Post integrated measles campaign and routine immunization coverage evaluation survey 2011

Post Campaign Evaluation Report

April, 2012

MINISTRY OF HEALTH AND SOCIAL WELFARE

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Table of contents

Post integrated measles campaign and routine immunization coverage evaluation survey 2011 1

Table of contents ...... 2

Acronyms ...... 6

Executive summary ...... 7

Background ...... 7

Methods ...... 8

Results ...... 8

Discussion ...... 9

Conclusion ...... 10

Acknowledgements ...... 12

Background ...... 13

Global burden of diseases in under five children ...... 13

Measles control activities in Tanzania ...... 14

Historical perspective of measles immunization ...... 14

Accelerated Measles Control: 1999-2009 ...... 15

Routine Immunization services ...... 16

Immunization coverage survey-the post 2008 Iintegrated Measles Campaing (IMC) ...... 16

Overall goal of the campaign ...... 17

Tanzania 2011 post integrated Immunizaation Campaign coverage survey ...... 18

Main survey objectives were: ...... 18

Methods ...... 18

Tanzania basic country profile ...... 18

Target survey population groups and sampling procedures ...... 19

Survey procedures ...... 19

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Survey Area ...... 19

Survey Population ...... 19

Basic routine immunization case definitions ...... 20

Sampling Methodology ...... 20

Field households’ smpling procedures ...... 22

Questionnaires ...... 22

Survey planning and implementation ...... 23

Data collection ...... 27

Data analysis ...... 28

Ethical approval ...... 28

Results ...... 28

A. Integrated Measles Campaign Results ...... 29

Target population and survey characteristics ...... 29

(i) Measles vaccination coverage ...... 30

(ii) The bOPV vaccination coverage ...... 31

Children with Adverse Events Following Immunization ...... 33

Source of information ...... 34

B. Routine Immunization ...... 36

Target population and survey characteristics ...... 36

Routine Immunization Cards retention ...... 37

Vaccination system access and management (utilization) ...... 40

Ability to target children under one year ...... 42

Reasons for children not vaccinated ...... 42

Discussion ...... 45

(A) Compign coverage of measles and bOPV vaccination ...... 45

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(B) Routine immunization coverage ...... 47

Conclusion ...... 48

Other materials in annexes ...... 48

References ...... 49

ANNEXES ...... 50

ANNEX 1: ENUMERATION AREAS IN ARUSHA ...... 50

ANNEX 2: ENUMERATION AREAS IN DODOMA ...... 51

ANNEX 3: ENUMERATION AREAS IN DAR ES SALAAM ...... 52

ANNEX 4: ENUMERATION AREAS IN IRINGA ...... 54

ANNEX 5: ENUMERATION AREAS IN KIGOMA ...... 55

ANNEX 6: ENUMERATION AREAS IN KILIMANJARO ...... 56

ANNEX 7: ENUMERATION AREAS IN LINDI ...... 57

ANNEX 8: ENUMERATION AREAS IN MANYARA ...... 58

ANNEX 9: ENUMERATION AREAS IN MBEYA ...... 59

ANNEX 10: ENUMERATION AREAS IN MOROGORO ...... 60

ANNEX 11: ENUMERATION AREAS IN MTWARA ...... 61

ANNEX 12: ENUMERATION AREAS IN MARA ...... 62

ANNEX 13: ENUMERATION AREAS IN MWANZA ...... 63

ANNEX 14: ENUMERATION AREAS IN PEMBA ...... 64

ANNEX 15: ENUMERATION AREAS IN PWANI ...... 66

ANNEX 16: ENUMERATION AREAS IN RUKWA ...... 67

ANNEX 17: ENUMERATION AREAS IN SHINYANGA ...... 68

ANNEX 18: ENUMERATION AREAS IN SINGIDA ...... 69

ANNEX 19: ENUMERATION AREAS IN TABORA ...... 70

ANNEX 20: ENUMERATION AREAS IN TANGA ...... 71

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ANNEX 21: ENUMERATION AREAS IN UNGUJA ...... 72

ANNEX 22: ENUMERATION AREAS IN KAGERA ...... 74

ANNEX 23: ENUMERATION AREAS IN RUVUMA ...... 75

ANNEX 24: DODOSO LA WATOTO CHINI YA MIAKA MITANO [H1] ...... 76

ANNEX 25: DODOSO LA WATOTO [H2] ...... 77

ANNEX 26: DODOSO LA MAMA MWENYE MTOTO CHINI YA MWAKA MMOJA [H3] ..... 80

ANNEX 27: TABLE OF OVERALL RAPID IMC COVERAGE ...... 82

ANNEX 28: VALID TT2 AND TT3 DOSES ADMINISTERED ...... 82

ANNEX 29: MAIN REASONS FOR UNVACCINATED CHILDREN ...... 83

ANNEX 30: ABILITY TO TARGET UNDER ONE YEAR AGE CHILDREN ...... 84

ANNEX 31: IMMUNIZATION PROGRAM ACCESS (WOMEN RECEIVED TT1) ...... 85

ANNEX 32: WOMEN RECEIVING PRENATAL CARE ...... 86

ANNEX 33: HEALTH CARE PROVIDERS ...... 86

ANNEX 34: CRUDE TETANUS VACCINE COVERAGE FOR WOMEN WITH INFANTS ... 87

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Acronyms

bOPV bivalent Oral Polio Vaccine

BCG Bacillus Calmette-Guérin (or Bacille Calmette- Guérin, BCG)

CI Confidance Intervals-(95%)

DRC Democratic Republic of Congo

DPT-HepBHib1 Diphtheria, Pertussis ,Tetanus Hepatatis B and Haemophilus type b conjugate Vaccine

DANIDA Danish International Development Agency

EA clusters/Enumeration Areas

EPI Expanded Programme on Immunization

IMC Integrated Measles Campaign

IHI Ifakara Health Institute

IRB Institutional Review Board

JICA Japan International Cooperation Agency

MDG4 United Nations Millennium Development Goal 4

MOHSW Ministry of Health and Social Welfare

REC Reaching Every Child approach

RCH Reproductive and Child Health Section

SIAs Supplementary Immunization Activities

TDHS Tanzania Demographoic and Health survey

UNICEF The United Nations Children's Fund

WHO World Health organization

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Executive summary

Background The United Nations Millennium Development Goal 4 (MDG4) aims for a two-thirds reduction in mortality among children aged, 5 years in 2015 as compared to baseline in 1990. Measles is one of the most contributors to under five child mortality. The estimated measles-related mortality among children aged, 5 years worldwide however has been steadily under decline since in 1990 (86% reduction). Routine childhood immunization with measles vaccine is recommended as an effective intervention to reduce mortality due to measles.

The Expanded Programme on Immunization (EPI) in Tanzania routinely vaccinates intants at birth with Bacillus Calmette-Guérin/Bacille Calmette-Guérin (BCG) for protection against turbeculosis and Oral Polio Vaccine (OPV) against polio viruses. At one month, two and three months later of life other rounds of vaccination against polio (OPV1, 2&3) and difteria, pertussis, tetanus, hepatitis B and hemophilus influenza viruses (DPT-HepB-Hib vaccine) are conducted. Finaly at nine months of infancy measles vaccine is olso given. Despite global support to increase coverage of routine vaccination with six targeted antigens against infants’s illness, the national coverage of these antigens is still not optimal. Few unvaccinated children who normaly miss the routine immunization are expected to carry dangerous strains of infections. In the vaccinated group there is another few children whose immunity may not respond well with given vaccine. It is due to these reason the programme considerered an intergrated measles campaign in order to give a second opportunity to those who were missed during the routine immunization and those who got the vaccine but couldn’t sero- convert .

Here we report the intergrated measles campaign (IMC) coverage evaluation for the campaign that was conducted in November 2011. This evaluation was conducted by Ifakara Health Institute (IHI) in the aftermath of the campaign. The evaluation was to document the campaign coverage in terms of target antigens; measles and bOPV. The evaluation was also aimed to document essential indicators for routine immunization

7 coverage in children between 12-23 months and tetanus coverage among reproductive age women with children below 11 months on the date of survey. This survey was designed to specifically answer the following objectives:

I. To determine the measles and bOPV vaccination coverage II. To determine the reason why children missed were not vaccinated and source of information III. To determine the status of routine vaccination coverage of children 12-23 months and the reasons for not completing the vaccination schedule; and IV. To determine tetanus toxoid vaccine coverage of mothers with children aged 0-11 months

Methods In November 2011 following a four days nationwide IMC in 21 regions in the mainland Tanzania and 2 on the Zanzibar islands a sample of 300 enumeration clusters (villages) per region were surveyed. Survey was conducted such that in each cluster nearly 14 children or mother/care takers were interviewed during the survey that was completed at the household level. Children under five years who were 0-59 months at the time of survey represented age group for campaign population in which bOPV and measles was evaluated. Furthermore this evaluation provided opportunity to document coverage of other antigens that are immunized through routine immunization in children between 12-23 months who werethe representative age group. In the reproductive women, this survey also mapped coverage of tetanus toxoid (TT) immunization in mothers that gave birth to children less than 11 months at the time of 2011 campaign.

Results There were11695 children available to be evaluated for measles and bOPV vaccination. Among all children 8,066 (91.6 %) with 95% confidance intervals (CI; 90.9-92.1) aged between 9 to 59 months (with their mothers/care takers) and were seen by the survey teams to confirm that have been vaccinated with measles vaccine during the campaign. The bOPV coverage was 10,622 (90.8%) with (95% CI; 90.3-91.3). The overall campaign coverage was high on the Zanzibar islands( 96%). The three leading regions in coverage of both antigens were Kagera, Shinyanga and Arusha. The main source of

8 information was community leaders and health care workers in all regions except in Rukwa were health workers highly dominated.

Under the routine immunization, information was available for a total of 9,132 children who were between 12 to 23 months old. Overall 75.7% retained vaccination cards. Tabora region had high cards retention rate of nearly 99.8%. Nationwide 90.1% children were fully immunized (with 95% CI; 86.5% - 93.8%) through card and history. The valid immunization coverage was 63.7% with (95% CI; 57.4%-71.2%).

The overall crude immunization coverage was BCG 98.6%, [DTP-HepB-Hib1] 97.1%, [DTP-HepB-Hib3] 95.1%, [OPV1] 96.6%, [OPV3] 91.9% and Measles 95.1%. while valid immunization coverage was BCG 98.0%, [DTP-HepB-Hib1] 31.2%, [DPT-HepB-Hib 3] 25.4%, [OPV1] 32.4%, [OPV3] 23.4% and Measles 58.5%.

The countrywide drop-out rate was 1.8%. Shinyanga and Ruvuma are the two regions with high drop-out rates with Shinyanga leading top by 10.9%.

The ability to target children below one year was above 80% across regions with exception of Pemba, Rukwa and Ruvuma. The main three reasons given by mother or caretakers whose children were found not vaccinated wasthe fear of child to get side effects 23%. This was the main perceived leading problem in Ruvuma 8.9%, Mwanza 8.8% and Rukwa 5.7%.

The crude tetanus vaccine coverage for women with infancy was 93.6% for TT1 while crude TT2+ was 65.7%.

Discussion

The 2011 IMC was completed on time (12-15 November 2012) and coverage of both campaign and the routine immunization has been evaluated from 16-20 th November 2011 across Tanzania. In IMC both antigens (measles and bOPV) the coverage was above 90% and slightly high on the Zanzibar islands. A stratified coverage by regions in

9 both antigens was above 85% with exception of Tabora and Rukwa regions. The campaign coverage rates have improved as compared to those recorded back during the 2008 survey. The 2011 survey was a follow-up campaign after the 2008 integrated measles campaign that recorded nearly 80.6% of all vaccination in both antigens.

The main source of information was community leaders and health care workers almost in all regions except in Rukwa were the most prevalent source of information was health care workers. There were 4% of children that reported to have Adverse Events Following Immunization (AEFI). All these cases were mostly pain at the site of injection.

Among the routine immunized 9,132 children 4,684 (51.3%) were male and 4,448 (48.7%) females. The crude country rate was 90.4% whereas the valid one was 62.9%. Across Tanzania, Rukwa region presented the lowest valid coverage of measles vaccine while Tabora was the most immunized region with 78.9% of measles vaccination. The overall card retention rate was 77.8% and significantly high in Tabora and still very low in corresponding Pemba (50.5%), again highlighting the required urgent serious level of programme intervention to improve immunization activities in this region. The crude tetanus vaccine coverage for TT1 in women with infancy was significantly high but very low in corresponding valid TT2+.

The vaccination system access and management/utilization was nearly 1.8% whereas Shinyanga and Ruvuma were the two regions with high drop-out rates with Shinyanga leading top with 10.9%. The programme ability to target children during infancy was good with the exception of Pemba, Rukwa and Ruvuma; these regions were not able to reach a country benchmark of at least 80% immunization with measles vaccine.

Conclusion The immunization campaign activities are crucial programmatic milestone necessary to reach never-vaccinated children who might also have never had vaccine preventable diseases for them to develop sufficient natural active immune response in places where programmatic coverage is low. These campaigns are in particular important also to

10 provide protection to a cohort of under five who might have missed routine immunization of the target antigens or have had primary vaccine failure. These activities are therefore required to be systematically implemented and evaluated at the same time to guide progamme’s performance and forecast.

The 2011 post campaign coverage evaluation has documented good immunization coverage across Tanzania both in bOPV and Measles. It has further documented an optimal vaccination system access and management/utilization for routine immunization. The evaluation has furthermore documented achievements in the programme’s ability to reach children with target antigens during infancy with the exception of isolated places like Pemba, Rukwa and Ruvuma; where more programmatic emphasis is therefore advised to be directed. It is therefore imperative to note here that, the programme has to maintain the achieved gains as documented in this report in order to reach the measles pre elimination goal the country has set forward.

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Acknowledgements Ifakara Health Institute’ EPI National-wide Coverage Survey Team is grateful to the following individuals. Programme manager EPI section Ministry of health and social welfare for her collaborative efforts that enabled the Integrated Measles Campaign (IMC) Implementation. WHO country office to organize all implementation logistics and monitoring the implementations. We are very grateful to Christopher Kamugisha for his tremendous support. American Red Cross provided institution funds that supported IHI to implement overall activity. We are also very grateful to all regional EPI coordinators and Regional medical Officers throughout Tanzania without them this work would be impossible. This report was jointly prepared by scientists from IHI and WHO country office representative EPI focal person.

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Background

Global burden of diseases in under five children The United Nations Millennium Development Goal 4 (MDG4) aims for a two-thirds reduction in mortality among children aged 5 years in 2015 as compared to baseline in 1990 [14]. Measles is one of the big contributors to under five child mortality. The estimated measles-related mortality among children aged 5 years worldwide however has been steadily declining since in 1990 from 872,000 deaths to 556,000 in 2001 (36% reduction) and to 118,000 in 2008 (86% reduction) 1 due to good vaccination coverage. In particular, the all-cause mortality in this age group decreased from 12 million in 1990 to 10.6 million in 2001 (13% reduction) and to 8.8 million in 2008 (28% reduction) 1. Measles accounted for about 7% of deaths in this age group in 1990 and 1% in 2008, that is equal to 23% of the global reduction in all-cause mortality in this age group from 1990 to 2008 1. WHO estimates that as many as 2.5 million deaths among under-5 children worldwide are averted annually by immunization against diphtheria, tetanus, pertussis, and measles 2. Although the recent trend related to global vaccination coverage is positive with 120 countries reaching 90% DTP3 coverage in 2008, points of under vaccination continue to persist in parts of sub-Saharan Africa [10]. In Tanzania a recent estimate showed that the overall DPT-HepB-Hib immunization coverage of infants was 82%, and 23.5 million children did not receive DTP3 vaccine in 2008 2.

Measles is among the most highly infectious diseases known, affecting at least 95% of exposed populations in the absence of vaccination 3. The large preventable disease burden attributable to measles infection, combined with an inexpensive and highly effective vaccine, makes measles vaccination one of the most cost-effective health interventions worldwide 4. Routine childhood immunization with measles vaccine is recommended as an effective intervention to reduce mortality due to measles 1. Considerable progress has been attained toward the global goal of 90% reduction in measles mortality by 2010 5. The World Health Assembly in 2010 endorsed the milestones toward measles eradication 6. However, if universal mass coverage with measles vaccine is not continued after global eradication, the risk of measles reintroduction will appear, and it is likely that a number of national authorities will

13 choose to continue current routine immunization activities after eradication 7. Immunization coverage is also one of the best general measures of the utilization of child health Services 8.

Measles control activities in Tanzania

Historical perspective of measles immunization In Tanzania during the pre immunization era, measles outbreaks were commonly experienced characterized by short intervals of 2-3 years. Measles incidence rates ranged between 100-800 cases /100,000 populations. The rates were mainly in the under five years age group with high case fatality rates of more than 25%.

The Expanded Programme on Immunization (EPI) in Tanzania was established in 1975 with the primary aim of protecting children from Vaccine Diseases. The overall goal of this programme is to contribute to the reduction of infant and childhood mortality rates. Under this programme, six antigens are delivered to target children and reproductive age women. These include Bacillus Calmette-Guérin/Bacille Calmette-Guérin (BCG) against turbeculosis; Oral Polio Vaccine (OPV) against polio viruses; Difteria, pertussis, tetanus, hepatitis B and hemophilus influenza viruses (DPT-HepB-Hib vaccine, Measles and ietanus toxoid vaccine. Since the launch of EPI, measles vaccine is given to children at 9 months. Following launch of routine vaccination programme the immunization coverage increased from 5% to 50% with corresponding decrease in incidence of measles from 800 to 600/100,000 population in early 1980s [. Contrally to this, case fatality rate remained as high as in pre-immunization era (25%). Between 1985 through 1989 in Tanzania the Universal Child Immunization (UCI) raised the immunization coverage from below 50% to more than 80%. Although measles disease was still very common in health facilities this period has recorded a significant decline of measles incidence rate from 600 /100,000 in 1985 to 42 cases per 100,000 in 1989. The case fatality rate also decreased to less than 5% with a higher proportion of cases occurring in children above five years. In areas with low vaccination coverage, cases occurred in the under five year old with high case fatality rates. Immediately after the

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UCI campaign, the vaccination coverage started to fall from 80% in 1990 to 72% in 1998. This decline in coverage was attributed to internal several factors some of them being shortages of kerosene, human resource problems and changes in the health systems. These chages affected the distribution of vaccine, equipment and other supplies as well as the monitoring systems.

