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

Alba, Sandra, Dillip, Angel, Hetzel, Manuel W., Mayumana, Iddy, Mshana, Christopher, Makemba, Ahmed, Alexander, Mathew, Obrist, Brigit, Schulze, Alexander, Kessy, Flora, Mshinda, Hassan and Lengeler, Christian (2010) Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions - a user perspective. Malaria Journal, 9 Article # 163: . doi:10.1186/1475-2875-9-163


Author Alba, Sandra
Dillip, Angel
Hetzel, Manuel W.
Mayumana, Iddy
Mshana, Christopher
Makemba, Ahmed
Alexander, Mathew
Obrist, Brigit
Schulze, Alexander
Kessy, Flora
Mshinda, Hassan
Lengeler, Christian
Title Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions - a user perspective
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2010
Sub-type Article (original research)
DOI 10.1186/1475-2875-9-163
Open Access Status DOI
Volume 9
Issue Article # 163
Total pages 16
Place of publication United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: The 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.
Methods: Three 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.
Results: Treatment-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.
Conclusions: An 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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Created: Tue, 20 Sep 2011, 22:57:02 EST by Dr Manuel Hetzel on behalf of School of Public Health