Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective

Abstract

BackgroundThe ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment.MethodsThree treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS) and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days.ResultsTreatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%); an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%); higher treatment coverage with anti-malarials (86% to 96%) and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs). Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%). The availability of outlets (health facilities or drug shops) is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent.ConclusionsAn integrated approach aimed at improving understanding and treatment of malaria has led to tangible improvements in terms of people's actions for the treatment of malaria. However, progress was hindered by the low availability of the first-line treatment after the switch to ACT.

Saleability of anti-malarials in private drug shops in Muheza, Tanzania: a baseline study in an era of assumed artemisinin combination therapy (ACT)

“…These data support the findings of a 2008-9 survey in other parts of Tanzania, showing that SP still accounted for three quarters of the sale of anti-malarials in private drug shops [26]. Even in Morogoro region, where the ADDO programme is already implemented, 65% of anti-malarial customers received SP, and only 13% received ALu [27]. The present study has shown that, although ACT is available in private shops, it is only accessed by a minority of the population.…”

Acceptability – a neglected dimension of access to health care: findings from a study on childhood convulsions in rural Tanzania

“…The area is covered by 13 public and private health facilities (11 dispensaries and 2 health centres) with 55 and 135 ADDOs in Ulanga and Kilombero districts respectively [4]. …”

Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal

“…The World Health Organization (WHO), therefore, recommends home-based management of malaria (HMM) as a means to increase access to prompt and effective treatment of malaria [2]. Bringing treatment closer to home through the implementation of HMM should improve access to malaria case management services in areas with scarce health facilities and qualified human resources, as is typically found in rural Africa [3-5] . A number of studies, some of them conducted under the leadership of the WHO, have demonstrated its feasibility and efficacy [6-9], and several studies have evaluated the introduction of ACT through HMM programmes [10,11].…”