While much progress has been made in reaching children with routine immunization services and achieving high immunization coverage over a decade, measles remains a significant contributor to childhood illnesses.

Accelerated Measles Control: 1999-2009 In 1999, the government of Tanzania began implementation of accelerated measles control strategies to address the low coverage, frequent measles outbreaks, and the mortality associated with measles.

At the beginning of the strategy implementation the aim was to conduct yearly campaigns, each year focusing on a third of the country using the high-risk approach for the selection of the districts. Table 1: Coverage of accelerated measles controlactivitie (1999-2009)

In 1999, a measles campaign was conducted in 31 districts in Mainland and 6 districts on Zanzibar. In September 2000, a second measles mass campaign was held in 4 districts in Zanzibar and 52 districts in Mainland of the remaining 83 districts with the same target age group. In 2001 the target age group was changed to under fifteen years, the campaign was also conducted in 30 districts in Mainland and 5 districts in Zanzibar. In 2005 the follow up measles campaign was conducted countrywide to children aged 9 – 59

15 months and the coverage achieved was above 90% nationally. The measles cases were reduced significantly after campaign. In 2008 the follow up measles campaign that was done to children of 6 months to 10 years the coverage was 95%.

Routine Immunization services Immunization is offered free of charge as part of primary health care (PHC) in all Reproductive and Child Health (RCH) clinics, in both public and private health facilities. Overll 4,406 facilities (78.8% of the total number of facilities) provide immunization services. The two tables below show the trend of administrative coverage of all antigens in both Tanzania Mainland and Zanzibar.

Table 2: Immunization coverage (%) by Year in Tanzania Mainland( 2004-2009)

COVERAGE (%) Vaccine 2004 2005 2006 2007 2008 2009 BCG 99 91 89 88 89 93 OPV 0 66 65 62 58 62 OPV3 96 91 89 88 89 88 DTP-HepB3 94 90 87 83 84 85 MEASLES 94 91 89 90 88 91 TT2+ 88 81 78 74 73 75 Source: EPI annual evaluation meeting reports (2004 – 2010)

Table 3: Immunization coverage (%) by Year in Zanzibar( 2005-2009)

Vaccine 2005 2006 2007 2008 2009 BCG 125.0 115.0 101.4 116.3 113 OPV 0 53.3 46.0 51.8 57.1 48.3 DTP Hep B3 85.7 86.0 78.4 85.3 88.0 Measles 93.4 88.8 87.7 91.0 96.4 OPV3 85.0 85.0 78.0 81.0 78.6 TT2+ 67.0 60.0 60.3 63.6 60.7 SOURCE: MoHSW ZANZIBAR

Immunization coverage survey-the post 2008 Iintegrated Measles Campaing (IMC) Immunization coverage survey was conducted in September 2008 and results indicate that routine immunization by crude coverage (card and history) by antigen showed that the coverage for BCG was 98.4%, DPT-HepB-Hib 3 were 94.7% and measles were

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84.8%. Valid coverage based on the card only and BCG was 96.7%, DPT-HepB-Hib 3 80.6% and measles 71.3%.

Despite all these initiatives to increase coverage of routine vaccination with target antigens against infant’s illness, the national coverage of these antigens are still not optimal. Few unvaccinated children who normaly miss the routine immunization are therefore expected to carry dangerous strains of infections and another few children whose immunity may not respond well with given vaccine are remaing behind. There is also a threat from importation of wild poliovirus (WPV). Last case of WPV was reported in Tanzania in 30th July 1996. In recent years neighbouring countries Kenya, Uganda and DRC had importation of WPV which created a threat to Tanzania. It is due to these reason the programme envisaged another round of Integrated Measles Campaign (IMC) in December 2011. Theoverall goal was to give a second opportunity of vaccination to those who were missed during the routine immunization and those who got the vaccine but couldn’t sero-convert .

Overall goal of the campaign The main goal was to sustain reduction in measles morbidity and mortality following the 2008 follow-up campaign as interim to achieving the measles pre elimination goal. The campaign also targeted to stop importation of wild poliovirus transmission in the country.

Specificobjective for the 2011 campaign were to: 1. Immunise at least 95% of children aged 9-59 months with measles vaccine regardless of their previous immunisation status 2. Immunize at least 95% of children aged 0-59 months with bOPV regardless of their previous immunization status 3. Administer vitamin A supplements to 95% of children aged 6-59 months 4. Administer de-worming tablets to 95% of children aged 12-59 months

In particular the 2011 IMC was destined to be followed with an evaluation by the independent post campaign coverage survey designed to verify the reported

17 immunization campaign coverage and routine immunization. It was envisaged in this evaluation to identify reasons for not immunizing and make recommendation for strategies and interventions that will improve the achievement and sustainability of the Immunization and Vaccines Development (IVD) planned activities.

Tanzania 2011 post integrated Immunizaation Campaign coverage survey The Ministry of Health and Social Welfare commissioned Ifakara Health Institute (IHI) to undertake the survey. In November 2011 following a four days nationwide IMC in 21 regions in the mainland Tanzania and 2 on the Zanzibar islands the IHI conducted countrywide post IMC evaluation survey across Tanzania.

Main survey objectives were: 1. To determine the measles and bOPV vaccination coverage 2. To determine the reason why children missed were not vaccinated and source of information 3. To determine the status of routine vaccination coverage of children 12-23 months and the reasons for not completing the vaccination schedule; and 4. To determine tetanus toxoid vaccine coverage of mothers with children aged 0-11 months

Methods

Tanzania basic country profile The United Republic of Tanzania is a union between Tanganyika and Zanzibar. It occupys a surface area of about 945,087 sq km. Administratively Tanzania Mainland is divided into 21 regions and 131 functional councils while Zanzibar is divided into 5 regions and 10 districts. Based on the population projections made by National Bureau of Statistics (NBS), the 2011 total population of the United Republic of Tanzania is estimated to be 44 million of which children aged 0 months to 59 months is estimated to be 7,123,134 whereas the under one population is 1,801,474 children (NBS vol. VIII, Feb. 2006). The population distribution is predominantly rural in the Mainland (about 77%), while Zanzibar rural population is 57%. Crude birth rate is 38.1 per 1,000

18 populations and life expectancy at birth is estimated at 51 years. The population growth per year is estimated to be2.9%1.

Table 4: Demographic indicators, Tanzania Mainland, 2010 i

Infant Mortality Rate (per 1,000 live births) 51 Child Mortality Rate (per 1,000 live births) 81 Maternal Mortality Ratio (per 100,000 live 454 births)

Target survey population groups and sampling procedures

Survey procedures The design was a household based survey of children 0 to 59 months for the integrated measles campaign and children between 12 to 23 months old for the routine immunization coverage as well as the mothers of infants between 0 to 11 months. The target population was identified through a sample of households in among selected clusters from each region.

Survey Area The survey was designed to produce regional and national data. Samples were drawn from 21 regions in Tanzania Mainland and 2 Zones on Zanzibar islands which are Unguja and Pemba.

Fig1: Survey area Tanzania map

Survey Population The survey population for the post campaign evaluation was mothers or care givers of children aged 0 to 59 months who were eligible to receive measles and bOPV vaccination. Children were physically seen and the mother or caretaker asked to verify if the child was vaccinated either with one or both antigens. The plan was to check if their left hand little fingers were marked by a

19 special ink during the campaign. Children aged 12 to 23 months were assessed for routine immunization status using the second questionnaire. Tetanus toxoid vaccine coverage was assessed for women whose children are 0-11 months of age using the third questionnaire.

Basic routine immunization case definitions

Fully immunized child was defined as a child who has received doses of the “standard six” antigens – BCG, (DPT-HepB-Hib) 3 doses, OPV 3 doses), and measles vaccines 2. The “crude immunization coverage” was defined as vaccine given, evidenced by card or history from mother or caretaker while the “valid immunization coverage”defined as evidenced by card only. Immunization access is defined as the possibility of the mother/caretakers reaching the immunization service easily and gets the required quality. In Tanzania DPT-HepB-Hib1 is used as determinant.

Immunization system management (utilization) is determined by those who accessed the services and continued to use the services. Utilization is determined by drop-out rates between DPT-HepB-Hib1and DPT-HepB-Hib3 i.e, (DPT-HepB-Hib1minus DPT- HepB-Hib3)

Sampling Methodology While a sample of 10 children per cluster was considered prerequisite for IMC rapid coverage survey, a multi stage cluster sampling was employed to provide estimates at national and regional levels for routine immunization. The determination of the sample size was based on the principles that are documented in the “immunization overage cluster survey reference Manual in annex C” of the WHO, the 2005 version 9. To get a desired precision number of children per cluster to be surveyed and minimize marginal errors Table C-1 in the manual was used.

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In order to test the hypothesis that the 2011 national measles campaign coverage would result in to an overall coverage of 95% of the target population in the two antigens in

Table 5: Basic sampling characteristics Region Required Total EAs Required Estimated EA/Clusters children children Sampled

Mainland 21 30 630 14 8,820

Zanzibar 2 30 60 14 860

Total estimated sample size 690 9,660

each region this lead to assume that 5% of children not vaccinated were spread evenly across the districts and clusters. Using the WHO/EPI cluster sampling methodology therefore, assuming a desirable precission of ±3 % to get 14 children per cluster this gave the expected optimum size of 30 clusters per region. This is also in line with the central limit theorem that recommends using at least 30 clusters for the approximation to normal distribution and in order to get a regional representation. The Tanzania National Master Sample (NMS) also recommend using 30 cluster per region.

Under this sampling therefore the household was a focus of survey activity of observation. It is for this reason therefore refugee centres, prisons, and boarding schools were omitted from the sampling frame, except where resident of these areas are included in a household outside of it. In urban areas, the sampling unit (SU) was an enumeration area (EA) from the 2002 population and housing census. In rural areas, the sampling units constituted the entire villages, drawn from the population of villages recorded in the same census.

In order to select the sample, both probability proportional to size and simple systematic random sampling methods was employed as documented in the manual. 14 children per cluster were chosen in the 30 clusters that were selected in each region giving a

21 total of 690 clusters with expected number of children to be surveyed are 9,660. A summary of the sampling characteristics is given below in; Table 5. Details of selected districts, wards and clusters are attached to this report as annex (1-20)

Field households’ smpling procedures Once in a cluster, the supervisor and editors identified the centre of the cluster and randomly selected a direction. The first household was randomly selected in one direction and the next closest homestead reachable in the shortest time on foot was visited until all 14 children/mother or care takers were interviewed. At minimal each cluster was expected to yield 14 children. All children aged 0 to 59 months were included in the post campaign survey while those aged 12 to 23 months and mothers of infants were again included for the assessment of their routine immunization status as well as TT evaluation in reproductive women with children who were 11 months on December 12 th 2011..

Questionnaires Three types of the questionnaires were developed. The first one was the household questionnaire (H1) and other two were individual questionnaire i.e H2 for mother/caregivers of children 12 to 23 months and H3 for mothers of infants. The H1 questionnaire intended to capture information on all individuals in the household and it was basically for the evaluation of IMC. The household questionnaire was also used to select respondents for the individual respondent i.e those who was supposed to respond to the second and third questionnaires.

The second questionnaire (H2) was for assessing routine immunization service delivery. On the same questionnaire the information for either three mothers with one eligible child each or a mother with three children could be captured. Mothers were reporting on vaccination practices to these childen in the selected household. The third questionnaire (H3) was for mother with infants 0 to 11 months old. This was specifically for collecting information on tetanus toxoid vaccination to mothers with infants in the selected

22 household. On the same questionnaire the information for either three mothers with one eligible child each or a mother with three children could be captured.

Survey planning and implementation Survey implementation involved recruitment of trainers, training of trainers (TOT) at national seminars in Bagamoyo, and training of interviewers in each region by the regional survey implementation teams.

In the beginning of November 2011, one week ahead of nationwide IMC a two-day training session of the national IMC survey field coordinators was provided to 23 regions candidates in Bagamoyo that included also two candidates from Zanzibar and Pemba Islands. The trainees were selected from each region based on a set of criteria that was communicated before hand to the regional health management teams that assisted to identify each member per region. This training aimed at equipping the national representative team with skills on survey questionnaires, use of WinCosas database programme by data editors and the mode of survey sampling to be implemented during the survey. For each region the principal data editor from IHI was identified who was also an IT specialist and was provided with a laptop uploaded with WinCosas programme. In each region this staff was required to put up a regional representative team that was further trained at the regional level. The team at the regional level included regional data clerk personnel, seven interviewers and two village leaders who assisted to guide the team through appropriate enumeration clusters. Each training session comprised a package of materials that included practical hands on real time data collection and data management package. This training was conducted jointly by facilitators from the investigating body IHI with material developed together with WHO EPI focal personnel country officials. During the training session, delegates were instructed on how to identify age specific candidates target vaccination age groups.

(Figures ( Fig 2-4) depicts field based experience from Dodoma region (Pictures: by coutersy of Dr Chembele).

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Data collection During the data collection each survey team had 6 field interviewers, survey supervisor and data editor. Data collection was done for 7 days. The interviewers visited households to administer the survey. Call-backs were made to households where no one was home during the first visit and to complete gaps identified during the data editing. Mothers of eligible children were interviewed to asses if their children had been vaccinated with measles and bOPV during the Integrated Measles Campaign. Mother of caregivers recall and fore arm finger marked with ink was used to certify the child if was vaccinated. For the routine immunization information was abstracted from child card and where cards were not available mothers were asked to recall whether their children had received any vaccination. If the answer was yesthen were asked about specific vaccination procedures. All children were also examined for a BCG scar. Mothers were

27 also asked to give reasons in case where the child was not given an immunization either during the campaign or for routine immunization. This allowed capturing reason of not being vaccinated. Editors edited questionnaires in the field to check the validity of the recorded responses and to ensure that there was consistency. Any errors, which could not be corrected by the editors, were referred back to the interviewers for further clarifications.

Data analysis During the data collection each set of data was on real time entered in a computer tailored database by the IT who was destined data editor for each regional survey team. Integrated measles campaign coverage survey data was captured and analysed using STATA version 11.0 (Stata Corp.2010) whereas routine immunization coverage survey data was captured and analyzed using the WinCosas version 1.5.5 (WHO) program. Descriptive analyses of the major campaign coverage outcome were performed using STATA. For routine immunization survey analysis, WinCosas programme was used. Outputs of routine imuunization coverages for all six antigens were automatically produced by WinCosas. This programme further provided rates of immunization system access and the ability to target infants with given antigens.

Ethical approval The survey followed standard WHO EPI survey methods as described in the WHO “Evaluate Vaccination Coverage training for mid-level managers” monograph. The protocol was submitted to the Ifakara Health Institute Institutional Review Board (IRB) and the ethical clearance was obtained before the conduct of the survey in November 2011. From each individual that participated in the evaluation, informed consent prior to being interviewed was obtained.

Results

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A. Integrated Measles Campaign Results

Target population and survey characteristics In a selected sample of 960 clusters that were included in the sampling frame and surveyed yielded 11695 children who were available across all clusters to be evaluated for measles and bOPV vaccination. On average this sample gave 12 eligible children per cluster, highest being in Kigoma 36 and lowest in Mtwara 10 children per cluster. Table 6 shows the distribution of clusters, children between 0 to 8 months, 9 to 59 and overall (0 to 59) children seen per each region.

Table 6: Number of children by age group per each region

REGION Number of 0-8 months 9-59 months Total (0-59 months) clusters Arusha 300 92 344 436 Dar-es-salaam 300 130 302 432 Dodoma 300 56 341 397 Iringa 300 195 450 645 Kagera 300 260 279 539 Kigoma 300 266 830 1096 Kilimanjaro 300 102 296 398 Lindi 300 145 361 506 Manyara 300 110 376 486 Mara 300 135 465 600 Mbeya 300 66 312 378 Morogoro 300 85 376 461 Mtwara 300 75 222 297 Mwanza 300 134 506 640 Pwani 300 48 322 370 Rukwa 300 107 355 462 Ruvuma 300 77 397 474 Shinyanga 300 165 236 401 Singida 300 115 372 487 Tabora 300 123 609 732 Tanga 300 149 271 420 Mainland 300 2635 8022 10657 Unguja 300 116 368 484 Pemba 300 136 418 554 Zanzibar 300 252 786 1038

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NATIONAL 300 2887 8808 11695

(i) Measles vaccination coverage A total of 8,066 which is 91.6% (with 95% confance intervals CI; 90.9-92.1) of overall 8,808 children aged between 9 to 59 months with mothers or caretakers seen by the survey teams confirmed were vaccinated against measles during the campaign. Table 7, shows the number of children seen by survey teams and those confirmed to be vaccinated with measles by region.

Table 7: Number of children seen and confirmed to be vaccinated by measles by region

REGION Total children children % vaccinated by visited (9-59) vaccinated by history (95%CI) history Arusha 344 344 100.0 Dar-es-Salaam 302 256 84.8 (80.7 – 88.8) Dodoma 341 333 97.7(96.0-99.3) Iringa 450 440 97.8(96.4-99.1) Kagera 279 279 100.0 Kigoma 830 749 90.2(88.2-92.3) Kilimanjaro 296 269 90.9(87.6-94.2) Lindi 361 321 88.9(98.6-1.00) Manyara 376 343 91.2(88.3-94.0) Mara 465 462 99.4(98.6-1.0) Mbeya 312 267 85.6(81.6-89.5) Morogoro 376 351 93.4(90.8-95.7) Mtwara 222 202 91.0(87.2-94.8) Mwanza 506 494 97.6(96.3-98.9) Pwani 322 310 96.3(94.2-98.3) Rukwa 355 280 78.9(74.6-83.1) Ruvuma 397 366 92.2(94.7-98.4) Shinyanga 236 236 100.0 Singida 372 316 84.9(81.3-88.5) Tabora 609 441 72.4(68.9-75.9) Tanga 271 250 92.3 (89.1 – 95.4) Mainland 8022 7309 91.1(90.4-91.7)

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Unguja 368 347 94.3(91.9-96.7) Pemba 418 410 98.1(96.8-99.4 Zanzibar 786 757 96.3(94.9-97.6) NATIONAL 8808 8066 91.6(90.9-92.1)

Arusha, Kagera and Shinyanga presented highest coverages with 100% whereas Mara region had measles coverage of 99.4% and Tabora had lowest measles coverage of 80.6%. The national average measles coverage was 91.6% (95% CI; 90.9-92.1).

