Abstract
BackgroundMalaria control strategies emphasize the need for prompt and effective treatment of malaria episodes. To increase treatment efficacy, Tanzania changed its first-line treatment from chloroquine to sulphadoxine-pyrimethamine (SP) in 2001. The effect of this policy change on the availability of antimalarials was studied in rural south-eastern Tanzania.MethodsIn 2001 and 2004, the study area was searched for commercial outlets selling drugs and their stocks were recorded. Household information was obtained from the local Demographic Surveillance System.ResultsFrom 2001 to 2004, the number of general shops stocking drugs increased by 15% and the number of drug stores nearly doubled. However, the proportion of general shops stocking antimalarials dropped markedly, resulting in an almost 50% decrease of antimalarial selling outlets. This led to more households being located farther from a treatment source. In 2004, five out of 25 studied villages with a total population of 13,506 (18%) had neither a health facility, nor a shop as source of malaria treatment.ConclusionWhile the change to SP resulted in a higher treatment efficacy, it also led to a decreased antimalarial availability in the study area. Although there was no apparent impact on overall antimalarial use, the decline in access may have disproportionately affected the poorest and most remote groups. In view of the imminent policy change to artemisinin-based combination therapy these issues need to be addressed urgently if the benefits of this new class of antimalarials are to be extended to the whole population.
Highlights
Malaria control strategies emphasize the need for prompt and effective treatment of malaria episodes
The first and foremost malaria control strategy promoted by the World Health Organization (WHO) and adopted by most African countries emphasizes the need for treatment of malaria episodes with an efficacious drug within 24 hours after onset of symptoms [1,2]
African heads of state agreed at the Abuja summit in April 2000 to ensure that by 2005 at least 60% of those suffering from malaria have access to affordable, appropriate and timely treatment [3]
Summary
Malaria control strategies emphasize the need for prompt and effective treatment of malaria episodes. Tanzania changed its first-line treatment from chloroquine to sulphadoxine-pyrimethamine (SP) in 2001 The effect of this policy change on the availability of antimalarials was studied in rural south-eastern Tanzania. The first and foremost malaria control strategy promoted by the World Health Organization (WHO) and adopted by most African countries emphasizes the need for treatment of malaria episodes with an efficacious drug within 24 hours after onset of symptoms [1,2]. While in case of a malaria attack many factors influence care seeking behaviour [8], one of the prerequisites for successful treatment of a malaria episode is the availability of effective antimalarial drugs close to where the episode occurs
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