Socio-ecological Systems Analysis of the Prevention and Control of Dengue in two Districts of Dar es Salaam City, Tanzania

Abstract Background: Since 2010, Tanzania has been experiencing frequent outbreaks of dengue. The objective of this study was to carry out a socio-ecological systems analysis and assess the readiness in dengue prevention and control in Kinondoni and Ilala districts of Dar es Salaam City, Tanzania.Methods: Twenty-seven key district officials responsible for human and animal health were involved in a socio-ecological systems framework analysis as regards to dengue. In addition, the readiness of the districts to respond to dengue outbreaks and the performance of the disease surveillance system was assessed.Results: The two districts were characterized by both urban and peri-urban ecosystems, with a mixture of planned and unplanned settlements which support breeding and proliferation of Aedes mosquitoes. The results indicate inadequate levels of readiness in the management and control of dengue outbreaks, in terms of clinical competence, diagnostic capacities, surveillance system and control/prevention measures. Mosquito breeding sites, especially discarded automobile tyres, were reported to be scattered in the districts. Constraining factors in implementing disease surveillance included both intrapersonal and interpersonal factors, lack of case management guidelines, difficult language used in standard case definitions, inadequate laboratory capacity, lack of appropriate rapid response teams, inadequate knowledge on outbreak investigation and inadequate capacities in data management. Conclusion: The two districts had limited readiness in the management and control of dengue, in terms of clinical competence, diagnostic capacities, surveillance system and prevention and control measures. These challenges require the immediate attention by the authorities, as they compromise the effectiveness of the national strategy for community health support.