(ii) The bOPV vaccination coverage A total of 10,622 (90.8%) with (95% CI; 90.3-91.3) children between 0 to 59 months were vaccinated by bOPV out of all 11,695 seen by the survey teams. Table 8 shows the number of children seen by survey teams and those confirmed to be vaccinated by bOPV across all regions.

Table 8: Number of children seen and confirmed to be vaccinated by bOPV by region

REGION Total children children % vaccinated by visited (0-59) vaccinated by history (95%CI) history

Arusha 436 432 99.1(98.2-99.9) Dar-es-salaam 432 374 86.6(83.3-89.8) Dodoma 397 387 97.5(95.9-99.0) Iringa 645 633 98.1(97.1-99.2) Kagera 539 539 100.0 Kigoma 1096 990 90.3(88.6-92.1) Kilimanjaro 398 363 91.2(88.4-93.9) Lindi 506 461 91.1(88.6-93.6) Manyara 486 357 73.5(69.5-77.4) Mara 600 595 99.2(98.4-99.9) Mbeya 378 291 77.0(72.7-81.2)

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Morogoro 461 428 92.8(90.5-95.2) Mtwara 297 268 90.2(86.9-93.6) Mwanza 640 621 97.0(95.7-98.3) Pwani 370 355 95.9(93.9-97.9) Rukwa 462 362 78.4(74.6-82.1) Ruvuma 474 432 91.1(88.6-93.7) Shinyanga 401 401 100.0 Singida 487 410 84.2(80.9-87.4) Tabora 732 536 73.2(70.0-76.4) Tanga 420 387 92.1(89.6-94.7) Mainland 10657 9622 90.3(89.7-90.9)

Unguja 484 457 94.4(92.4-96.5) Pemba 554 543 98.0(96.9-99.1) Zanzibar 1038 1000 96.3(95.2-97.4) NATIONAL 11695 10622 90.8(90.3-91.3)

The three leading regions were Kagera, Shinyanga (both 100%) and Arusha region 99.1% in bOPV coverage. Tabora recorded the lowest measles coverage of 73.2%. The national average measles coverage was 90.8 %( 95% CI; 90.3-91.3). Chart 2 shows the comparison of the bOPV and measles coverages by regions obtained through history.

Fig5: Comparison of the Measles and bOPV coverage by regions

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coverage of main IMC antigens

100 90 80 70 60 50 Measles 40

Percentage bOPV 30 20 10 0 LINDI MARA PWANI TANGA IRINGA MBEYA PEMBA RUKWA KAGERA TABORA ARUSHA SINGIDA UNGUJA SALAAM KIGOMA - RUVUMA MTWARA DODOMA MWANZA MANYARA ES SHINYANGA - MOROGORO KILIMANJARO DAR Regions

Children with Adverse Events Following Immunization A total of 428 children were reported to have Adverse Events Following Immunization (AEFI) which is 4% of the total number (10,622) of children or mother /caretakers who were asked and reported . All cases were observed and most of them managed with analgesics. No one report was sent to the health facilities for treatment. Most of AEFI reported were pain on the injection sites.

Table 9: Ch ildren reported adverse events following immunization REGION Total children vaccinated Children with % children with by history AEFI AEFI (0-59 months) Arusha 432 10 2% Dar-es-salaam 374 15 4% Dodoma 387 13 3% Iringa 633 3 0% Kagera 539 0 0% Kigoma 990 29 3%

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Kilimanjaro 363 16 4% Lindi 461 3 1% Manyara 357 10 3% Mara 595 4 1% Mbeya 291 43 15% Morogoro 428 30 7% Mtwara 268 2 1% Mwanza 621 1 0% Pwani 355 1 0% Rukwa 362 7 2% Ruvuma 432 14 3% Shinyanga 401 0 0% Singida 410 43 10% Tabora 536 12 2% Tanga 387 10 3% Mainland 9622 266 3%

Unguja 457 17 4% Pemba 543 145 27% Zanzibar 1000 162 16% NATIONAL 10622 428 4%

Source of information The main source of information was Community Leaders and Health Workers in all regions except in Rukwa were most got information from vaccinators (same health Workers). Neighbours, Radios and Megaphones contributed to the provision of information to the community. Table 10 shows the source information in all regions.

Table 10: Sources of information by regions

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REGION Village HW Radio TV Neighbour Vaccinator Religious Poster Newspaper Volunteer Megaphone SMS leader Arusha 23.4 39.8 40.5 17.2 2.2 7.3 1.5 2.6 2.2 5.8 25.6 1.5 Dar-es-salaam 13.3 28.5 26.3 36.7 11.5 2.2 13.7 1.1 33.7 0.4 25.6 1.5 Dodoma 38.0 2.6 0.6 6.1 0.0 4.2 4.8 0.0 0.3 8.3 41.2 0.0 Iringa 37.8 26.5 8.0 30.5 14.9 19.5 14.9 14.2 1.0 0.3 30.8 4.0 Kagera 38.6 10.7 7.5 24.6 9.6 16.4 0.0 0.0 0.0 0.0 35.0 0.0 Kigoma 20.5 13.2 3.8 22.2 0.9 17.8 2.1 0.3 1.2 26.9 19.6 0.0 Kilimanjaro 0.3 22.5 3.2 6.8 0.0 17.4 2.3 2.6 0.3 8.0 21.9 0.0 Lindi 18.2 4.1 0.0 1.0 0.0 0.0 0.0 0.0 0.0 36.0 31.2 0.0 Manyara 21.9 10.6 2.7 3.7 0.0 8.8 3.0 0.0 0.0 17.0 49.5 0.0 Mara 5.0 14.2 0.0 7.5 0.0 6.3 7.9 0.0 7.5 41.7 45.8 0.8 Mbeya 9.7 8.8 0.7 13.0 1.0 2.3 0.0 0.0 0.3 2.9 50.7 0.3 Morogoro 36.0 18.5 1.9 11.4 2.2 3.4 4.6 0.6 0.3 36.3 17.5 0.0 Mtwara 31.0 9.2 13.7 12.6 12.2 11.8 13.7 10.3 10.3 4.1 30.6 4.1 Mwanza 6.5 0.3 0.7 4.1 0.3 0.0 0.0 0.0 0.0 3.8 83.2 0.0 Pwani 33.3 2.4 2.1 8.9 0.0 0.0 1.4 0.0 0.0 0.0 48.1 0.0 Rukwa 4.0 2.0 0.0 8.3 72.1 0.0 6.3 0.0 0.0 0.0 0.0 0.0 Ruvuma 62.1 5.2 1.0 2.9 0.7 12.3 0.3 0.7 0.7 1.3 24.6 0.0 Shinyanga 45.1 43.6 1.8 44.7 1.5 0.7 43.6 0.7 26.0 0.0 34.4 0.0 Singida 18.9 0.7 0.0 18.9 0.0 3.0 1.7 0.0 0.0 8.6 29.5 0.0 Tabora 21.4 1.0 0.7 6.2 0.3 4.2 0.3 0.0 2.3 13.6 33.7 0.3 Tanga 25.9 3.3 0.0 12.0 0.0 0.0 5.0 0.0 0.0 15.0 55.5 0.0 Mainland 24.4 12.4 5.2 14.0 6.1 6.7 5.8 1.5 3.8 11.0 34.8 0.6 Pemba 31.5 5.1 2.9 17.0 0.0 0.0 0.0 0.0 0.0 12.3 35.5 0.0 Unguja 15.0 14.6 8.5 12.2 1.2 0.0 0.0 0.0 0.0 0.4 74.0 0.0 Zanzibar 23.8 9.6 5.6 14.8 0.6 0.0 0.0 0.0 0.0 6.7 53.6 0.0 NATIONAL 24.4 12.2 5.2 14.1 5.7 6.1 5.3 1.4 3.5 10.7 36.2 0.5

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B. Routine Immunization

Target population and survey characteristics Information on routine immunization was available for a total of 9,132 children whereas 4,684 (51.3%) being male and 4,448 (48.7%) females. Table 11 shows the sex distribution of children between 12 to 23 months by region found in the areas of survey.

Table 11: Sex distribution for children 12-23 months

REGION Total Male (%) Female (%) Arusha 323 49.8% 50.2% Dar es Salaam 254 50.4% 49.6% Dodoma 420 51.7% 48.3% Iringa 420 52.1% 47.9% Kagera 389 49.4% 50.6% Kigoma 428 51.4% 48.6% Kilimanjaro 428 54.9% 45.1% Lindi 420 50.0% 50.0% Manyara 420 48.8% 51.2% Mara 389 55.8% 44.2% Mbeya 420 48.1% 51.9% Morogoro 428 53.0% 47.0% Mtwara 381 52.2% 47.8% Mwanza 421 51.5% 48.5% Pwani 393 51.1% 48.9% Rukwa 421 51.3% 48.7% Ruvuma 422 51.7% 48.3% Shinyanga 381 47.2% 52.8% Singida 393 52.2% 47.8% Tabora 426 50.5% 49.5% Tanga 422 50.5% 49.5% Mainland 8399 51.2% 48.8% Pemba 354 50.3% 49.7% Unguja 379 55.1% 44.9% Zanzibar 733 52.8% 47.2% NATIONAL 9132 51.3% 48.7%

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Routine Immunization Cards retention Under the routine immunization coverage 77.8% of all children who were evaluated were seen with cards. Tabora region scored high in terms of the cards retention which is 99.8% while Pemba scored lowest with retention of nearly 50.5%. Figure 2 shows the routine immunization card retention by region.

Figure 6: Routine Immunization card retention by region

120 94.7 94.9 98.7 99.8 100 88.7 90.5 83.4 84.8 86.786.7 87 76.1 76.776.7 80.3 80 68.9 70.7 73.1 57.457.4 61.5 50.5 60 44.4 40 20 0

At the time of the survey 90. 1% children were fully immunized (95% CI ; 86.5% - 93.8%) using cards and history. The valid immunization coverage was 63.7% (95% CI; 57.4%- 71. 2%). Table 12 below shows crude and varid immunization coverage of children between 12 months to 23 months by region.

Table 13: Fully immunized children 12 -23 months by region

CARD AND HISTORY CARD Total % 95% CI Total % 95% CI TANZANIA 8231 90.1 86.5 93.8 5793 63.7 57.4 71.2 Dodoma 390 92.9 87.7 98.1 311 74.1 66.3 81.8 Arusha 291 90.1 82.5 97.7 219 67.8 58.9 76.7 Kilimanjaro 396 92.5 90.5 94.6 233 54.4 49.9 59

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Tanga 381 90.3 87.3 93.3 211 50 42.6 57.5 Morogoro 421 98.4 96.8 99.9 321 75 68.4 81.6 Pwani 376 95.7 93.5 97.9 314 79.9 74.9 84.9 Dar es salaam 247 97.2 95.2 99.3 187 73.6 68 79.2 Lindi 385 91.7 87.3 96.1 211 50.2 45.2 55.2 Mtwara 369 96.9 94.8 98.9 336 88.2 84.1 92.3 Ruvuma 359 85.1 80.7 89.4 246 58.3 52.3 64.3 Iringa 394 93.8 91.2 96.5 275 65.5 58.4 96.5 Mbeya 382 91 87.4 94.5 339 80.7 74.4 87.1 Singida 356 90.6 84.8 96.4 282 71.8 65.2 78.3 Tabora 409 96 93.8 98.2 408 95.8 93.6 98 Rukwa 369 87.9 87.3 91.8 142 33.8 27.2 40.4 Kigoma 388 90.7 86.9 94.4 279 65.2 58.4 72 Shinyanga 134 35.2 28.9 41.4 133 34.9 28.9 40.9 Kagera 389 100 100 100 293 75.3 69 81.7 Mwanza 343 81.5 75.6 87.3 132 31.4 26 36.7 Mara 379 97.4 95.5 99.4 252 64.8 57.2 72.4 Manyara 409 97.4 95 99.8 231 55 44.4 65.6 7567 90.1 86.8 93.6 5355 64.1 57.8 71.5 MAINLAND Unguja 309 87.3 80.1 94.5 267 75.4 65.5 85.3 Pemba 355 93.7 89.1 98.3 171 45.1 40.9 49.4 ZANZIBAR 664 90.5 84.6 96.4 219 60.3 53.2 67.4

The overall crude and valid immunization coverage per each antigen by region is given in table 14 and 15. The crude immunization coverage was BCG 98.6%, [DTP-HepB- Hib1] 97.1%, [DTP-HepB-Hib3] 95.1%, OPV1 96.6%, [OPV3] 91.9% and Measles 95.1%. The corresponding valid immunization coverage was BCG 98.0%, [DTP-HepB- Hib1] 31.2%, [DTP-HepB-Hib3] 25.4%, OPV1[32.4%], [OPV3] 23.4% and Measles 58.5%.

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Table 13: Crude immunization coverage for children 12-23 months (card and history)

MEASLES BCG OPV0 OPV1 OPV2 OPV3 DTP - DTP - DTP - HepBHib1 HepBHib2 HepBHib3 % % % % % % % % % TANZANIA 95.1 98.6 91.3 96.6 95.6 91.9 97.1 96.4 95.1 Dodoma 94.3 99 97.9 98.1 97.6 96.4 99 98.3 97.1 Arusha 93.2 99.7 93.8 93.8 94.4 92.3 94.1 94.4 93.8 Kilimanjaro 95.1 97.9 97.4 97 96.5 95.1 97.7 97 96.5 Tanga 94.3 98.6 87.2 98.6 97.6 95.5 98.8 97.9 96 Morogoro 98.8 100 100 100 99.5 99.5 100 100 99.3 Pwani 96.9 99.5 99.5 99.2 99.2 98.7 99.5 99 99 Dar es salaam 97.2 100 99.2 99.2 99.2 99.2 100 99.6 99.2 Lindi 94.3 99.3 99.5 99.8 99.5 96.4 99.8 99.5 97.1 Mtwara 96.9 98.7 97.1 97.6 97.6 97.4 97.6 97.6 97.6 Ruvuma 91.7 98.1 91.9 96.7 94.3 91 97.4 96.4 94.1 Iringa 96 99.8 99 99.3 99.5 97.9 99.5 99.5 99 Mbeya 93.1 96.7 80.5 96.7 96 94.5 96.7 96 96 Singida 93.9 96.9 92.6 98.5 97.5 95.9 99.2 97.5 96.7 Tabora 96.7 98.8 98.1 97.7 97.7 97.2 98.1 97.9 97.4 Rukwa 91.7 98.3 64.5 97.4 97.4 95.2 98.1 97.4 95.2 Kigoma 94.2 97.2 83.6 97.7 96.7 94.2 98.1 97.2 95.1 Shinyanga 95.8 99.2 98.2 95 86.1 36 99 94.5 88.2 Kagera 100 100 93.8 100 100 100 100 100 100 Mwanza 90.5 96.9 96.7 96 94.3 89.1 98.6 98.6 96 Mara 97.9 99 52.4 99 99 98.5 98.7 98.7 98.2 Manyara 98.8 100 99.8 99.8 99.8 98.6 100 100 100 MAINLAND 95.3 98.7 93.2 98.0 97.1 93.3 98.6 97.9 96.7 Unguja 91.2 95.5 45.8 65.3 62.1 57.9 64.4 61.9 59 Pemba 94.2 99.7 98.7 98.4 97.9 97.1 99.2 98.4 97.4 ZANZIBAR 92.7 97.6 72.25 81.85 80 77.5 81.8 80.15 78.2

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Table 14: Valid immunization coverage by target antigens for children 12-23 months

MEASLES BCG OPV0 OPV1 OPV2 OPV3 DTP - DTP - DTP - HepBHib1 HepBHib2 HepBHib3 % % % % % % % % % TANZANIA 58.5 98.0 50.4 32.4 28.4 23.4 31.2 28.2 25.4 Dodoma 61.7 97.4 56.4 52.1 46.9 42.1 51.9 47.6 43.8 Arusha 56.7 99.1 62.2 20.7 18 14.2 18.3 15.8 13.3 Kilimanjaro 45.1 97.4 80.6 7.7 7.2 6.3 7.2 7 6.3 Tanga 42.2 97.9 36.5 29.1 26.5 24.2 32.5 29.9 28 Morogoro 63.6 99.5 61 31.3 26.6 24.1 29.4 27.3 25 Pwani 71.5 99 62.6 48.1 44.8 41.5 48.1 45 42.5 Dar es salaam 64.2 99.6 77.2 36.2 32.3 28.3 33.9 31.1 28 Lindi 47.6 98.6 54.8 1.2 1.2 1.2 1.2 1.2 1.2 Mtwara 62.2 984 75.1 28.6 25.2 21.3 27 23.9 21 Ruvuma 51.2 97.6 48.8 37.2 29.1 25.8 37.4 31.8 28.9 Iringa 57.6 99.5 61.9 9.8 9 8.1 9.3 9 8.6 Mbeya 63.3 96.4 58.3 21.4 18.3 16.4 20 17.6 16.9 Singida 66.7 95.7 45 42.7 38.2 33.6 44 39.2 34.1 Tabora 78.9 98.8 86.6 13.6 12.2 11 14.1 12.7 11.7 Rukwa 33.6 96.2 8.3 27.6 25.7 21.9 31.2 28.3 25.2 Kigoma 64.3 96 49.5 39.7 34.8 30.8 42.1 37.6 34.6 Shinyanga 74.3 99.2 28.3 79 65.6 17.8 62.7 54.3 46.5 Kagera 65.3 99.7 46.5 36.2 30.8 26.7 36.2 31.1 27 Mwanza 42.5 95 26.8 28.3 19 12.4 28.5 24 17.6 Mara 55 99 27 31.1 29.3 27.5 28.8 26.7 25.2 Manyara 70 99.5 39.8 18.1 15.5 13.3 18.1 15.7 13.6 MAINLAND 58.9 98.1 52.1 30.5 26.5 21.4 29.6 26.5 23.8 Unguja 65.8 95.5 45.8 65.3 62.1 57.9 64.4 61.9 59 Pemba 42.5 98.7 20.1 39.6 35.6 31.4 32.2 28.8 25.6 ZANZIBAR 54.2 97.1 33.0 52.5 48.9 44.7 48.3 45.4 42.3

Rukwa region presented the lowest valid coverage of measles vaccine while Tabora was the most immunized region with 78.9% of measles vaccination.

Vaccination system access and management (utilization) Children receiving DPT-HepB-Hib1 (card and history) was 98.4% (95% CI 95.9% - 99.7 %). The countrywide drop-out rate for [DPT-HepB-Hib1-DPT-HepB-Hib3] was 1.8%. Table 16 below shows the immunization system access and management by regions.

