Mvumi Hospital is a 280 bed church hospital, 40 km. south east of Dodoma. The hospital serves the population of Dodoma Rural District, south and east of Dodoma. Over 75% of patients come from 2 divisions: Mvumi and Makang’wa which make up the project area: 29 villages within a 80 km. radius of the hospital.

All inhabitants of Mvumi and Makang’wa Divisions:

Total population: 116,916 (projected from 1988 census).

Estimated no of under 5s and pregnant women 31,567 (from MTUHA data).

No. of households 25,416 (4.6 people/ household).

The main tribe in the area is the Gogo: most people are subsistence farmers growing millet, maize and peanuts. Farming is by traditional methods and is dependent on rainfall. The rainy season is from December to April. Traditionally the Wagogo keep cattle and goats but grazing was stopped in Mvumi Division in 1986 because of soil erosion and only about 600 dairy cows are kept by zero-grazing in the whole division. About 20% of households in Makang’wa Division keep livestock. Income generating activities include selling sugar cane, tomatoes, sweet potatoes, charcoal and home brewed millet beer.

Poor harvests in 1997, 1998 and 1999 have led to severe food shortages with famine relief being distributed by the Norwegian People’s Aid. Food shortages are predicted again from October 1999.

The educational level is low with only approximately 50% of the population having primary school education.

Malaria is present all year round but transmission is increased during the rainy season with a peak in April. Malaria is the leading cause of outpatient consultations, admissions and deaths in Mvumi Hospital. Admissions for severe malaria have increased from 350 to over 1500 per year since the mid-1980s. The area is at risk of malaria epidemics.

The hospital started a net making project in 1994 selling them from the hospital pharmacy. When netting material became difficult to get, it bought ready made nets from Central Medical Stores and started selling insecticide for home treatment in 1997.

In 1995 the Mvumi Hospital Community Health Department in collaboration with local government public health officers sold permethrin impregnated Olyset nets to inhabitants of Mvumi Mission village at a subsidised price of Tsh 800. 4,300 nets were sold with a coverage of 98% households resulting in a 50% decrease in children’s malaria admissions to the hospital. The success of this project led to demands from other villages for the hospital to expand its malaria control activities.

The Mvumi SMITN project was launched in June 1998 and products initially sold from the Hospital Pharmacy. PRA was carried out in 6 villages in July 1998 to identify potential sales agents. Agents were selected from interested church groups, health staff and shopkeepers. Now 60 outlets are selling nets and insecticide in 25 villages.

The hospital orders nets and insecticide from PSI. The pharmacy staff handle stock control and sell nets direct to customers and to agents who come to collect. The hospital also distributes nets and insecticide on mobile sales trips to distant villages, during MCH mobile clinics and during supervision visits to first line health units.

Total sales of nets and insecticide from June 1998 to the end of August 1999 are 3993 nets and 4834 packets of Ngao insecticide. The coverage of nets has increased from 5% (SMITN baseline household survey 1998) to 21% of households.

28% of net owners have retreated their nets with Ngao.

Famine has meant that people have little spare cash to buy nets and insecticide.

Retreatment rates are low; people perceive malaria to be a seasonal problem.

Many church groups lack capital to start selling nets and insecticide and so require small loans.

To work with village and local political leaders to promote nets and insecticide.

To increase emphasis on the need for retreatment of nets, before the rainy season.

To look for funding for transport to increase distribution and support to agents in distant villages.