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The malaria testing and treatment landscape in mainland Tanzania, 2016.
Malar J. 2017 04 24; 16(1):202.MJ

Abstract

BACKGROUND

Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and price of anti-malarials and malaria diagnosis in 2016.

METHODS

A nationally-representative malaria outlet survey was conducted between 18th May and 2nd July, 2016. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all anti-malarials, malaria rapid (RDT) diagnostic tests and microscopy.

RESULTS

A total of 5867 outlets were included in the nationally representative survey, across both public and private sectors. In the public sector, availability of malaria testing was 92.3% and quality-assured (QA) ACT was 89.1% among all screened outlets. Sulfadoxine-pyrimethamine (SP) was stocked by 51.8% of the public sector and injectable artesunate was found in 71.4% of all screened public health facilities. Among anti-malarial private-sector stockists, availability of testing was 15.7, and 65.1% had QA ACT available. The public sector accounted for 83.4% of the total market share for malaria diagnostics. The private sector accounted for 63.9% of the total anti-malarial market, and anti-malarials were most commonly distributed through accredited drug dispensing outlets (ADDOs) (39.0%), duka la dawa baridi (DLDBs) (13.3%) and pharmacies (6.7%). QA ACT comprised 33.1% of the national market share (12.2% public sector and 20.9% private sector). SP accounted for 53.3% of the total market for anti-malarials across both private and public sectors (31.3 and 22.0% of the total market, respectively). The median price per adult equivalent treatment dose (AETD) of QA ACT in the private sector was $1.40, almost 1.5 times more expensive than the median price per AETD of SP ($1.05). In the private sector, 79.3% of providers perceived ACT to be the most effective treatment for uncomplicated malaria for adults and 88.4% perceived this for children.

CONCLUSIONS

While public sector preparedness for appropriate malaria testing and case management is showing encouraging signs, QA ACT availability and market share in the private sector continues to be sub-optimal for most outlet types. Furthermore, it is concerning that SP continues to predominate in the anti-malarial market. The reasons for this remain unclear, but are likely to be in part related to price, availability and provider knowledge or preferences. Continued efforts to implement government policy around malaria diagnosis and case management should be encouraged.

Authors+Show Affiliations

No affiliation info availablePSI/Tanzania, Plot # 1347/48 Masaki, Msasani Peninsula, Haile Selassie Road, PO Box 33500, Dar es Salaam, Tanzania. dmichael@psi.or.tz.National Malaria Control Programme, Dar es Salaam, United Republic of Tanzania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28521811

Citation

ACTwatch Group, et al. "The Malaria Testing and Treatment Landscape in Mainland Tanzania, 2016." Malaria Journal, vol. 16, no. 1, 2017, p. 202.
ACTwatch Group, Michael D, Mkunde SP. The malaria testing and treatment landscape in mainland Tanzania, 2016. Malar J. 2017;16(1):202.
Michael, D., & Mkunde, S. P. (2017). The malaria testing and treatment landscape in mainland Tanzania, 2016. Malaria Journal, 16(1), 202. https://doi.org/10.1186/s12936-017-1819-7
ACTwatch Group, Michael D, Mkunde SP. The Malaria Testing and Treatment Landscape in Mainland Tanzania, 2016. Malar J. 2017 04 24;16(1):202. PubMed PMID: 28521811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The malaria testing and treatment landscape in mainland Tanzania, 2016. AU - ,, AU - Michael,Daniel, AU - Mkunde,Sigsbert Patila, Y1 - 2017/04/24/ PY - 2017/03/01/received PY - 2017/04/11/accepted PY - 2017/5/20/entrez PY - 2017/5/20/pubmed PY - 2018/1/20/medline KW - ACT KW - Anti-malarial markets KW - Quality-assured artemisinin combination therapy KW - Rapid diagnostic testing SP - 202 EP - 202 JF - Malaria journal JO - Malar J VL - 16 IS - 1 N2 - BACKGROUND: Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and price of anti-malarials and malaria diagnosis in 2016. METHODS: A nationally-representative malaria outlet survey was conducted between 18th May and 2nd July, 2016. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all anti-malarials, malaria rapid (RDT) diagnostic tests and microscopy. RESULTS: A total of 5867 outlets were included in the nationally representative survey, across both public and private sectors. In the public sector, availability of malaria testing was 92.3% and quality-assured (QA) ACT was 89.1% among all screened outlets. Sulfadoxine-pyrimethamine (SP) was stocked by 51.8% of the public sector and injectable artesunate was found in 71.4% of all screened public health facilities. Among anti-malarial private-sector stockists, availability of testing was 15.7, and 65.1% had QA ACT available. The public sector accounted for 83.4% of the total market share for malaria diagnostics. The private sector accounted for 63.9% of the total anti-malarial market, and anti-malarials were most commonly distributed through accredited drug dispensing outlets (ADDOs) (39.0%), duka la dawa baridi (DLDBs) (13.3%) and pharmacies (6.7%). QA ACT comprised 33.1% of the national market share (12.2% public sector and 20.9% private sector). SP accounted for 53.3% of the total market for anti-malarials across both private and public sectors (31.3 and 22.0% of the total market, respectively). The median price per adult equivalent treatment dose (AETD) of QA ACT in the private sector was $1.40, almost 1.5 times more expensive than the median price per AETD of SP ($1.05). In the private sector, 79.3% of providers perceived ACT to be the most effective treatment for uncomplicated malaria for adults and 88.4% perceived this for children. CONCLUSIONS: While public sector preparedness for appropriate malaria testing and case management is showing encouraging signs, QA ACT availability and market share in the private sector continues to be sub-optimal for most outlet types. Furthermore, it is concerning that SP continues to predominate in the anti-malarial market. The reasons for this remain unclear, but are likely to be in part related to price, availability and provider knowledge or preferences. Continued efforts to implement government policy around malaria diagnosis and case management should be encouraged. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/28521811/The_malaria_testing_and_treatment_landscape_in_mainland_Tanzania_2016_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-017-1819-7 DB - PRIME DP - Unbound Medicine ER -