4.3 3,076 7.6 3403 7
Sikonge 892 5.7 875 5 1,043 6.7 1,210 6.4 1,317 6.1 1647 5.3
Tabora 2,918 7.8 2,445 7.8 1,487 8.1 - - - - 3201 5
Urambo 1,593 7.7 1,801 8.8 1,515 10.8 1,197 9 1,522 11.3 1543 5.3
Tanga 10,967 8.3 9,749 8.8 9,583 8.6 6,100 9.8 9,276 7.4 11637 5.9
Handeni 1,531 9.7 1,296 5.3 1,937 3.5 799 1.9 1,571 2.9 1840 2.6
Kilindi 499 0
Korogwe 1,945 9 1,034 6.1 795 6.8 - - 1,798 6.4 1839 3.7
Lushoto 450 22.2 811 13.2 537 11 179 11.2 916 15.1 1338 9
Muheza 2,667 8.1 1,712 10.2 2,463 9.1 1,537 6.4 1,036 6.5 2381 7.2
Pangani 621 5.5 1,169 5.7 509 4.7 545 4.8 1,345 5.5 1237 5.1
Tanga 3,753 6.3 3,727 10.1 3,342 11.7 3,040 14.4 2,610 9.5 2503 8.7
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B

UNITED REPUBLIC OF TANZANIA

ANNUAL HEALTH STATISTICAL

AIDS Acquired Immune Deficiency Syndrome

1.1 Human Resource Statistics

0 50 100 150 200 250 300 350

0 50 100 150 200 250 300 350 400

Aru sha 278

Ave rage 1,021

0 500 1000 1500 2000 2500 3000 3500

Aru sha 231

Ave rage 356

1.2 Health Facilities in Tanzania

Total 87 87 8 37 219 331 101 10 39 481

Table 1.2 Distribution of dispensaries and total health facilities by region

Figure 1.8 The number of health facilities by ownership

Figure 1.9 The number of hospitals by ownership, Tanzania Mainland: 2004/05

1.2.2 Health facility beds

Figure 1.11 Number of hospital beds by type of ownership

Voluntary Age ncie s

1.2.3 Health Facility Equipment

Table 1.4 (Contd) Health facilities wquipment by region, 2004/05

1.2.5 Proportion of health facilities in good state by type

Figure 1.12 Proportion of health facilities in good state of repair

1.3.1 Health in relation to the total Government of Tanzania (GOT) budget

Figure 1.13 Spending on the health sector as a proportion of the total

1.3.2 Other measures of health spending

Table 1.5 Other measures of spending, MOF data FY01 – FY05

CPI deflator 100.0 104.8 109.4 113.6 118.4

Note: break in series of CPI/inflation deflator from FY 2003/04

Table 1.6 Total expenditure on health, Tanzania Mainland: Y2001/02 – FY2004/05

Total on budget 160.01 141.01 195.40 176.36 220.40 220.10 312.81

Grand Total 226.16 221.62 244.66 237.13 291.06 310.37 453.15

Notes: AGO spending on NHIF

Note: On-budget only

1.3.3 Regional level trend

Figure 1.16 Allocation of funds for health purposes to regions

Table 1.7 Regional sub-vote budgets and expenditure,

1.3.4 Local government trend

Table 1.8 Central government health subventions to local government,

N/A = Not Available, PE = Personal Emolument, OC = Other Charges

Table 1.9 Sector expenditure by level, Tanzania mainland:

Total on-budget 141.01 176.36 220.10 43.75 25%

CHAPTER 2: MORBIDITY AND MORTALITY STATISTICS

Ill Defined Conditions 2.0%

0% 5% 10% 15% 20% 25% 30% 35% 40%

ART: Acute Respiratory Infections

Minor Surgical Conditions 3%

Ill Defined Conditions 3%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Other Respiratory Diseases 1.6%

Intestinal Worms 4.9%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%

Ill Defined Symptoms 0.84%

Intestinal Worms 4.3%

Diarrhoea Diseases 7.2%

Malaria Uncomplicated 42.1%

Perinatal C onditions 3.0%

0% 5% 10% 15% 20% 25% 30%

Cardiac Failure 2.6%

Dirrhoea Diseases 2.9%

Typhoid Diseases 6.2%

Uncomplicated M alaria 6.9%

Severe M alaria 19.0%