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Shinyanga and Ruvuma are the two regions with high drop-out rates with Shinyanga leading top with 10.9%.

Table 15: Immunization system access and management by regions

DTP -HepBHib1 (CARD AND HISTORY) DROP -OUT RATE FOR DTP-HepB1 - DTP-HepBHib3 Total % 95% CI % TANZANIA 8991 98.4 95.9 99.7 1.8 Dodoma 416 99.1 97.7 100.5 1.9 Arusha 304 94.1 87.7 100.6 0.3 Kilimanjaro 418 97.7 96.3 99 1.2 Tanga 417 98.8 97.9 99.8 2.9 Morogoro 428 100 100 100 0.7 Pwani 391 99.5 98.8 100.2 0.5 Dar es salaam 254 100 100 100 0.8 Lindi 419 99.8 99.3 100 2.6 Mtwara 372 97.6 65.8 99.5 0 Ruvuma 411 97.4 95.8 98.9 3.4 Iringa 418 99.5 98.9 100.2 0.5 Mbeya 406 96.7 95 98.4 0.7 Singida 390 99.2 98.4 100.1 2.6 Tabora 418 98.1 96.2 100.1 0.7 Rukwa 412 98.1 96.8 99.4 2.9 Kigoma 420 98.1 96.8 99.5 3.1 Shinyanga 377 99 98 99.9 10.9 Kagera 389 100 100 100 0 Mwanza 415 98.6 97.5 99.6 2.7 Mara 384 98.7 97.5 100 0.5 Manyara 420 100 100 100 0 MAINLAND 8281 98.6 95.9 99.8 1.9 Unguja 336 94.9 92.8 97.1 0.3 Pemba 376 99.2 98.4 100 1.9 ZANZIBAR 712 97.1 95.6 98.6 1.1

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Ability to target children under one year Most of the regions were able to vaccinate children with measles vaccine before the age of one year. This ability diminished in Pemba, Rukwa and Ruvuma, these regions did not reach a modest benchmark of at least 80%. Chart below shows the percent of children receiving a valid dose of measles before one year of age.

Figure 7: Ability to target under one year age children

100 91.4 91.5 91.5 91.7 91.7 91.8 92.4 92.8 93.4 93.7 94.5 87.6 87.7 88 88 89.3 89.7 89.7 90 81.9 83.6 76.6 78.2 80 70 56.5 60 50 40 30 20 10 0

Reasons for children not vaccinated The main three reasons given by mother or caretakers whose children were found not vaccinated are; 1. Fear of child to get side effects 23% 2. Negative attitude of child immunization 13.4% 3. Immunization place to be too far (access) 11.9% Table 16 below the reasons given by mothers or caretakers.

Table 16: Reasons for children unvaccinated in routine immunization

Reason for unvaccinated n Percent Fear child to get side effects 204 23.0 Negative attitudes of child immunization 119 13.4 Place of immunization was too far 106 11.9 Place / time of immunization was unknown 74 8.3 Postponed until next time 70 7.9

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Mother was too busy 46 5.2 Vaccine was not available 40 4.5 Long waiting time 37 4.2 Unaware of need for immunization 27 3.0 Doctor advice 26 2.9 Health staff rude 23 2.6 No faith in immunization 22 2.5 High cost of transport 21 2.4 Time of immunization was inconvenience 20 2.3 Vaccinator absent 14 1.6 Child ill, not brought 11 1.2 Rumours 10 1.1 Child ill, brought but not immunized 9 1.0 Family problem / illness of mother 4 0.5 Unaware of need to return for 2nd and 3rd dose 2 0.2 Other reasons 3 0.3

Fear of child to get side effects was the main perceived leading reason for children to not be vaccinated in Ruvuma 8.9%, Mwanza 8.8% and Rukwa 5.7%. Negative attitude of child immunization is mainly in Rukwa, Mbeya and Shinyanga while immunization place perceived to be too far was mostly prevalent in Shinyanga 12.4%. The table 17 below shows the rates of the main three reasons for children not being vaccinated.

Table 17: Rates of the main three reasons for children not to be vaccinated

Negative Total Fear child to Place of attitudes of Region children get side immunization child visited effects was too far immunization n n % N % n % Dodoma 432 1 0.2 8 1.9 10 2.3 Iringa 431 1 0.2 1 0.2 0 0 Kagera 393 1 0.3 3 0.8 1 0.3 Kigoma 429 16 3.7 18 4.2 0 0 Lindi 421 0 0 1 0.2 4 1 Manyara 420 1 0.2 2 0.5 0 0 Mara 389 0 0 1 0.3 1 0.3 Mbeya 425 17 4 19 4.5 5 1.2 Morogoro 434 4 0.9 0 0 0 0 Mtwara 383 3 0.8 0 0 0 0

43

Mwanza 421 37 8.8 2 0.5 6 1.4 Pwani 394 4 1 0 0 0 0 Rukwa 423 24 5.7 21 5 1 0.2 Ruvuma 426 38 8.9 11 2.6 9 2.1 Shinyanga 418 1 0.2 18 4.3 52 12.4 Singida 395 16 4.1 6 1.5 5 1.3 Tabora 428 1 0.2 1 0.2 1 0.2 Tanga 422 26 6.2 4 0.9 2 0.5 Mainland 7484 191 2.6 116 1.5 97 1.3

Pemba 383 1 0.3 2 0.5 3 0.8 Unguja 354 12 3.4 1 0.3 6 1.7 Zanzibar 737 13 1.8 3 0.4 9 1.2 Tanzania 8221 204 2.5 119 1.4 106 1.3

44

The crude tetanus vaccine coverage for women with infancy was 93.6% for TT1 while crude TT2+ was 65.7%. The corresponding valid TT1 was 39.7% whereas valid TT2+ was19.5%. The details of coverage among women with infants are provided in tables: Annex 30-32. Immunization drop-out rates above 50% are prevalent in Arusha, Mtwara and Kilimanjaro. The figure 8 below shows the tetanus toxoid drop out rates by regions.

Figure 8: Immunization system management (drop-out rate for TT1-TT3)

70 57.4 60 54.2 51 47.9 50 39 40.8 40 32.3 32.6 34.7 25.6 27.4 30 23 24.2 17.817.8 19 19.6 20 14.4 15.3 16.8 10.4 11.1 10 6.7

0

Discussion The 2011 IMC was completed on time (12-15 November 2012) and coverage of both the compaign and the routine immunization has been evaluated from 16-20 th November 2011 across Tanzania.

(A) Compign coverage of measles and bOPV vaccination

45

It has been reported from this campaign that nearly 92% of children who were between 9-59 months the targeted age group for measles vaccine were fully immunized. Likewise it was recorded that 90.1% of children between 0-59 months that were a target population for bOPV were fully immunized in Tanzania. In both antigens the coverage on the Zanzibar islands went up by neary 4-6% point higher as compared to the coverage in the mainland Tanzania. Chidren above three months and nine months up to 59 months for bOPV and measles respectively were included in the campaign in order to maximize protection in those that might have missed previously through the routine scheduled vaccinations. For this campaign it was also envisaged to give them another chance in those who got the vaccine before but couldn’t sero-convert . The campaign coverage rates have improved as compared to those recorded back during the 2008 survey 10 . The 2011 survey was a follow-up campaign after the 2008 integrated measles campaign that recorded nearly 80.6% of vaccination in both antigens 10 . A stratified coverage by reagions in both antigens was above 85% with exception of Tabora and Rukwa regions. In both regions the coverage was also persistently low corresponding the 2008 IMC, this underline the need for the cord chain system in these regions to be more proactive in order to meet the country benchmarks.

The main source of information provided to the community for them to access vaccination was the community leaders and health care workers almost in all regions except in Rukwa were it was shown the most prevalent source of information was the vaccinators (same health Workers). Other sources contributed equally toprovide information to the community although in some regions like Lindi, Kigoma and Mara the use of Megaphones was the main source.

There were 4% of children that reported to have Adverse Events Following Immunization (AEFI). All of these cases were mostly pain at the site of invjection. None of the report was refered to the health facilities for treatment. As regards to these few AEFI the insignificantly very low number of events and the level of intensity in these events underscores the scale of preparedness by the programme to undertake

46 vaccination activity with required level of preparedness. This too underlines the good management of target antigens by the cold chain system that is in place.

(B) Routine immunization coverage

The routine immunization evaluation indicated that in 9,132 children assessed 4,684 (51.3%) were male and 4,448 (48.7%) females. All antigens provided showed good coverage in both crude and and valid immunization rates. The crude country rate was 90.1% whereas the valid one was 63.7%. Across Tanzania, Rukwa region presented the lowest valid coverage of measles vaccine while Tabora was the most immunized region with 78.9% of measles vaccination. Despite the fact that both regions were in the past not performing up to the optimal, the significant jump to nearly 80% by Tabora in measles immunization in this evaluation underscore the fact that there has been consistent effort that the programme has had put in place to realize this change. The card retention rate was also high in Tabora and still very low in corresponding Pemba (50.5%), again highlighting something at the programme level has to be urgently done to improve immunization ativities in this region.

The vaccination system access and management/utilization went high to nearly 1.8% whereas Shinyanga and Ruvuma are the two regions with high drop-out rates with Shinyanga leading top with 10.9%. It is imperative to note here that despite the good coverage rates of the compaign with measles and bOPV in Shinyanga recorded earlier in this report, a potential problem that the system is not accessive through routine delivery of DPT-HepHib3 is of major concerned. The coverage of crude TT1 is high while valid TT1 and the corresponding TT2+ coverage is still very low at the rate of nearly less than 40%. This underscores the need for the programme to increase coverage of routine immunization preparedness among reproductive women.

The programme ability to target children during infancy with vaccine services was good with the exception of Pemba, Rukwa and Ruvuma; these regions were not able to reach a country benchmark of at least 80% immunization with measles vaccine. Because

47 these reagions are the most peripheral in terms of geographical locations in the country, this too highlights the programme ability to operate optimaly in most hard to reach areas, which emphasizesmore resources to be directed in these regions.

Conclusion The intergrated immunization campaign activities are crucial programmatic milestone necessary to reach never-vaccinated children who might also never had vaccine preventable diseases for them to develop sufficient natural active immune response in places with the low programatic coverage. The campaign is in particular important also to provide protection to a cohort of underfive who might have missed routine immunization of target antigens or have had primary vaccine failure. These activities are therefore required to be systematically implemented and evaluated at the same time in order to guide progamme’s performance and forecast. It is believed that a second dose of measles or bOPV vaccines, available through good quality supplemental immunization, does reduce the proportion of susceptible individuals in a given population. It does further prevent outbreaks and in the context of high routine immunization coverage, eliminates indigenous or wild strains transmissions.

The 2011 post campaign coverage evaluation has documented good immunization coverage across Tanzania both in bOPV and Measles. It has further documented an optimal vaccination system access and management/utilization for routine immunization. The evaluation has furthermore documented achievements in the programme’s ability to reach children with target antigens during infancy with the exception of islolated places like Pemba, Rukwa and Ruvuma. These are regions where more programmatic emphase is therefore advised to be directed. It is thefore imperative to note here that, the programme has to maintain the achieved gains that will ultimately lead to a measles pre elimination goal the country has set forward.

Other materials in annexes

48

Annex 1-29: Materials on sampling enumeration areas and survey tools.

Annex 30: Baseline characteristics for IMC

Anexx 31-38: Routine immunization coverage indices

References 1. van den Ent MVX; Brown DW; Hoekstra EJ; Christie A; Cochi SL. Measles Mortality Reduction Contributes Substantially to Reduction of All Cause Mortality Among Children Less Than Five Years of Age, 1990–2008. . The Journal of Infectious Diseases 2011;204:S18–S23. 2. WHO & UNICEF. Global Immunization Data. [http://www.who.int/immunization/newsroom/Global_Immunization_Data.pdf] . 2008. 3. Simons E; Mort M; Dabbagh A; Strebel P; Wolfson L. Strategic Planning for Measles Control: Using Data to Inform Optimal Vaccination Strategies. . The Journal of Infectious Diseases 2011;204:S28–S34 4. Edejer TT; Aikins M; Black R; Wolfson L; Hutubessy R; Evans DB. Achieving the millennium development goals for health - Cost effectiveness analysis of strategies for child health in developing countries. . BMJ 2005;331 1177–80. 5. Dabbagh A; Gacic-Dobo M; Simons E; et al. Global measles mortality 2000—2008. MMWR 2009;58 1321–6. 6. Who calls for renewed commitment for measles control available at http://southasia.oneworld.net/globalheadlines/who-calls-for-renewed-commitment-for- measles-control accessed on August 19 2011. 2010. 7. Sanders R; Dabbagh A; Featherstone D. Risk Analysis for Measles Reintroduction After Global Certification of Eradication. . The Journal of Infectious Diseases 2011;204:S71–S77. 8. Brown J; Monasch R; Bicego G; Burton A; Boerma JT. MEASURE Evaluation: An Assessment of the Quality of National Child Immunization Coverage Estimates in Population-based Surveys 2002. 9. WHO. Immunization coverage cluster survey reference manual. 2005; WHO/IVB/04.23 :129. 10. MoHSW. Post intergrated measles campaign evaluation and EPI coverage survey-2008. Report 2009:91.

49

ANNEXES

ANNEX 1: ENUMERATION AREAS IN ARUSHA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 388 02 Arusha 03 Arusha 122 Unga Ltd 039 Esso 83 02 Arusha 04 Karatu 041 Endabash 021 Endabash 490 02 Arusha 03 Arusha 142 Ngarenaro 015 Ngarenaro - Darajani 181 02 Arusha 03 Arusha 082 Lemara 010 Lemara Kati 93 02 Arusha 02 Arumeru 043 King'ori 303 Malula 32 02 Arusha 03 Arusha 022 Kaloleni 022 Kaloleni - Mashariki 304 02 Arusha 03 Arusha 112 Daraja Mbili 006 Ali Nyanya 188 02 Arusha 05 Ngorongoro 111 Enduleni 042 Esere 419 02 Arusha 02 Arumeru 243 Murieti 306 Olasiti 242 02 Arusha 01 Monduli 131 Gelai Meirugoi 013 Magadini 33 02 Arusha 02 Arumeru 021 Ngarenanyuki 031 Kisimiri chini 617 02 Arusha 03 Arusha 172 Elerae 058 Azimio 344 02 Arusha 01 Monduli 201 Ol -molog 012 Elerai 642 02 Arusha 02 Arumeru 321 Oltrumet 013 Ekenywa 33 02 Arusha 05 Ngorongoro 013 Orgosorok 312 Olorien Magaiduru 220 02 Arusha 05 Ngorongoro 141 Soit Sambu 021 soitsambu 61 02 Arusha 02 Arumeru 031 Leguruki 045 Leguruki 383 02 Arusha 03 Arusha 122 Unga Ltd 034 Makaburi ya Baniani 156 02 Arusha 01 Monduli 081 Esilalei 021 Esilalei 47 02 Arusha 02 Arumeru 031 Leguruki 013 Miririny 352 02 Arusha 01 Monduli 201 Ol -molog 051 Irkaswa 698 02 Arusha 02 Arumeru 351 Olkokola 024 Ilkurot 369 02 Arusha 02 Arumeru 211 Mlangarini 012 Kiseriani

396 02 Arusha 02 Arumeru 231 Oljoro 012 Mbuyuni 59 02 Arusha 04 Karatu 021 Endamarariek 047 Endamarariek

658 02 Arusha 02 Arumeru 331 Musa 031 Oloitushula 681 02 Arusha 02 Arumeru 341 Mwandeti 035 Losikito 140 02 Arusha 04 Karatu 071 Mang'ola 021 Mang'ola Barazani 711 02 Arusha 02 Arumeru 351 Olkokola 044 Lemanyata

50

ANNEX 2: ENUMERATION AREAS IN DODOMA Serial Reg Reg Dist DistName Ward Ward Name EA Code Vill_street Code Name Code Code

398 01 Dodoma 04 Dodoma 351 Chali 041 Chikopelo Rural 47 01 Dodoma 05 Dodoma 032 Chamwino 022 Mazengo Urban 168 01 Dodoma 01 Kondoa 111 Chandama 031 Soya 172 01 Dodoma 01 Kondoa 111 Chandama 035 Soya 182 01 Dodoma 01 Kondoa 111 Chandama 053 Mwaikisabe 167 01 Dodoma 04 Dodoma 161 Handali 015 Handali Rural 55 01 Dodoma 01 Kondoa 041 Haubi 012 Haubi ( Part I ) 143 01 Dodoma 04 Dodoma 131 Igandu 032 Chinoje Rural 484 01 Dodoma 04 Dodoma 421 Ilindi 011 Mindola Rural 13 01 Dodoma 04 Dodoma 021 Itiso 012 Itiso Rural 86 01 Dodoma 02 Mpwapwa 053 Kibakwe 042 Kibakwe 509 01 Dodoma 01 Kondoa 331 Kikore 044 Mitati 310 01 Dodoma 01 Kondoa 221 Kingale 012 Kingale 491 01 Dodoma 01 Kondoa 321 Kisese 031 Madisa 91 01 Dodoma 01 Kondoa 061 Kwadelo 032 Makirinya 216 01 Dodoma 04 Dodoma 181 Makang'wa 031 Mloda Rural 106 01 Dodoma 04 Dodoma 101 Manchali 014 Manchali Rural 111 01 Dodoma 04 Dodoma 101 Manchali 024 Chalinze Rural 241 01 Dodoma 04 Dodoma 211 Manzase 012 Manzese Rural 458 01 Dodoma 01 Kondoa 291 Masange 042 Mkekena 204 01 Dodoma 05 Dodoma 063 Miyuji 328 Miyuji Urban 184 01 Dodoma 03 Kongwa 091 Mlali 051 Nghumbi 279 01 Dodoma 04 Dodoma 231 Mlowa 036 Nhinhi Rural Bwawani 197 01 Dodoma 02 Mpwapwa 111 Mlunduzi 041 Chipogoro 359 01 Dodoma 04 Dodoma 321 Mtitaa 013 Mtitaa Rural 186 01 Dodoma 04 Dodoma 173 Mvumi 309 Salimu Rural Mission 143 01 Dodoma 03 Kongwa 081 Pandambili 033 Kiteto 175 01 Dodoma 02 Mpwapwa 101 Rudi 042 Kisima 25 01 Dodoma 02 Mpwapwa 023 Vin'ghawe 031 Isinghu

