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Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective.
Malar J. 2010 Jun 15; 9:163.MJ

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.

Authors+Show Affiliations

Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. sandra.alba@unibas.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20550653

Citation

Alba, Sandra, et al. "Improvements in Access to Malaria Treatment in Tanzania Following Community, Retail Sector and Health Facility Interventions -- a User Perspective." Malaria Journal, vol. 9, 2010, p. 163.
Alba S, Dillip A, Hetzel MW, et al. Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective. Malar J. 2010;9:163.
Alba, S., Dillip, A., Hetzel, M. W., Mayumana, I., Mshana, C., Makemba, A., Alexander, M., Obrist, B., Schulze, A., Kessy, F., Mshinda, H., & Lengeler, C. (2010). Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective. Malaria Journal, 9, 163. https://doi.org/10.1186/1475-2875-9-163
Alba S, et al. Improvements in Access to Malaria Treatment in Tanzania Following Community, Retail Sector and Health Facility Interventions -- a User Perspective. Malar J. 2010 Jun 15;9:163. PubMed PMID: 20550653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective. AU - Alba,Sandra, AU - Dillip,Angel, AU - Hetzel,Manuel W, AU - Mayumana,Iddy, AU - Mshana,Christopher, AU - Makemba,Ahmed, AU - Alexander,Mathew, AU - Obrist,Brigit, AU - Schulze,Alexander, AU - Kessy,Flora, AU - Mshinda,Hassan, AU - Lengeler,Christian, Y1 - 2010/06/15/ PY - 2010/02/15/received PY - 2010/06/15/accepted PY - 2010/6/17/entrez PY - 2010/6/17/pubmed PY - 2010/8/25/medline SP - 163 EP - 163 JF - Malaria journal JO - Malar J VL - 9 N2 - 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/20550653/Improvements_in_access_to_malaria_treatment_in_Tanzania_following_community_retail_sector_and_health_facility_interventions____a_user_perspective_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-9-163 DB - PRIME DP - Unbound Medicine ER -