Abstract
BackgroundNew malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-lumefantrine (Coartem®), popularly known as ALu or dawa mseto. Very little is known about how people in malaria endemic areas interpret policy makers' decision to replace existing anti-malarials, such as sulphadoxine-pyrimethamine (SP) with "new" treatment regimens, such as ALu or other formulations of ACT. This study was conducted to examine community level understandings and interpretations of ALu's efficacy and side-effects. The paper specifically examines the perceived efficacy of ALu as articulated by the mothers of young children diagnosed with malaria and prescribed ALu.MethodsParticipant observation, six focus group discussions in two large villages, followed by interviews with a random sample of 110 mothers of children less than five years of age, who were diagnosed with malaria and prescribed ALu. Additionally, observations were conducted in two village dispensaries involving interactions between mothers/caretakers and health care providers.ResultsWhile more than two-thirds of the mothers had an overall negative disposition toward SP, 97.5% of them spoke favourably about ALu, emphasizing it's ability to help their children to rapidly recover from malaria, without undesirable side-effects. 62.5% of the mothers reported that they were spending less money dealing with malaria than previously when their child was treated with SP. 88% of the mothers had waited for 48 hours or more after the onset of fever before taking their child to the dispensary. Mothers' knowledge and reporting of ALu's dosage was, in many cases, inconsistent with the recommended dosage schedule for children.ConclusionDeployment of ALu has significantly changed community level perceptions of anti-malarial treatment. However, mothers continue to delay seeking care before accessing ALu, limiting the impact of highly subsidized rollout of the drug. Implementation of ACT-based treatment guidelines must be complemented with educational campaigns to insure that mothers seek prompt help for their children within 24 hours of the onset of fever. Improved communication between health care providers and mothers of sick children can facilitate better adherence to ALu's recommended dosage. Community level interpretations of anti-malarials are multifaceted; integrating knowledge of local beliefs and practices surrounding consumption of anti-malarials into programmatic goals can help to significantly improve malaria control interventions.
Highlights
New malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-® lumefantrine (Coartem ), popularly known as ALu or dawa mseto
While more than two-thirds of the mothers had an overall negative disposition toward SP, 97.5% of them spoke favourably about ALu, emphasizing it’s ability to help their children to rapidly recover from malaria, without undesirable side-effects. 62.5% of the mothers reported that they were spending less money dealing with malaria than previously when their child was treated with SP. 88% of the mothers had waited for 48 hours or more after the onset of fever before taking their child to the dispensary
Implementation of artemisininbased combination therapy (ACT)-based treatment guidelines must be complemented with educational campaigns to insure that mothers seek prompt help for their children within 24 hours of the onset of fever
Summary
New malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-® lumefantrine (Coartem ), popularly known as ALu or dawa mseto. Very little is known about how people in malaria endemic areas interpret policy makers’ decision to replace existing anti-malarials, such as sulphadoxinepyrimethamine (SP) with “new” treatment regimens, such as ALu or other formulations of ACT. Lumefantrine-based combination therapy (ACT) popularly known as ALu or dawa mseto in public health facilities, to treat uncomplicated malaria [1]. These new guidelines were implemented five years after the government decided to replace chloroquine (CQ) with sulphadoxine-pyrimethamine (SP) as the first-line treatment for uncomplicated malaria. Studies detailing how people in malaria endemic areas interpret policy makers’ decisions to replace existing anti-malarials, such as SP, with “new” treatments, such as ALu or another artemisininbased combination therapy (ACT), are lacking. Understanding how cultural perceptions influence decisions regarding the use and consumption of anti-malarials, both “old” and “new,” can provide valuable insights into how the delivery of newer treatment regimens can be better managed
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