51

ANNEX 3: ENUMERATION AREAS IN DAR ES SALAAM Serial Reg Reg Dist DistName Ward Ward Name EA Vill_street Code Name Code Code Code 1526 07 Dar es 01 Kinondoni 152 Kawe 043 Mzimuni Salaam 1256 07 Dar es 03 Temeke 152 Keko 081 Keko Magurumbasi Salaam 'A' 594 07 Dar es 03 Temeke 102 Charambe 036 Rangi tatu Salaam 2501 07 Dar es 01 Kinondoni 232 Kijito Nyama 006 Bwawani Salaam 2382 07 Dar es 01 Kinondoni 212 Makumbusho 170 Mbuyuni Salaam 2235 07 Dar es 01 Kinondoni 212 Makumbusho 023 Kisiwani Salaam 1070 07 Dar es 03 Temeke 142 Mtoni 029 Sabasaba Salaam 419 07 Dar es 02 Ilala 062 Ilala 016 Sharifu Shamba salaam 2785 07 Dar es 01 Kinondoni 252 Mikocheni 021 Mikocheni 'A' Salaam 1574 07 Dar es 03 Temeke 182 Tandika 042 Tandika Salaam 1561 07 Dar es 02 Ilala 202 Segerea 091 Liwiti salaam 2925 07 Dar es 01 Kinondoni 272 Hananasif 036 Hananasif Salaam 807 07 Dar es 03 Temeke 102 Charambe 249 Kwazomboko Salaam 1038 07 Dar es 02 Ilala 102 Buguruni 170 Madenge salaam 2386 07 Dar es 01 Kinondoni 212 Makumbusho 174 Mbuyuni Salaam 9 07 Dar es 01 Kinondoni 012 Magomeni 009 Makuti - 'B' Salaam 1950 07 Dar es 01 Kinondoni 163 Kunduchi 476 Kilongawima Salaam 789 07 Dar es 01 Kinondoni 082 Mzimuni 010 Idrisa Salaam 1029 07 Dar es 03 Temeke 132 Temeke 065 Njaro Salaam 1597 07 Dar es 02 Ilala 202 Segerea 127 Segerea salaam 908 07 Dar es 01 Kinondoni 092 Kigogo 069 Mkwajuni Salaam 1273 07 Dar es 02 Ilala 192 Kiwalani 010 Kiwalani salaam 49 07 Dar es 01 Kinondoni 012 Magomeni 049 Suna Salaam

52

2884 07 Dar es 01 Kinondoni 263 Mbezi 332 Mbezi - Temboni Salaam 133 07 Dar es 03 Temeke 051 Somangira 021 Mwongozo Salaam 333 07 Dar es 02 Ilala 042 Tabata 085 Tenge salaam 1221 07 Dar es 01 Kinondoni 112 Manzese 064 Mnazi Mmoja Salaam 137 07 Dar es 03 Temeke 051 Somangira 031 Amani gomvu Salaam 1725 07 Dar es 02 Ilala 223 Chanika 028 Chanika I salaam

53

ANNEX 4: ENUMERATION AREAS IN IRINGA

58 11 Iringa 06 Iringa Urban 023 Mtwivila 320 Idunda

115 11 Iringa 06 Iringa Urban 053 Ruaha 307 Ipogolo E 150 11 Iringa 06 Iringa Urban 072 Mivinjeni 013 MkwawaKanisani 410 11 Iringa 04 Njombe 111 Igongolo 032 Tagamenda 112 11 Iringa 06 Iringa Urban 053 Ruaha 304 Ngeleli 365 11 Iringa 02 Mufindi 271 Luhunga 022 Ikaning'ombe

306 11 Iringa 04 Njombe 093 Makambako 317 Ubena Kati 219 11 Iringa 07 Kilolo 091 Ukumbi 012 Winome 159 11 Iringa 04 Njombe 031 Igosi 102 Igosi 11 11 Iringa 02 Mufindi 023 Makungu 023 Lugolofu 164 11 Iringa 02 Mufindi 131 Ikweha 021 Ugenza 165 11 Iringa 05 Ludewa 181 Lupingu 023 Mtumbati 72 11 Iringa 03 Makete 051 Ukwama 041 Ihanga 281 11 Iringa 04 Njombe 093 Makambako 054 LyamkenaMalombwe 219 11 Iringa 07 Kilolo 091 Ukumbi 012 Winome 131 11 Iringa 02 Mufindi 103 Malangali 303 Mwilavila 37 11 Iringa 05 Ludewa 041 Lupanga 035 Lusala 501 11 Iringa 04 Njombe 141 Mdandu 092 Itowo/Isupilo 261 11 Iringa 06 Iringa Urban 133 Mkwawa 012 Itamba 371 11 Iringa 02 Mufindi 271 Luhunga 043 Mkonge 215 11 Iringa 07 Kilolo 081 Dabaga 054 Ng'ang'ange - Mdeke 'A' 105 11 Iringa 01 Iringa R 061 Magulilwa 031 Ikuvilo Makongoma 244 11 Iringa 07 Kilolo 091 Ukumbi 064 Ng'uruhe 192 11 Iringa 07 Kilolo 071 Mtitu 042 Itimbo 56 11 Iringa 04 Njombe 013 Njombe Mjini 342 Kibena Shule 218 11 Iringa 02 Mufindi 173 Mafinga 064 Changarawe 159 11 Iringa 02 Mufindi 121 Ihowanza 043 Ihowanza 321 11 Iringa 02 Mufindi 231 Kibengu 012 Igomtwa 39 11 Iringa 07 Kilolo 021 Irole 052 Mbigili 40 11 Iringa 07 Kilolo 021 Irole 053 Mbigili 283 11 Iringa 01 Iringa R 151 Itunundu 061 Mboliboli

54

ANNEX 5: ENUMERATION AREAS IN KIGOMA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 343 16 Kigoma 04 Kigoma U 132 Mwanga 063 Mwembengoma Kaskazini 112 16 Kigoma 04 Kigoma U 033 Kagera 307 Kagera 115 16 Kigoma 02 Kasulu 302 Kasulu Mjini 048 Kumsenga 14 16 Kigoma 04 Kigoma U 013 Gungu 313 Gezaulole 53 16 Kigoma 04 Kigoma U 013 Gungu 352 Bulonge 318 16 Kigoma 03 Kigoma R 083 Nguruka 346 Bweru 86 16 Kigoma 04 Kigoma U 013 Gungu 385 Kibirizi "B" 61 16 Kigoma 02 Kasulu 151 Muzye 024 Nkundutsi 332 16 Kigoma 04 Kigoma U 132 Mwanga 052 Block 'N' Kaskazini 84 16 Kigoma 02 Kasulu 211 Rusaba 037 Rusaba 'A' - Kavumu 'B' 58 16 Kigoma 02 Kasulu 151 Muzye 021 Nkundutsi 316 16 Kigoma 03 Kigoma R 083 Nguruka 344 Bweru 94 16 Kigoma 02 Kasulu 241 Buhigwe 051 Bweranka – Mwilala 106 16 Kigoma 02 Kasulu 281 Muyama 012 Nyanga - Nyampemba Juu 100 16 Kigoma 03 Kigoma R 051 Matendo 013 Matendo 589 16 Kigoma 03 Kigoma R 221 Kagunga 012 Kagunga 73 16 Kigoma 02 Kasulu 191 Muhunga 022 Heru Juu – Kumlama 191 16 Kigoma 03 Kigoma R 063 Uvinza 950 Lugufu Camp 489 16 Kigoma 03 Kigoma R 161 Kandaga 052 Mlela 471 16 Kigoma 03 Kigoma R 161 Kandaga 026 Kazuramimba 102 16 Kigoma 02 Kasulu 271 Kajana 013 Katundu – Nyamalembe 11 16 Kigoma 02 Kasulu 021 Heru Shingo 938 Nyarugusu Camp - Zone6 Village 536 16 Kigoma 03 Kigoma R 193 Mwandiga 022 Kibingo 553 16 Kigoma 03 Kigoma R 201 Kagongo 017 Mgaraganza 8 16 Kigoma 02 Kasulu 021 Heru Shingo 920 Nyarugusu Camp - Zone 2Village 16 16 Kigoma 02 Kasulu 041 Nyamidaho 022 Nyamidaho – Majengo 6 16 Kigoma 02 Kasulu 011 Kitanga 016 Kitanga

55

ANNEX 6: ENUMERATION AREAS IN KILIMANJARO Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 302 03 Kilimanjaro 05 Hai 103 Siha Kati 106 Karansi 229 03 Kilimanjaro 03 Same 133 Maore 305 Maore 367 03 Kilimanjaro 01 Rombo 193 Tarakea 322 Mbomai Motamburu 284 03 Kilimanjaro 01 Rombo 171 Ubetu kahe 022 Kahe - Part 1 25 03 Kilimanjaro 03 Same 012 Same - Mjini 025 Station 87 03 Kilimanjaro 05 Hai 031 Machame 026 Wari - Urara Kaskazini 291 03 Kilimanjaro 01 Rombo 171 Ubetu kahe 029 Kahe - Part 1 423 03 Kilimanjaro 04 Moshi 'R' 251 Kibosho 041 Mkomongo Magharibi 352 03 Kilimanjaro 03 Same 211 Chome 021 Marieni 521 03 Kilimanjaro 04 Moshi 'R' 311 Kilema Kati 012 Kimaroroni 292 03 Kilimanjaro 03 Same 161 Bendera 013 Mgandu/Msigani 216 03 Kilimanjaro 05 Hai 083 Masama Kusini 301 Kwasadala 165 03 Kilimanjaro 06 Moshi 'U' 072 Korongoni 019 Sabasaba 225 03 Kilimanjaro 01 Rombo 141 Olele 041 Kiooti 485 03 Kilimanjaro 05 Hai 141 Siha Kaskazini 032 Ngarony 242 03 Kilimanjaro 05 Hai 091 Siha Mashariki 072 Kishisha 451 03 Kilimanjaro 05 Hai 132 Hai Mjini 019 Geza ulole 205 03 Kilimanjaro 04 Moshi 'R' 111 Kirua Vunjo 073 Iwa Magharibi 310 03 Kilimanjaro 03 Same 171 Myamba 051 Mang'a - Kiranga 85 03 Kilimanjaro 01 Rombo 061 Shimbi 012 Shimbi Kati 123 03 Kilimanjaro 04 Moshi 'R' 073 Makuyuni 021 Kilimo - Makuyuni 313 03 Kilimanjaro 04 Moshi 'R' 191 Uru South 051 Kitandu Mawela 26 03 Kilimanjaro 04 Moshi 'R' 021 Mwika kaskazini 014 Lole Makera 26 03 Kilimanjaro 05 Hai 011 Machame 073 Urori Mashariki 52 03 Kilimanjaro 04 Moshi 'R' 031 Mamba kaskazini 031 Kokirie 146 03 Kilimanjaro 05 Hai 061 Masama 022 Mudio Mashariki 284 03 Kilimanjaro 04 Moshi 'R' 171 Uru Mashariki 041 Materuni

165 03 Kilimanjaro 04 Moshi 'R' 091 Kilema Kusini 032 Kilema Pofo

111 03 Kilimanjaro 01 Rombo 071 Makiidi 022 Makiidi

80 03 Kilimanjaro 01 Rombo 051 Keni/Aleni 025 Aleni - Chini

56

ANNEX 7: ENUMERATION AREAS IN LINDI Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 269 08 Lindi 01 Kilwa 203 Masoko 031 Masoko 101 08 Lindi 02 Lindi Rural 081 Mnolela 013 Simana 21 08 Lindi 06 Lindi Urban 042 Mitandi 007 Rahaleo

18 08 Lindi 04 Liwale 013 Liwale mjini 312 Nangando

211 08 Lindi 05 Ruangwa 151 Mandarawe 032 Mandarawe

95 08 Lindi 06 Lindi Urban 133 Msinjahili 302 Msinjahili

42 08 Lindi 06 Lindi Urban 072 Matopeni 008 Matopeni

179 08 Lindi 01 Kilwa 131 Kiranjeranje 053 Mtandi

46 08 Lindi 03 Nachingwea 023 Kilimani hewa 306 Kilimanihewa

191 08 Lindi 05 Ruangwa 131 Nambilanje 023 Mtondo

214 08 Lindi 03 Nachingwea 211 Mtua 901 JKT

342 08 Lindi 02 Lindi Rural 221 Tandangongoro 031 Tandangongoro

4 08 Lindi 06 Lindi Urban 012 Ndoro 004 Ndoro

54 08 Lindi 03 Nachingwea 031 Ruponda 011 Ruponda

385 08 Lindi 02 Lindi Rural 261 Chikonji 022 Jangwani

176 08 Lindi 05 Ruangwa 121 Mandawa 012 Mchichili

85 08 Lindi 02 Lindi Rural 073 Mingoyo 302 Mnazimmoja

364 08 Lindi 02 Lindi Rural 241 Milola 017 Milola Magharibi

17 08 Lindi 02 Lindi Rural 021 Kitomanga 023 kitomanga

209 08 Lindi 02 Lindi Rural 123 Nyangao 304 Nyangao "A"

277 08 Lindi 02 Lindi Rural 181 Mandwanga 011 Lindwandwali

401 08 Lindi 02 Lindi Rural 281 Nangaru 022 Mkumbamosi

396 08 Lindi 02 Lindi Rural 271 Matimba 033 Kikomolela

205 08 Lindi 03 Nachingwea 211 Mtua 011 Kipara Mtua

164 08 Lindi 05 Ruangwa 111 Mnacho 051 Namahema

179 08 Lindi 05 Ruangwa 121 Mandawa 021 Nahanga

143 08 Lindi 01 Kilwa 081 Njinjo 041 Ngongowele

114 08 Lindi 03 Nachingwea 121 Kiegei 013 Kiegei

116 08 Lindi 04 Liwale 151 Liwale 'B' 024 Liwale 'B'

267 08 Lindi 01 Kilwa 203 Masoko 011 Mpara Mkwanyule

57

ANNEX 8: ENUMERATION AREAS IN MANYARA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 43 21 Manyara 01 Babati 012 Babati 043 Bagara 116 21 Manyara 05 Kiteto 081 Lengatei 026 Olkitikiti 132 21 Manyara 04 Simanjiro 083 Mererani 307 Mirerani 9 21 Manyara 01 Babati 012 Babati 009 Maisaka 91 21 Manyara 01 Babati 021 Mamire 062 Mamire 84 21 Manyara 02 Hanang 061 Bassodesh 017 Garawja

212 21 Manyara 05 Kiteto 153 Bwagamoyo 024 Kaloleni

16 21 Manyara 05 Kiteto 021 Partimbo 013 Mbigiri

11 21 Manyara 02 Hanang 011 Balangdalalu 026 Balangdalalu

59 21 Manyara 05 Kiteto 043 Olbolot 013 Machiga

243 21 Manyara 01 Babati 101 Sigino 042 Sigino

119 21 Manyara 03 Mbulu 072 Mbulu Mjini 021 Imboru

15 21 Manyara 02 Hanang 011 Balangdalalu 033 Mureru

156 21 Manyara 02 Hanang 091 Mogitu 045 Dumbeta

230 21 Manyara 01 Babati 091 Riroda 039 Riroda

318 21 Manyara 01 Babati 141 Ufana 016 Setcheda

327 21 Manyara 03 Mbulu 161 Masieda 013 Masieda

190 21 Manyara 01 Babati 071 Gidas 052 Gidas

222 21 Manyara 03 Mbulu 121 Maretadu 011 Qamtananati

210 21 Manyara 01 Babati 091 Riroda 011 Endaberg

198 21 Manyara 05 Kiteto 143 Matui 043 Matui - Kitongoji cha Wezamti 19 21 Manyara 03 Mbulu 021 Bargish 014 Antsi

280 21 Manyara 02 Hanang 203 Nangwa 037 Dirma

243 21 Manyara 02 Hanang 171 Simbay 013 Simbay

462 21 Manyara 01 Babati 201 Mwada 031 Sangaiwe

13 21 Manyara 02 Hanang 011 Balangdalalu 031 Mureru

47 21 Manyara 05 Kiteto 031 Njoro 022 Ndaleta

206 21 Manyara 05 Kiteto 143 Matui 307 Matui - Mtaa wa Azimio 164 21 Manyara 05 Kiteto 111 Songambele 033 Magungu - Kitongoji cha Emarti 468 21 Manyara 01 Babati 211 Nkaiti 021 Minjingu

58

ANNEX 9: ENUMERATION AREAS IN MBEYA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 577 12 Mbeya 08 Mbeya U 342 Nonde 003 Mwalingo 350 12 Mbeya 08 Mbeya U 193 Iyela 337 Mapambano 289 12 Mbeya 08 Mbeya U 182 Ruanda 036 Mwenge 508 12 Mbeya 08 Mbeya U 273 Iyunga 311 Maendeleo 236 12 Mbeya 03 Kyela 143 Ipinda 305 Ipinda - Kati 28 12 Mbeya 02 Mbeya (R) 023 Ulenje 303 Ikeka 133 12 Mbeya 08 Mbeya U 113 Iduda 303 Iduda Chini 253 12 Mbeya 02 Mbeya (R) 113 UT/Usongwe 327 Mbalizi 183 12 Mbeya 01 Chunya 141 Galula 037 Magamba 263 12 Mbeya 02 Mbeya (R) 113 UT/Usongwe 337 Mbalizi 151 12 Mbeya 02 Mbeya (R) 081 Isuto 072 Idiwili 491 12 Mbeya 06 Mbozi 181 Ihanda 093 Malonji 254 12 Mbeya 01 Chunya 183 Mkwajuni 061 Patamela 127 12 Mbeya 02 Mbeya (R) 071 Iwiji 034 Izyira 139 12 Mbeya 02 Mbeya (R) 081 Isuto 023 Iwowo 203 12 Mbeya 01 Chunya 151 Mbuyuni 024 Chang'ombe 176 12 Mbeya 02 Mbeya (R) 091 Igale 061 Wimba 54 12 Mbeya 08 Mbeya U 063 Itezi 011 Gombe Kusini 55 12 Mbeya 02 Mbeya (R) 033 Tembela 113 Simambwe 76 12 Mbeya 01 Chunya 083 Itewe 012 Soweto 615 12 Mbeya 06 Mbozi 241 Kapele 052 Kapele 146 12 Mbeya 06 Mbozi 061 Isansa 076 Isansa 284 12 Mbeya 07 Mbarali 113 Igurusi 041 Chamoto 82 12 Mbeya 06 Mbozi 051 Itaka 013 Ikonya 301 12 Mbeya 06 Mbozi 121 Igamba 063 Igamba 364 12 Mbeya 02 Mbeya (R) 161 Inyala 024 Inyala 15 12 Mbeya 07 Mbarali 021 Madibira 034 Mkunywa 465 12 Mbeya 06 Mbozi 181 Ihanda 013 Ipapa 139 12 Mbeya 04 Rungwe 121 Kisegese 021 Kisegese 300 12 Mbeya 06 Mbozi 121 Igamba 062 Igamba

