Despite all efforts, malaria remains a major problem in Africa particularly among children under five

years of age and pregnant mothers. In Tanzania, malaria is believed to be directly or indirectly

responsible for about 16 million annual malaria episodes and 100,000-125,000 annual deaths of which

70-80,000 are children under five (MOH, 2002). Global and national malaria control strategies have

mainly relied on low cost interventions through improved prevention and effective treatment, with the

aim of reducing malaria related deaths. However, in many places, people still lack access to effective

treatment due to various interrelated factors.

The proposed study is conducted within the frame of the ACCESS Programme, a five year programme

which intends to improve access to effective malaria treatment in the districts of Kilombero and Ulanga,

Tanzania. The study aims at understanding local knowledge of malaria and factors that positively or

negatively influence whether care takers of under five year old children are able to gain access to

prompt and appropriate malaria treatment.

In a setting of high malaria endemicity, illness episodes with fever and/or convulsions are very likely to

be caused by malaria parasites. The local people use different terms for these conditions. The first task

of this research project was to carry out a household study to examine local illness concepts which are

related to malaria and to investigate associated health seeking practices (baseline study). These

findings were fed into an extended social marketing campaign which drew on local illness concepts to

raise awareness of danger symptoms and biomedically appropriate treatment. The household study was

then repeated to find out whether the social marketing campaign had changed people’s knowledge and

treatment seeking practices.

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The research project further provides a deeper understanding of access to malaria treatment in the

research area. The general environment and service of selected health facilities is explored in order to

learn how children with fever and convulsions (degedege) are attended. However, the focus is not only

on household and health facility levels. The last part of the study focuses on services offered by non

governmental and community organizations that are active in the research area. The project

investigates whether these services assist those most at risk, pregnant women and children, in

accessing various preventive and health care services.