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

Malaria Journal

Research

Ib C Bygbjerg¹  Frank M Ringsted¹  Isolide S Massawe²  Martha M Lemnge² 

[1] Department of International Health, Immunology and Microbiology (ISIM), Faculty of Health Sciences, University of Copenhagen, 1014, Øster Farimagsgade 5,Copenhagen K, DK, Denmark;National Institute for Medical Research (NIMR), Tanga Centre, P.O. Box 5004, Tanga, Tanzania;

关键词: Malaria;    Artemisinin Combination Therapy;    Amodiaquine;    Drug Shop;    Drug Sale;   

DOI  :  10.1186/1475-2875-10-238

 received in 2011-04-04, accepted in 2011-08-15,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundArtemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance.The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidized ALu.MethodsAll drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume.ResultsAll surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for 74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%).ConclusionsIn community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for IPTp, as stipulated in the national anti-malarial policy.It is a major reason for concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy.Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to train private drug dispensers.

【 授权许可】

CC BY   
© Ringsted et al; licensee BioMed Central Ltd. 2011