59

ANNEX 10: ENUMERATION AREAS IN MOROGORO Serial Reg Reg Name Dist DistName Ward Ward Name EA Code Vill_street Code Code Code

288 05 Morogoro 03 Kilombero 083 Ifakara 361 Lipangalalai 187 05 Morogoro 05 Morogoro 93 Mazimbu 338 Chamwino (U) 350 05 Morogoro 05 Morogoro 102 Mwembesongo 61 Mbuyuni (U) 241 05 Morogoro 03 Kilombero 083 Ifakara 314 Viwanja Sitini 584 05 Morogoro 01 Kilosa 243 Kisanga 307 Kisanga 189 05 Morogoro 03 Kilombero 061 Kiberege 36 Signali -Mailimia 699 05 Morogoro 01 Kilosa 321 Chanjale 22 Kumbulu 168 05 Morogoro 02 Morogoro 121 Kidugalo 022 Visaraka -Gezaulole & Mgulukan 379 05 Morogoro 01 Kilosa 171 Mabwerebwere 051 Mabwerebwere 92 05 Morogoro 01 Kilosa 043 Magubike 051 Ifunde 26 05 Morogoro 02 Morogoro 021 Kolero 042 Lubasazi - Kivumba,Tavi & Salali 515 05 Morogoro 03 Kilombero 191 Uchindile 031 Kitete

421 05 Morogoro 02 Morogoro 251 Tawa 061 Kitungwa - Ubito,Suini,Mosa,Tan 270 05 Morogoro 04 Ulanga 223 Mtimbira 032 Munga 425 05 Morogoro 03 Kilombero 141 Chita 038 Chita 324 05 Morogoro 01 Kilosa 142 Mkwatani 009 Manzese 'A' 15 05 Morogoro 06 Mvomero 013 Mvomero 314 Mvomero -Mahakama 91 05 Morogoro 02 Morogoro 071 Kisaki 25 Gomero -Kichangani 173 05 Morogoro 04 Ulanga 161 Kilosa Mpepo 021 Kilosa Mpepo 56 05 Morogoro 06 Mvomero 21 Hembeti 024 Mkindo -Mtakuja 364 05 Morogoro 06 Mvomero 151 Mlali 024 Mlali - Peapea 2 05 Morogoro 03 Kilombero 013 Kidatu 012 Kidatu -Kidatu 'B' 109 05 Morogoro 02 Morogoro 091 Singisa 022 Lumba Chini -Mnguzi Juu,Mnguzi

60

ANNEX 11: ENUMERATION AREAS IN MTWARA Serial Reg Reg Name Dist Code DistName Ward Ward Name EA Code Vill_street Code Code

49 09 Mtwara 02 Newala 013 Luchingu 332 Luchingu Butiama 67 09 Mtwara 03 Masasi 012 Masasi 067 Mkuti Madeco 244 09 Mtwara 03 Masasi 053 Lukuledi 315 Lukuledi (Taxes) 669 09 Mtwara 03 Masasi 291 Sindano 022 Luatala Misufini 333 09 Mtwara 02 Newala 171 Maputi 032 Ndenga Kadengwa 90 09 Mtwara 03 Masasi 012 Masasi 090 Nyasa Silabu 15 09 Mtwara 03 Masasi 012 Masasi 015 Migongo/Migongo 405 09 Mtwara 03 Masasi 133 Nanganga 023 Nangoo Mnazimmoja 350 09 Mtwara 03 Masasi 123 Mwena 022 Mtunungu Bondeni 367 09 Mtwara 02 Newala 191 Mkwedu 014 Mkwedu Mgulani 66 09 Mtwara 01 Mtwara R 041 Mahurunga 011 Kihimika 320 09 Mtwara 02 Newala 161 Chiwonga 062 Mzunguko Viokoli 237 09 Mtwara 01 Mtwara R 131 Kitere 074 Libobe 465 09 Mtwara 03 Masasi 163 Likokona 301 Michiga Ndibwa A 262 09 Mtwara 03 Masasi 061 Namatutwe 045 Namatutwe Chimbo 352 09 Mtwara 03 Masasi 123 Mwena 024 Mtunungu Namali 194 09 Mtwara 01 Mtwara R 111 Dihimba 021 Mwembe togwa 776 09 Mtwara 03 Masasi 341 Sengenya 031 Masyalele Msokoyoka 21 09 Mtwara 04 Tandahimba 013 Tandahimba 314 Matogoro 248 09 Mtwara 03 Masasi 053 Lukuledi 319 Lukuledi Missionary 2 659 09 Mtwara 03 Masasi 281 Mkululu 032 Miiba 446 09 Mtwara 03 Masasi 163 Likokona 011 Mkumbaru Namaka 308 09 Mtwara 02 Newala 161 Chiwonga 023 Muungano Dimene 776 09 Mtwara 03 Masasi 341 Sengenya 031 Masyalele Msokoyoka 481 09 Mtwara 03 Masasi 171 Mkonona 051 Mtumbati Elimu 688 09 Mtwara 03 Masasi 311 Mnavira 012 Mnavira 339 09 Mtwara 03 Masasi 111 Chigugu 062 Chikukwe Chakamba 102 09 Mtwara 01 Mtwara R 061 Kiromba 021 Kiromba/Ligula 304 09 Mtwara 03 Masasi 091 Nandete 021 Mtalikachau Misufini 15 09 Mtwara 03 Masasi 012 Masasi 015 Migongo/Migongo

61

ANNEX 12: ENUMERATION AREAS IN MARA Serial Reg Reg Dist DistName Ward Ward Name EA Vill_street Code Name Code Code Code

176 20 Mara 05 Musoma 083 Kigera 334 Kiara U 334 20 Mara 1 Tarime 162 Tarime 041 Nyamisangura 15 20 Mara 05 Musoma 022 Mwigobero 007 Mwigobero U 'A' 32 20 Mara 01 Tarime 033 Sirari 301 Buhemba 27 20 Mara 04 Bunda 013 Nyamuswa 315 shuleni 234 20 Mara 04 Bunda 093 Bunda 405 Nyamakokoto 494 20 Mara 01 Tarime 251 Kyang'ombe 045 Ruhu 118 20 Mara 01 Tarime 061 Nyarero 042 Nyarero 129 20 Mara 03 Musoma 093 Kukirango 301 Madaraka R 331 20 Mara 04 Bunda 151 Kisorya 013 Masahunga 467 20 Mara 01 Tarime 231 Komuge 031 Komuge 611 20 Mara 01 Tarime 321 Bukura 042 Bwiri 611 20 Mara 01 Tarime 321 Bukura 042 Bwiri 664 20 Mara 01 Tarime 371 Mirare 032 Malongo 251 20 Mara 01 Tarime 141 Binagi 041 Mogabiri 348 20 Mara 03 Musoma 221 Bugwema 022 Masinono R 261 20 Mara 04 Bunda 111 Butimba 022 Buzimbwe 356 20 Mara 03 Musoma 231 Murangi 013 Lyasembe R 194 20 Mara 03 Musoma 131 Nyankanga 042 Bisumwa R 656 20 Mara 01 Tarime 361 Ikoma 033 Nyamasanda 474 20 Mara 01 Tarime 241 Nyamunga 013 Kibuyi 456 20 Mara 01 Tarime 221 Rabour 033 Rabour 189 20 Mara 03 Musoma 131 Nyankanga 026 Nyankanga R 37 20 Mara 04 Bunda 021 Salama 032 Salama Kati 131 20 Mara 01 Tarime 071 Nyamwaga 031 Nyamwaga 410 20 Mara 03 Musoma 261 Bwasi 051 Kome R 200 20 Mara 01 Tarime 111 Nyarokoba 014 Genkuru 65 20 Mara 03 Musoma 063 Butiama 015 Butiama R 429 20 Mara 03 Musoma 271 Bukumi 035 Busekera R

62

ANNEX 13: ENUMERATION AREAS IN MWANZA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 350 19 Mwanza 04 Kwimba 253 Ngudu 303 Welamasonga 70 19 Mwanza 03 Nyamagana 022 Nyamanoro 045 Kona ya Bwiru 428 19 Mwanza 05 Sengerema 191 Maisome 011 Kanoni 207 19 Mwanza 01 Ukerewe 131 Namilembe 053 Busagami 163 19 Mwanza 01 Ukerewe 121 Ilangala 026 Masonga 265 19 Mwanza 08 Ilemela 032 Nyakato 160 Bugarika 'B'/Mwananchi 344 19 Mwanza 05 Sengerema 151 Nyehunge 014 Kayenze 397 19 Mwanza 02 Magu 221 Badugu 011 Mwaniga 291 19 Mwanza 06 Geita 131 Bukoli 026 Bugogo 468 19 Mwanza 02 Magu 261 Shishani 066 Mahaha 82 19 Mwanza 04 Kwimba 071 Mwagi 033 Mwabilanda 463 19 Mwanza 05 Sengerema 201 Kazunzu 025 Bulyaheke 80 19 Mwanza 04 Kwimba 071 Mwagi 031 Mwabilanda 221 19 Mwanza 04 Kwimba 171 Hungumalwa 022 Buyogo 286 19 Mwanza 07 Missungwi 181 Mbarika 011 Igenge 203 19 Mwanza 05 Sengerema 071 Tabaruka 012 Busulwangiri 175 19 Mwanza 01 Ukerewe 121 Ilangala 052 Gallu 260 19 Mwanza 04 Kwimba 191 Kikubiji 024 Kikubiji 166 19 Mwanza 02 Magu 091 Nyigogo 043 Kipeja 285 19 Mwanza 07 Missungwi 171 Ilujamate 052 Mwagimagi 2 19 Mwanza 05 Sengerema 013 Sengerema 012 Ibondo 121 19 Mwanza 04 Kwimba 101 Maligisu 014 Mwabalatulu 356 19 Mwanza 08 Ilemela 061 Bugogwa 034 Igombe 272 19 Mwanza 07 Missungwi 171 Ilujamate 011 Nyang'homango 439 19 Mwanza 08 Ilemela 101 Buswelu 014 Buswelu 408 19 Mwanza 06 Geita 181 Busolwa 021 Kaboha 280 19 Mwanza 04 Kwimba 201 Mhande 032 Mhande 71 19 Mwanza 02 Magu 031 Lutale 046 Kayenze 454 19 Mwanza 05 Sengerema 201 Kazunzu 011 Lushamba

63

ANNEX 14: ENUMERATION AREAS IN PEMBA Serial Reg Reg Dist DistName Ward Ward Name EA Vill_street Code Name Code Code Code

109 54 Kaskazini 01 Wete 091 Kiuyu 045 Kiuyu Pemba 153 55 Kusini 02 Mkoani 171 Wambaa 012 Kwaazani Pemba 163 55 Kusini 01 Chake 171 Matale 023 Mwembe/Karata Pemba 159 54 Kaskazini 01 Wete 151 Shengejuu 014 Kiungoni Pemba 175 54 Kaskazini 01 Wete 162 Bobwe 003 Kizimbani Pemba 1 55 Kusini 01 Chake 013 Chanjaani 011 Kilimni Pemba 163 54 Kaskazini 01 Wete 151 Shengejuu 031 Kungumoja Pemba 73 55 Kusini 02 Mkoani 103 Kengeja 051 Chole Pemba 98 54 Kaskazini 02 Micheweni 083 Konde 304 Kiungani Pemba 174 55 Kusini 02 Mkoani 211 Ukutini 011 Miamboni Pemba 160 55 Kusini 02 Mkoani 183 Mbuguani 031 Kwachangawe Pemba 155 55 Kusini 02 Mkoani 171 Wambaa 021 Waamba Pemba 124 55 Kusini 01 Chake 132 Tibirinzi 004 Muharitani Pemba 189 54 Kaskazini 01 Wete 162 Bopwe 017 Bahani Pemba 184 54 Kaskazini 01 Wete 162 Bopwe 012 Bopwe Pemba 43 54 Kaskazini 01 Wete 041 M/Mdogo 052 Jojo Pemba 199 54 Kaskazini 01 Wete 172 utaani 008 Kilimahewa Pemba 29 55 Kusini 01 Chake 031 Pujini 011 Mtimbu Pemba 35 55 Kusini 02 Mkoani 061 Michenzani 061 Magombani Pemba 71 55 Kusini 02 Mkoani 103 Kengeja 031 Mfuuni Pemba

64

60 55 Kusini 02 Mkoani 091 Kangani 034 Kangani Pemba 18 55 Kusini 01 Chake 021 Wawi 031 Mtemani Pemba 97 55 Kusini 01 Chake 081 Ngambwa 033 Vukunguni Pemba Buyuni 22 55 Kusini 01 Chake 021 Wawi 071 Ditia Pemba 97 55 Kusini 01 Chake 081 Ngambwa 033 Vukunguni Pemba Buyuni 22 55 Kusini 01 Chake 021 Wawi 071 Ditia Pemba 147 54 Kaskazini 02 Michew eni 121 Wingwi/Njuguni 027 Njuguni Pemba 131 54 Kaskazini 01 Wete 121 Gando 021 Junguni Pemba

65

ANNEX 15: ENUMERATION AREAS IN PWANI Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 239 06 Pwani 02 Kibaha 093 Maili Moja 309 Maili Moja 16 06 Pwani 03 Kisarawe 013 Kisarawe 308 Kisarawe 232 06 Coast 05 Rufiji 093 Bungu 313 Bungu 'A' 97 06 Coast 04 Mkuranga 033 Vikindu 314 Vikindu 110 06 Pwani 02 Kibaha 023 Kibaha 320 Mwenda Pole 93 06 Coast 04 Mkuranga 033 Vikindu 310 Mwandege 67 06 Pwani 03 Kisarawe 051 Marumbo 052 Mfuru 207 06 Pwani 02 Kibaha 073 Mlandizi 336 Mlandizi 'A' - Njia panda JKT 343 06 Coast 05 Rufiji 171 Mbuchi 032 Mbuchi - Barabarani,Makondoro 147 06 Pwani 03 Kisarawe 153 Kiluvya 012 Tondoroni 36 06 Pwani 02 Kibaha 013 Tumbi 321 Picha ya ndege 293 06 Pwani 01 Bagamoyo 151 Mbwewe 021 Mbwewe 74 06 Coast 05 Rufiji 043 Utete 043 Ngarambe Mashariki 250 06 Pwani 01 Bagamoyo 133 Lugoba 024 Lunga 200 06 Pwani 01 Bagamoyo 123 Chalinze 015 Mbwilingu 124 06 Pwani 03 Kisarawe 111 Mafinzi 041 Ving'andi 275 06 Coast 04 Mkuranga 153 Mwalusembe 033 Bigwa 51 06 Pwani 06 Mafia 051 Mibulani 031 Chemuchemu 89 06 Pwani 03 Kisarawe 073 Msanga 041 Msanga 318 06 Coast 05 Rufiji 151 Ruaruke 042 Ruaruke Nyamtimba 28 06 Coast 04 Mkuranga 013 Mkuranga 122 Tengelea 137 06 Coast 05 Rufiji 083 Kibiti 024 Kimbuga 237 06 Coast 05 Rufiji 101 Mahege 031 Mchungu 141 06 Pwani 02 Kibaha 051 Visaga 032 Visiga - Madafu 212 06 Coast 04 Mkuranga 113 Kimanzichana 033 Kilimahewa Kaskazini 42 06 Pwani 01 Bagamoyo 031 Miono 063 Mandera - Mkunguni 252 06 Coast 05 Rufiji 111 Mchukwi 021 Mlanzi 315 06 Pwani 01 Bagamoyo 161 Kibindu 033 Kibindu - Chapuku 313 06 Pwani 01 Bagamoyo 161 Kibindu 031 Kibindu - Kikomba

66

ANNEX 16: ENUMERATION AREAS IN RUKWA Serial Reg RegName Dist DistName Ward Ward EA Vill_street Code Code Code Name Code 23 15 Rukwa 04 Sumbawanga U 022 Mazwi 013 Tukuyum& RTC 100 15 Rukwa 04 Sumbawanga U 043 Katandala 338 Kasakalawe 553 15 Rukwa 02 Sumbawanga R 231 Kipeta 045 Kilyamatundu 453 15 Rukwa 02 Sumbawanga R 191 Muze 121 Kasekela 81 15 Rukwa 03 Nkasi 043 Chala 032 Milundikwa 388 15 Rukwa 01 Mpanda 183 karema 307 Karema 195 15 Rukwa 02 Sumbawanga R 081 Mwimbi 051 Mnazi 432 15 Rukwa 01 Mpanda 201 Kabungu 069 Msungani I 330 15 Rukwa 01 Mpanda 153 Usevya 029 Ikuba 172 15 Rukwa 01 Mpanda 041 Mtapenda 022 Mtapenda 138 15 Rukwa 02 Sumbawanga R 061 Mwazye 023 Itekesha 81 15 Rukwa 02 Sumbawanga R 043 Matai 035 Myunga 271 15 Rukwa 02 Sumbawanga R 133 Laela 021 Mnokola 171 15 Rukwa 02 Sumbawanga R 071 Katazi 061 Ninga 52 15 Rukwa 01 Mpanda 033 Katumba 083 Kaburonge A 72 15 Rukwa 02 Sumbawanga R 043 Matai 012 Singiwe 20 15 Rukwa 01 Mpanda 033 Katumba 033 Kabuga 154 15 Rukwa 04 Sumbawanga U 063 Kizwite 320 OTC 483 15 Rukwa 01 Mpanda 223 Mishamo 102 Bulamata 127 15 Rukwa 01 Mpanda 033 Katumba 225 Msaginya 354 15 Rukwa 02 Sumbawanga R 161 Mpui 066 Mpui 212 15 Rukwa 04 Sumbawanga U 101 Pito 033 Katumba 503 15 Rukwa 01 Mpanda 223 Mishamo 152 Rugufu 428 15 Rukwa 01 Mpanda 201 Kabungu 065 Msungani I 471 15 Rukwa 01 Mpanda 223 Mishamo 072 Mazwe 550 15 Rukwa 01 Mpanda 241 Mpanda 062 Ifukutwa Ndogo 352 15 Rukwa 02 Sumbawanga R 161 Mpui 064 Mpui 239 15 Rukwa 01 Mpanda 091 Mamba 041 Mamba I 277 15 Rukwa 03 Nkasi 133 Kabwe 085 Kazovu

