Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

Malaria Journal

Research

Catherine Goodman¹  Christian Lengeler²  Angel Dillip³  Sandra Alba³  Jafari Liana⁴  Manuel W Hetzel⁵  Hassan Mshinda⁶ 

[1] Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK;and Kenya Medical Research Institute-Welcome Trust Research Programme, Nairobi, Kenya;Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;Ifakara Health Institute, Ifakara, Tanzania;Management Sciences for Health, Dar es Salaam, Tanzania;Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea;Tanzanian Commission for Science and Technology, Dar es Salaam, Tanzania;

关键词: Health Facility;    Public Health Facility;    Artemisinin Combination Therapy;    Amodiaquine;    Drug Shop;   

DOI  :  10.1186/1475-2875-9-164

 received in 2010-02-15, accepted in 2010-06-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundTo 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. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.MethodsThe study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.ResultsBetween 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)ConclusionsThe public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake.

【 授权许可】

CC BY   
© Alba et al; licensee BioMed Central Ltd. 2010