Historically, Zanzibar experienced a high burden of communicable diseases; however, due to
epidemiological change in recent years, non-communicable diseases (NCDs). NCDs has been
increasing in Zanzibar for quiet a decade. The three chronic NCDs that contribute to the
mortality in Zanzibar are cardio-vascular diseases, cancer, and diabetes. Other NCDs like oral
health, mental health and road traffic injuries have been considered as priorities diseases to be
The treatment of complicated NCDs already costs Zanzibar TSH 1.5 billion annually
in paying for treatment abroad. The burden of NCDs in Zanzibar is high, with over-weight and
obesity approaching epidemic proportions particularly among women at 42.6 percent. A third of
the 25-64-year-old population has raised blood pressure. and in 2011 about 4 percent had raised
The NCD strategic Plan of 2014 – 2019 has noted the admissions of hospitals due to Diabetes,
CVD and chronic lung diseases reached 3,094 out of a total of 10,715 admissions to medical
wards in hospitals in Zanzibar in 2009. In Zanzibar, CVD accounts for between 13-18% of all
recorded causes of death in hospital as per vital statistics. Management of hypertension is
essential to prevent stroke and in Zanzibar it was found that in the overall population 33.0% had
elevated blood pressure (male: 37.0%; female: 29.4%).
only 87.1% were taking medicine for their high blood pressure (male: 88.5%; female: 85.5%).
Hypertension in pregnancy was the most common complication accounting for 37.8% of all
pregnancy related complications in 2010. Furthermore, the STEPS survey indicated the access of
hypertension treatment in Zanzibar is extremely poor, only 12 percent of those with hypertention
are on treatment and only 7.8 percent had adequate BP control. A Major investment in Zanzibar
health system is needed to prevent the emerging diseases including NCD and other infectious
disease like COVID 19.
The recent data collected at Mnazi Mmoja Hospital at Oncology department shows that, there is
a total of 330 reported cancer cases of people aged 0-75+ years between 2018 and 2021. The
standardized incidence rate per 100,000 was prostate (male) 0.7%, Breast (female) 0.4%, cervix
(female) 0.3%, mouth and pharynx ( male) 0.1% and 0.001% (female).
The overall life expectancy in Zanzibar has generally increased from 57 years in 2002 (2002
census) to 59 years (2010) to the currently estimated level of 65.2 years (TDHS 2015/16).
Female live longer than male, the life expectancy is 63 years (2012) to 65 years (2018) for males
and 67 years (2012) to 70 years (2018) for females (Population Projection Report (2018/19).
There are regional differences with the lowest life expectancy being 62.3 in Kusini Unguja and
highest in Kaskazini Unguja at 66.6 years. A crude birth rate for Zanzibar stands at 38.1 births
per 1,000 population with total fertility rate of 5.3 children per woman (TDHS 2015/16 ) the low
contraceptive prevalence rate of 15% and early age at first marriage (TDHS 2015/2016).
Mortality rates are still high in under five years of age and women in their reproductive age.
The Institutional Maternal Mortality ration per 100,000 live birth has shown reduction from
191/100,000 in 2017 to 166/100,000 in 2019 though it is still un acceptable and still is far to
meet the target set of 96 per 100,000 live birth as stated Health Bulletin 2019. Pemba region has
shown a high Institutional Maternal Mortality Ratio of 175 dealth per 100,000 live birth
compared to Unguja where it is 162 per 100,000 live birth. This is the indication for the Ministry
in setting the relevant strategies that can lead mothers with their children to survive with better
health. The leading causes of maternal death has been reported as severe Anaemia at 27
percent, followed by Pregnancy induced hypertentions and Post parum hemorrhage at 21 percent
( HMIS 2020).
The under-five mortality rate per 1000 has shown a reduction from 73/1000 (2010 -TDHS) to
56/1000 (2015/16- TDHS). Still there is no significant reduction for neonatal mortality though it
has reduced to 28 per 1000 in 2015/16 from 29 in 2010 TDHS.
Furthermore, The infant mortality rate (per 1000 live births) has shown the decreases from 54/1000 (TDHS-2010) to 45 (TDH-MIS 2015/16). Ministry has documented that the newborn deaths account for almost 50 per cent of under five mortalities, this situation has put an alert to the Ministry to direct more focus on investing in child health and the health of mothers particularly during Antenatal period.
Causes of death
The most common causes of deaths in Zanzibar are still associated with infectious and parasitic
diseases. More than 13% of all deaths that occurred in Zanzibar hospitals in 2020 are attributed
to Cerebro Vascular Accident (CVA), Congestive cardiac Failure and hypertension stands. This
has been recognized as the most important contributor to premature mortality and disability in
The Cerebra Vascular Accident (CVA), hypertension and congestive cardiac failure is leading cause of death for adult in Zanzibar based on hospital information where by CVA contributes about 13 percent of all adults’ deaths, followed
by Hypertension and Congestive Cardiac failure, which accounts 7.9 and 6.4 percent respectively. Overall the first two
cause of Death are all NCD related and account for 20.9 percent of the cause of death.