67

ANNEX 17: ENUMERATION AREAS IN SHINYANGA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 13 17 Shinyanga 04 Kahama 013 Bugarama 032 Igwamanoni 604 17 Shinyanga 04 Kahama 241 Mpunze 053 Sabasabini 653 17 Shinyanga 04 Kahama 261 Nyandekwa 043 Kakebe 332 17 Shinyanga 05 Bukombe 071 Runzewe 051 Kazilamuyaye 373 17 Shinyanga 05 Bukombe 091 Ilolangulu 022 Nyashinge 492 17 Shinyanga 05 Bukombe 133 Uyovu 013 Nyampalahala 386 17 Shinyanga 05 Bukombe 091 Ilolangulu 051 Msendamila 82 17 Shinyanga 06 Meatu 051 Itinje 011 Mwagayi 431 17 Shinyanga 04 Kahama 171 Ukune 092 Igunda 45 17 Shinyanga 02 Maswa 031 Masela 015 Seng'wa 209 17 Shinyanga 06 Meatu 111 Mwabuzo 013 Mwabuzo / Mwanzugi 181 17 Shinyanga 02 Maswa 071 Sukuma 041 Isagenghe 151 17 Shinyanga 04 Kahama 061 Ngaya 022 Mwashimbayi A 111 17 Shinyanga 08 Kishapu 063 Mwadui 011 Bulima Lohumbo 76 17 Shinyanga 06 Meatu 041 Mwamishali 032 Bulyashi 81 17 Shinyanga 04 Kahama 033 Segese 051 Segese 195 17 Shinyanga 08 Kishapu 091 Mwakipoya 022 Mwakipoya 301 17 Shinyanga 08 Kishapu 181 Ukenyenge 033 Negezi 248 17 Shinyanga 08 Kishapu 131 Masanga 034 Bulekela 269 17 Shinyanga 04 Kahama 113 Isagehe 063 Mondo 595 17 Shinyanga 04 Kahama 241 Mpunze 026 Mpunze 636 17 Shinyanga 04 Kahama 251 Kinamapula 083 Kinamapula 351 17 Shinyanga 02 Maswa 151 Shishiyu 041 Mwatumbe 284 17 Shinyanga 02 Maswa 121 Badi 023 Muhida 126 17 Shinyanga 06 Meatu 071 Mwandoya 014 Mwakisandu 374 17 Shinyanga 02 Maswa 171 Kadoto 021 Mwang'anda 37 17 Shinyanga 02 Maswa 021 Isanga 041 Isanga 367 17 Shinyanga 05 Bukombe 081 Ikunguigazi 063 Kabanga 277 17 Shinyanga 06 Meatu 151 Mwabusalu 027 Mwabusalu

68

ANNEX 18: ENUMERATION AREAS IN SINGIDA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 122 13 Singida 01 Iramba 081 Nkinto 012 Matongo 180 13 Singida 03 Manyoni 173 Mgandu 024 Mitundu 127 13 Singida 04 Singida 071 Unyamikumbi 054 Kisaki - Kitope Urban 13 13 Singida 02 Singida 173 Ikungu 304 Ikungi - Misri Rural 13 13 Singida 02 Singida 221 Muhintiri 041 Munyange Rural 13 13 Singida 02 Singida 211 Minyughe 011 Misake Rural 13 13 Singida 02 Singida 261 Irisya 011 Irisya Rural 13 13 Singida 01 Iramba 121 Gumanga 031 Mgimba - Lugadi,Msinsi 13 13 Singida 01 Iramba 041 Kidaru 014 Luono 220 13 Singida 02 Singida 101 Mgori 043 Sughana - Ikaka,Isanga Rural 170 13 Singida 03 Manyoni 161 Rungwa 011 Mwamagembe - Mabatini,Isingiwe 182 13 Singida 01 Iramba 101 Ilunda 032 Kinampundu - Mdilika kaskazini 372 13 Singida 02 Singida 181 Dungunyi 031 372 Rural 130 13 Singida 02 Singida 061 Maghojoa 041 Mipilo - Nkambi Rural 105 13 Singida 03 Manyoni 081 Majiri 031 Majiri - Isuhula 442 13 Singida 01 Iramba 253 Shelui 025 Kizonzo - Nchala 72 13 Singida 01 Iramba 041 Kidaru 032 Kidaru - Tuelyambua,Mwando 56 13 Singida 01 Iramba 031 Tulya 022 Tulya 422 13 Singida 02 Singida 201 Ihanja 051 Chungu Rural 199 13 Singida 01 Iramba 111 Nduguti 013 199 147 13 Singida 03 Manyoni 131 Nkonko 012 Mpola - Usalama,Edekaa 'A & B' 29 13 Singida 02 Singida 023 Mtinko 041 Nduu - Utemini,Ujamaa Rural 32 13 Singida 02 Singida 023 Mtinko 052 Ikiwu - Rural Mtumba,Nambaru 89 13 Singida 01 Iramba 051 Mpambala 041 Lugongo 130 13 Singida 01 Iramba 081 Nkinto 032 Mntamba - Mwangaza,Kirumba,Dar 136 13 Singida 03 Manyoni 121 Heka - Azimio 021 Chikombo 98 13 Singida 02 Singida 051 Ikhanoda 014 Mjughuda - Ilala Rural Ziwani,Ng'ong

69

ANNEX 19: ENUMERATION AREAS IN TABORA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 76 14 Tabora 02 Igunga 031 Bukoko 051 Mtunguru 160 14 Tabora 03 Uyui 101 Ibiri 031 Mwakashindye 390 14 Tabora 04 Urambo 231 Igagala 034 Mtakuja 85 14 Tabora 03 Uyui 053 Ilolangulu 061 Mpenga 275 14 Tabora 05 Sikonge 111 Ipole 022 Ipole 83 14 Tabora 02 Igunga 041 Isakamaliwa 022 Kidalu 157 14 Tabora 06 Tabora 082 Isevya 003 Bomba Mzinga Urban 163 14 Tabora 06 Tabora 082 Isevya 009 Kariakoo Urban 220 14 Tabora 01 Nzega 141 Itilo 022 Itilo 372 14 Tabora 06 Tabora 201 Kalunde 015 Kalunde Urban 279 14 Tabora 04 Urambo 171 Kanindo 042 Mapigano 192 14 Tabora 04 Urambo 141 Kashishi 015 Kashishi 132 14 Tabora 06 Tabora 062 Kiloleni 018 Zahanati Urban 105 14 Tabora 01 Nzega 081 Magengati 014 Kaloleni 499 14 Tabora 01 Nzega 321 Mambali 026 Nkindu 516 14 Tabora 01 Nzega 321 Mambali 052 Mambali II 228 14 Tabora 01 Nzega 151 Muhugi 011 Upina 51 14 Tabora 01 Nzega 041 Mwakanshahala 021 Mwakanshahala 241 14 Tabora 02 Igunga 171 Mwashiku 042 Buchenjegele 340 14 Tabora 06 Tabora 171 Ndevelwa 032 Itulu Urban 120 14 Tabora 03 Uyui 071 Ndono 021 Tulieni 265 14 Tabora 06 Tabora 123 Ng'ambo 313 Kaze Hill Urban 290 14 Tabora 02 Igunga 201 Nkinga 051 Ikunguipima 179 14 Tabora 01 Nzega 102 Nzega Mjini 044 Nzega Mashariki 129 14 Tabora 03 Uyui 081 Ufuluma 023 Ufaluma 112 14 Tabora 04 Urambo 061 Ukondamoyo 017 Ukondamoyo 18 14 Tabora 04 Urambo 013 Urambo 315 Urambo Kusini 186 14 Tabora 04 Urambo 131 Uyowa 042 Mwenda Kulima 152 14 Tabora 04 Urambo 101 Uyumbu 042 Izengabatogwile 248 14 Tabora 02 Igunga 181 Ziba 014 Ziba

70

ANNEX 20: ENUMERATION AREAS IN TANGA Serial Reg RegName Dist DistName Ward Ward Name EA Code Vill_street Code Code Code 293 04 Tanga 04 Tanga 122 Mwanzange 011 Mwakizaro 155 04 Tanga 02 Korogwe 083 Korogwe 339 Old Korogwe 135 04 Tanga 07 Kilindi 131 Jaila 908 Mkuyu Camp Of Refugees 71 04 Tanga 04 Tanga 032 Nguvumali 902 Galanos Sec School 264 04 Tanga 01 Lushoto 161 Mgwashi 042 Mhanko 171 04 Tanga 04 Tanga 082 Usagara 025 Uhindini 366 04 Tanga 04 Tanga 142 Mabawa 044 Miembeni A 143 04 Tanga 01 Lushoto 081 Mamba 024 Kwekitui 146 04 Tanga 03 Muheza 111 Daluni 025 Kibaoni - Daluni 84 04 Tanga 03 Muheza 091 Misalai 012 Misalai 279 04 Tanga 01 Lushoto 171 Mtae 021 Kweshindo 222 04 Tanga 02 Korogwe 121 Dindira 032 Mpale 86 04 Tanga 06 Handeni 081 Kwankonje 022 Kwamsangazi 248 04 Tanga 01 Lushoto 151 Milingano 023 Bumba 34 04 Tanga 03 Muheza 043 Lusanga 051 Mgome 180 04 Tanga 06 Handeni 141 Kwamatuku 041 Komsala 487 04 Tanga 01 Lushoto 291 Malibwi 011 Kwekanga 540 04 Tanga 01 Lushoto 311 Makanya 031 Bombo

428 04 Tanga 01 Lushoto 261 Shume 041 Manolo

75 04 Tanga 02 Korogwe 073 Mnyuzi 041 Lusanga (Station) 305 04 Tanga 01 Lushoto 181 Sunga 023 Sunga

49 04 Tanga 05 Pangani 091 Kipumbwi 012 Kwakibuyu

129 04 Tanga 06 Handeni 101 Sindeni 011 Komfungo

13 04 Tanga 07 Kilindi 021 Kikunde 013 Kikunde

368 04 Tanga 01 Lushoto 231 Mng'aro 021 Mazinde

344 04 Tanga 01 Lushoto 201 Mnazi 031 Kwemkazu

195 04 Tanga 01 Lushoto 111 Bumbuli 051 Kwehangala

78 04 Tanga 07 Kilindi 101 Mvungwe 014 Kibirashi

13 04 Tanga 06 Handeni 011 Segera 072 Michungwani

431 04 Tanga 01 Lushoto 261 Shume 044 Manolo

71

ANNEX 21: ENUMERATION AREAS IN UNGUJA

Seria Reg Reg Name Dist DistName Ward Ward Name EA Code Vill_street l Code Code Code

317 51 kaskazini 02 Kaskazi 191 Kiwengwa 902 Hotel ni 'B' 1 51 kaskazini 02 Kaskazi 011 Misufini 011 Mkongwe ni 'B' Hagewa 161 51 kaskazini 01 Kaskazi 203 Gamba 034 Gamba ni 'A' 248 53 Mjini 02 Mjini 192 Mpendae 021 Mpendae Magharibi 436 53 Mjini 02 Mjini 392 Kwalinato 003 Kwalinato Magharibi 326 53 Mjini 02 Mjini 262 Vikokotoni 003 Vikokotoni Magharibi 405 53 Mjini 02 Mjini 352 Jang'ombe 011 Jang'ombe Magharibi 246 51 kaskazini 02 Kaskazi 041 Fujoni 022 Kiziwani ni 'B' 284 51 kaskazini 02 Kaskazi 121 Donge 011 Dunguni ni 'B' Mtambile 293 51 kaskazini 02 Kaskazi 131 Kinduni 012 Kinduni ni 'B' 23 51 kaskazini 02 Kaskazi 021 Makoba 041 Michungwani ni 'B' 145 53 Mjini 02 Mjini 142 Kilimahewa 002 Kilimahewa Magharibi 212 51 kaskazini 02 Kaskazi 011 Misufini 031 Mabuzini kask. ni 'B' 236 53 Mjini 02 Mjini 192 Mpendae 009 Mpendae Magharibi 181 53 Mjini 01 Maghari 163 Kiembesam 327 Milimani Magharibi bi aki 363 53 Mjini 02 Mjini 322 Mkele 003 Mkele Magharibi 261 51 kaskazini 02 Kaskazi 091 Kitope 021 Kitopendani ni 'B' 185 53 Mjini 02 Mjini 162 Nyerere 014 Nyerere Magharibi 375 53 Mjini 02 Mjini 332 Muungano 001 Muungano Magharibi 95 52 Kusini 01 Kati 211 Chwaka 014 Chwaka 240 51 kaskazini 02 Kaskazi 031 Manga 011 Manga Pwani 72

ni 'B' Pwani 121 51 kaskazini 01 Kaskazi 161 Nungwi 072 Uchejuwa ni 'A' Mwisho 146 51 kaskazini 01 Kaskazi 181 Kijini 021 Msasani/Makung ni 'A' e 98 53 Mjini 02 Mjini 112 Muembe 011 Muembe Magharibi Makumbi Makumbi

73

ANNEX 22: ENUMERATION AREAS IN KAGERA

Serial Reg Reg Dist DistName Ward Ward Name EA Vill_street Code Name Code Code Code 205 18 Kagera 02 Bukoba 161 Kitobo 041 Mbale Rural 56 18 Kagera 01 Karagwe 031 Igurwa 014 Kigarama 6 18 Kagera 04 Biharamulo 013 B'mulo Mjini 021 Rugondo 179 18 Kagera 02 Bukoba 141 Bwanjai 051 Rwamashonga Rural 66 18 Kagera 03 Muleba 051 Izigo 062 Bushumba 204 18 Kagera 03 Muleba 141 Kimwani 031 Katembe 72 18 Kagera 03 Muleba 061 Kagoma 022 Kagoma 252 18 Kagera 04 Biharamulo 101 Kachwamba 055 Kachwamba 275 18 Kagera 04 Biharamulo 121 Nyamigogo 015 Kagoma 479 18 Kagera 02 Bukoba 371 Izimbya 025 Izimbya Rural 398 18 Kagera 01 Karagwe 241 Isingiro 041 Kihanga 61 18 Kagera 04 Biharamulo 021 Nyarubungo 024 Rusabya 568 18 Kagera 04 Biharamulo 221 Nyakahura 912 Mihongoro 350 18 Kagera 03 Muleba 221 kabirizi 032 kabirizi 359 18 Kagera 05 Ngara 141 Ntobeye 013 Ntobeye 303 18 Kagera 01 Karagwe 181 Nyakakika 025 Chabuhora 307 18 Kagera 02 Bukoba 261 Kanyangereko 021 Butahyaibega Rural 120 18 Kagera 04 Biharamulo 031 Muganza 071 Katemwa Part II 182 18 Kagera 03 Muleba 131 Kasharunga 032 Kyamyorwa 30 18 Kagera 02 Bukoba 021 Minziro 021 Minziro Rural 433 18 Kagera 02 Bukoba 341 Ibwera 032 Kibona Rural 465 18 Kagera 01 Karagwe 281 Bugomora 033 Kibare 97 18 Kagera 05 Ngara 011 Rusumo 573 Kasulo (I) Camp'B' 143 18 Kagera 03 Muleba 111 Magata/Karutanga 011 Magata 318 18 Kagera 05 Ngara 111 Kanazi 043 Mukibogoye 290 18 Kagera 02 Bukoba 241 Karabagaine 033 Itahwa Rural 55 18 Kagera 03 Muleba 051 Izigo 031 Izigo 5 18 Kagera 03 Muleba 011 Muhutwe 022 Nyakashenye

74

ANNEX 23: ENUMERATION AREAS IN RUVUMA Serial Reg RegName Dist DistName Ward Ward Name EA Vill_street Code Code Code Code 90 10 Ruvuma 04 Songea Urban 053 Lizaboni 318 Misufini 104 10 Ruvuma 03 Mbinga 063 Mbinga Urban 334 Mbinga 'B' 191 10 Ruvuma 05 Namtumbo 113 Namtumbo 061 Mchomoro 253 10 Ruvuma 04 Songea Urban 123 Mshangano 307 Miembeni 39 10 Ruvuma 04 Songea Urban 032 Misufini 001 Misufini 392 10 Ruvuma 03 Mbinga 271 Linda 041 Silo 213 10 Ruvuma 03 Mbinga 141 Kingerikiti 052 Kilkole 293 10 Ruvuma 01 Tunduru 231 Matemanga 041 Matemanga 361 10 Ruvuma 03 Mbinga 251 Myangayanga 032 Myangayanga 278 10 Ruvuma 03 Mbinga 183 Liuli 303 Liuli 290 10 Ruvuma 03 Mbinga 201 Mikalanga 014 Ilela 156 10 Ruvuma 03 Mbinga 103 Tingi 061 Mpepo 212 10 Ruvuma 05 Namtumbo 121 Mgombasi 014 Nambecha 437 10 Ruvuma 03 Mbinga 301 Ngumbo 032 Mkili 52 10 Ruvuma 03 Mbinga 051 Utiri 032 Mtama 84 10 Ruvuma 01 Tunduru 071 Muhuwesi 011 Majimaji 14 10 Ruvuma 03 Mbinga 021 Litumbandyosi 032 Kingoli 171 10 Ruvuma 05 Namtumbo 101 Luegu 063 Mbimbi 187 10 Ruvuma 01 Tunduru 161 Mchoteka 061 Njenga 208 10 Ruvuma 04 Songea Urban 093 Ruvuma 311 Ngaiwona 137 10 Ruvuma 03 Mbinga 091 Liparamba 012 Ndondo 180 10 Ruvuma 03 Mbinga 121 Mtipwili 012 Chiula 167 10 Ruvuma 01 Tunduru 151 Nalasi 042 Chilundundu 177 10 Ruvuma 02 Songea R 133 Mahanje 021 Madaba 284 10 Ruvuma 03 Mbinga 191 Kihagara 031 Mango 125 10 Ruvuma 05 Namtumbo 081 Namabengo 031 Namabengo 146 10 Ruvuma 05 Namtumbo 091 Kitanda 041 Mputa 26 10 Ruvuma 01 Tunduru 033 M/Mashariki 052 Cheleweni 153 10 Ruvuma 01 Tunduru 131 Mchesi 041 Lukala 86 10 Ruvuma 01 Tunduru 071 Muhu esi 013 Majimaji

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ANNEX 24: DODOSO LA WATOTO CHINI YA MIAKA MITANO [H1]

NOTE: fill out one form for each settlement monitored. Select at least one of the settlements in the health facility/vaccination post catchment area and visit at least ten (10) randomly selected households. EA name:______HF/Vaccination post:______District:______Region:______

No. of children vaccinated Source of Reasons for Unvaccinated House No. of children Physically No. of children seen with Adverse Events No. of children not Information Children Number seen in the Household marked with Pen Marker Following Immunization vaccinated (Insert codes (Indicate Number of Children) (AEFI)* as key below)

Child Not Non- 0 - 8 months 9 - 59 months 0 - 8 months 9 - 59 months 0 - 8 months 9 - 59 months 0 - 8 months 9 - 59 months absent informed compliance (A) (B) (C) (D) (F) (G) (H) (I) (J) (K) (L) (M) (N) 1 2 3 4 5 6 7 8 9 10 Total Any comments (e.g. did you find pockets of unimmunized children or houses not visited? Describe): ______(continue on back of the form) AEFI*: Fever, Rash, Abscess, Vomiting, etc Regional Coordinator's NAME:______SIGNATURE: ______DATE: ______

Codes: Source of Information (all that apply): 1 = Health Worker 2 = Radio 3 = TV 4 = Neighbour/Friend; 5 = Vaccinator 6 = Religious leader; 7= Posters/leaflets; 8=Newspapers; 9= Volunteers (RED CROSS); 10=Megaphone message; 11= Village/Street leaders 12 = SMS message 13= Other (Specify)

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ANNEX 25: DODOSO LA WATOTO [H2] DODOSO LA WATOTO CS-1 WENYE WATOTO MIEZI 12-23 SIRI (Waliozaliwa kati ya 16.11.2009 - 16.11.2010)

UTAMBULISHO

MKOA

WILAYA

SHEHIA ......

NAMBA YA ENEO LA KUHESABIA ......

JINA LA SHEHA

NAMBA YA ENEO LA UTAFITI WA CS ......

IDADI ......

MJINI/KIJIJINI ...... (MJINI=1, KIJIJINI=2)

MIZUNGUKO YA MDADISI

1 2 3 MZUNGUKO WA MWISHO

TAREHE SIKU

MWEZI 0 2

MWAKA 2 0 1 1 JINA LA MDADISI Na. YA MDADISI

MATOKEO* MATOKEO

MZUNGUKO TAREHE UNAOFUATA: JUMLA YA MUDA MIZUNGUKO YOTE

*MAGERESHO YA MATOKEO: 1 MAHOJIANO YAMEKAMILIKA 4 MHOJIWA AMEKATAA 2 HAKUPATIKANA NYUMBANI 5 AMEJIBU SEHEMU TU YA MAHOJIANO 7 NYINGINE 3 MAHOJIANO YAMEAHIRISHWA 6 HAJIWEZI (ELEZA)

MSIMAMIZI MHARIRI KWENYE ENEO MHARIRI IMEINGIZWA OFISINI NA JINA JINA

TAREHE TAREHE

77

78

(1) Shehia (2) Tarehe (3) Eneo (4) Muda wa tarehe ya kuzaliwa

uliokadiriwa. Mtoto la Jina

Kutoka (5) Mpaka Iwapo mtoto hakukamilisha ratiba ya chanjo, Toa sababu MOJA TU kwanini hakuchanjwa. Nambari ya mtoto kwenye ‘ cluster’ 1 2 3 4 5 6 7 1 Kituo Cha huduma kiko mbali

2 Muda unaotelewa huduma si mzuri kwangu

3 Chanjo hazikuwepo 4 Mama ana shughuli nyingi

5 Mtoto alikua mgonjwa /hakupelekwa

Mtoto alikua mgonjwa /alipelekwa/ ila 6 hakuchanjwa 7 Muda wa kusubiri ni mkubwa Gharama za kwenda ni kubwa ( Usafiri au 8 malipo ya huduma) 9 Lugha ya mtoa huduma si nzuri 10 Mchanjaji Hakuwepo 11 Matatizo ya kifamilia/mama mgonjwa 12 Hakujua kama mtoto anahitaji chanjo Hakujua kama mtoto anahitaji kurudi kwa 13 chanjo ya 2 &3 14 Pahala /Muda wa chanjo hapajulikani 15 Khofu ya mtoto kupata madhara Fikra potofu kuhusu mambo yanayozuia 16 mtoto kuchanjwa. 17 Aliahirisha hadi wakati mwengine 18 Hana imani na chanjo 19 Uzushi Ushauri wa daktari kwamba mtoto hahitaji / 20 hapaswi kuchanjwa 21 Sababu nyengine (Eleza).

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ANNEX 26: DODOSO LA MAMA MWENYE MTOTO CHINI YA MWAKA MMOJA [H3] WIZARA YA AFYA - MPANGO WA CHANJO TAIFA DODOSO LA MAMA MWENYE MTOTO CHINI YA MWAKA MMOJA

CS-1 (Waliozaliwa kati ya 14.02.2010 - 18.02.2011) SIRI

UTAMBULISHO

MKOA

WILAYA

SHEHIA ......

NAMBA YA ENEO LA KUHESABIA ......

JINA LA SHEHA

NAMBA YA ENEO LA UTAFITI WA CS ......

IDADI YA KAYA ......

MJINI/KIJIJINI ...... (MJINI=1, KIJIJINI=2)

MIZUNGUKO YA MDADISI

1 2 3 MZUNGUKO WA MWISHO

TAREHE SIKU

MWEZI 0 2

MWAKA 2 0 1 1 JINA LA MDADISI Na. YA MDADISI

MATOKEO* MATOKEO

MZUNGUKO TAREHE UNAOFUATA: JUMLA YA MUDA MIZUNGUKO YOTE

*MAGERESHO YA MATOKEO: 1 MAHOJIANO YAMEKAMILIKA 4 MHOJIWA AMEKATAA 2 HAKUPATIKANA NYUMBANI 5 AMEJIBU SEHEMU TU YA MAHOJIANO 7 NYINGINE 3 MAHOJIANO YAMEAHIRISHWA 6 HAJIWEZI (ELEZA)

MSIMAMIZI MHARIRI KWENYE ENEO MHARIRI IMEINGIZWA OFISINI NA JINA JINA

TAREHE TAREHE

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(1) Shehia (2) Tarehe (3) Eneo

(4) Muda wa tarehe ya kuzaliwa uliokadiriwa. Jina la mama la Jina

Kutoka (5) Mpaka (6) Nambari ya mama kwenye ‘ cluster’ 1 2 3 4 5 6 7 8 9 (7) Tarehe ya kuzaliwa ya mtoto (8) Idadi ya mimba ulizobeba Idadi ya chanjo za TT ulizopata kabla ya mimba ya mwisho ni ngapi? (9) Historia ya Idadi ya chanjo za TT ulizopata wakati chanjo ya TT wa mimba ya mwisho ni ngapi? katika mimba ya Lete kadi inayoonyesha TT ulizopata mwisho wakati wa mimba ya mwisho (Y/N) Umeishawahi kupewa kadi kuonyesha umepata chanjo za TT (Y/N) Tarehe/+/0 (10) TT 1 Chanzo Tarehe/+/0 TT 2 Chanzo Tarehe/+/0 TT 3 Chanzo Tarehe/+/0 TT 4 Chanzo Tarehe/+/0 TT 5 Chanzo Mahudhurio ya Ulihudhuria mara ngapi kwenye kliniki kliniki wakati wa wakati wa mimba ya mwisho mimba ya mwisho Ulienda mara ngapi kituo cha afya wakati Mahudhurio ya ukiwa na mimba ya mwisho kwasababu kituo cha afya nyingine Nyumbani Ulijifungulia wapi Kituo cha afya Sehemu nyingine Mfanyakazi wa afya Mkunga wa jadi Nani alikuzalisha Mtu mwingine Wewe mwenyewe Mtoto amekingwa Ndio kwa kadi dhidi ya pepo punda Ndio kwa kadi na kumbukumbu

Chanzo Tarehe: Rekodi tarehe ya kwenye kadi 1 Kituo cha serikali + Mama amesema amechanjwa 2 Huduma ya mkoba (outreach) 0 Chanjo haikutolewa 3 Huduma ya gari (mobile) 4 Kituo cha binafsi 8 Wakati wa kampeni

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ANNEX 27: TABLE OF OVERALL RAPID IMC COVERAGE

Households Average Children REGION expected to children per (%) seen be visited visited household Arusha 300 274 91.3 436 1.59 Dar-es-salaam 300 270 90.0 432 1.60 Dodoma 300 313 104.3 397 1.27 Iringa 300 302 100.7 645 2.14 Kagera 300 280 93.3 539 1.93 Kigoma 300 342 114.0 1096 3.20 Kilimanjaro 300 311 103.7 398 1.28 Lindi 300 292 97.3 506 1.73 Manyara 300 329 109.7 486 1.48 Mara 300 240 80.0 600 2.50 Mbeya 300 308 102.7 378 1.23 Morogoro 300 325 108.3 461 1.42 Mtwara 300 271 90.3 297 1.10 Mwanza 300 292 97.3 640 2.19 Pemba 300 276 92.0 554 2.01 Pwani 300 291 97.0 370 1.27 Rukwa 300 301 100.3 462 1.53 Ruvuma 300 309 103.0 474 1.53 Shinyanga 300 273 91.0 401 1.47 Singida 300 302 100.7 487 1.61 Tabora 300 309 103.0 732 2.37 Tanga 300 301 100.3 420 1.40 Unguja 300 246 82.0 484 1.97 National 6,900 6,757 98 11,695 1.73

ANNEX 28: VALID TT2 AND TT3 DOSES ADMINISTERED % women receiving valid TT2 % women receiving valid TT3 doses doses (card only) (card only) TANZANIA 96.1 90.9 Dodoma 97.4 97.4 Arusha 97 93.9 Kilimanjaro 95.7 90.6 Tanga 100 97.1 Morogoro 98.8 96.8 Pwani 99.2 93.7

82

Dar es salaam 98.9 94.7 Lindi 100 97.8 Mtwara 100 97.5 Ruvuma 97 95.6 Iringa 99.6 88.1 Mbeya 99.6 94.8 Singida 98.8 96.9 Tabora 100 99.3 Rukwa 98.5 98.5 Kigoma 98.6 91.8 Shinyanga 91.1 87.2 Kagera 96 77.9 Mwanza 98.6 96.8 Mara 97.1 89.8 Manyara 99.6 96.3 MAINLAND 93.4 89.3 Unguja 98.2 89 Pemba 99.3 95.8 ZANZIBAR 98.75 92.4

ANNEX 29: MAIN REASONS FOR UNVACCINATED CHILDREN

Total Negative Place of Fear child to get Region children attitudes of child immunization side effects visited immunization was too far

n n % n % n % Dodoma 432 1 0.2 8 1.9 10 2.3 Tanga 422 26 6.2 4 0.9 2 0.5 Morogoro 434 4 0.9 0 0.0 0 0.0 Pwani 394 4 1.0 0 0.0 0 0.0 Mtwara 383 3 0.8 0 0.0 0 0.0 Ruvuma 426 38 8.9 11 2.6 9 2.1 Iringa 431 1 0.2 1 0.2 0 0.0 Mbeya 425 17 4.0 19 4.5 5 1.2 Singida 395 16 4.1 6 1.5 5 1.3 Tabora 428 1 0.2 1 0.2 1 0.2 Rukwa 423 24 5.7 21 5.0 1 0.2 Kigoma 429 16 3.7 18 4.2 0 0.0

83

Shinyanga 418 1 0.2 18 4.3 52 12.4 Kagera 393 1 0.3 3 0.8 1 0.3 Mwanza 421 37 8.8 2 0.5 6 1.4 Manyara 420 1 0.2 2 0.5 0 0.0 Lindi 421 0 0.0 1 0.2 4 1.0 Mara 389 0 0.0 1 0.3 1 0.3 Mainland 7484 191 2.6 116 1.5 97 1.3

pemba 383 1 0.3 2 0.5 3 0.8 unguja 354 12 3.4 1 0.3 6 1.7 Zanzibar 737 13 1.8 3 0.4 9 1.2 Ovearall (National) 8221 204 2.5 119 1.4 106 1.3

ANNEX 30: ABILITY TO TARGET UNDER ONE YEAR AGE CHILDREN

100 91.4 91.5 91.5 91.7 91.7 91.8 92.4 92.8 93.4 93.7 94.5 87.6 87.7 88 88 89.3 89.7 89.7 90 81.9 83.6 76.6 78.2 80 70 56.5 60 50 40 30 20 10 0

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ANNEX 31: IMMUNIZATION PROGRAM ACCESS (WOMEN RECEIVED TT1) 120 99.699.6 94.6 96 96.396.3 97 97.4 97.8 98.198.2 98.6 99.299.299.2 100 89.5 90.5 93.3 93.7 93.8 84.6 80 65.2 60

40

20 14.3

0

85

ANNEX 32: WOMEN RECEIVING PRENATAL CARE 120 99.2 99.6 94 94.9 95.2 95.9 96.1 96.496.496.5 97 97.197.1 98 98.1 98.2 98.6 100 86.1 90 80 71.7 65.5 60

40

20 0.4 4.5 0

ANNEX 33: HEALTH CARE PROVIDERS vaccination by service provider 100 90 80 70 60 50 40

Percentage% 30 20 10 0 BCG POLIO 1 POLIO 2 POLIO 3 DTP1 DPT2 DPT3 MCV Goverment health facility (%) 89.78 87.87 82.54 78.49 89.12 88.28 87.12 84.71 Outreach (%) 2.81 3.68 3.63 3.62 3.69 3.74 3.64 3.89 Mobile (%) 0.31 0.3 0.36 0.35 0.31 0.35 0.36 0.34 Private Health facility (%) 2.36 2.36 2.37 2.24 2.37 2.38 2.33 2.32 During Campaign (%) 0.02 0.03 0.02 0.01 0.02 0.01 0.01 0.12 Unspecified/missing (%) 4.71 5.75 11.08 15.29 4.47 5.24 6.54 8.62

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ANNEX 34: CRUDE TETANUS VACCINE COVERAGE FOR WOMEN WITH INFANTS CARD AND HISTORY CARD VALID COVERAGE TT1 TT2 TT3 TT4 TT5 TT1 TT2 TT3 TT4 TT5 TT1 TT2 TT3 TT4 TT5 % % % % % % % % % % % % % % % TANZANIA 93.6 89.5 72.1 55.3 45.7 39.7 37.8 27.4 18.4 13.7 39.7 35.6 19.4 12.6 10.3 Dodoma 96.3 90.4 65.2 53.7 46.7 45.2 42.6 20.4 14.4 10.7 45.2 39.6 17.8 11.5 9.6 Arusha 97 79.8 47.5 30.3 22.2 27.3 18.2 10.1 3 1 27.3 15.2 2 1 0 Kilimanjaro 94.6 81.9 40.2 23.2 18.5 37.3 31.5 9.8 2.5 0.7 37.3 27.2 0.4 0 0 Tanga 96.3 93 69.9 50.4 36 16.2 18.4 8.5 5.9 4 16.2 15.4 3.3 1.5 1.1 Morogoro 96 84.9 50 34.1 25.8 30.2 23.4 11.9 6.7 4.4 30.2 19 5.2 0.8 1.6 Pwani 99.2 89.7 60.5 47.4 40.3 49 43.1 22.1 15.4 12.3 49 39.5 10.7 5.9 4.3 Dar es salaam 84.6 79.3 50 31.6 24.4 30.8 27.4 10.2 3 2.3 30.8 25.9 4.1 1.9 2.3 Lindi 97.4 94.1 63.6 53.7 46.7 21.3 18 8.1 5.5 5.1 21.3 18 5.9 5.5 3.3 Mtwara 14.3 12.3 6.6 4.1 13.5 11.9 6.1 3.7 0 13.5 11.9 3.7 2.9 0 Ruvuma 89.5 85.1 68.9 49 39.5 24.7 25 14.9 11.5 8.1 24.7 21.3 10.1 7.4 6.1 Iringa 99.6 98.1 89.3 79.3 73.7 25.2 24.8 19.6 15.6 11.1 25.2 22.6 4.8 1.1 1.9 Mbeya 93.7 86.3 63.1 48 38 24.7 24 13.3 10 8.5 24.7 22.5 7 5.9 4.8 Singida 99.2 96.1 82.5 70.4 61.9 16.3 16 10.9 8.2 6.6 16.3 14.8 7.8 5.4 3.1 Tabora 34.8 33.7 28.6 20.5 15.4 4.8 4.8 2.9 2.2 2.2 4.8 4.8 2.2 1.5 2.2 Rukwa 93.8 85 69.7 52.6 42.3 17.2 16.4 12 9.9 7.3 17.2 15 10.2 6.9 5.5 Kigoma 93.3 88.7 72 56.4 48.6 29.4 27 17.7 12.4 11.7 29.4 25.2 9.2 11 9.6 Shinyanga 98.1 94.2 80.5 56.8 45.9 79 77.4 66.5 44 34.6 79 68.5 53.7 31.5 26.1 Kagera 99.2 97.6 83.9 59 32.1 78.7 78.3 67.5 47.8 25.3 78.7 74.3 45.4 29.3 17.7 Mwanza 90.5 84.2 73.2 60.9 52.5 20.4 18.7 13.4 8.8 7.4 20.4 17.3 8.8 5.6 3.9 Mara 99.6 96.7 85.2 60.7 48 46.7 45.1 37.7 28.3 25 46.7 42.2 27 17.6 16.8 Manyara 97.8 88.6 78.6 70.8 62.4 12.2 11.1 6.3 7.7 5.5 12.2 7 0.4 0.4 0 MAINLAND 88.8 82.8 63.3 48.2 39.1 31.0 28.7 18.6 12.7 9.2 31.0 26.1 11.4 7.4 5.7 Unguja 98.2 95 74.3 52.8 43.1 57.8 56 41.7 28.4 22.9 57.8 53.2 28.4 22 19.7 Pemba 98.6 97.2 87.6 72.1 61.5 39.2 37.8 30.7 19.8 13.4 39.2 37.1 26.5 13.8 10.2 ZANZIBAR 98.4 96.1 81.0 62.5 52.3 48.5 46.9 36.2 24.1 18.2 48.5 45.2 27.5 17.9 15.0

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Mulokozi150312

i Source: TDHS, 2010 (Preliminary results)

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