Abstract
BackgroundMalaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions.MethodsWe conducted community-based treatment-seeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources.ResultsAfter intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2–93.8) of the fever cases in children and 80.7% (68.1–90.0) in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine). However, only 22.5% (13.9–33.2) of the children and 10.5% (4.0–21.5) of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR = 7.7) but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers.ConclusionA clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health services in delivering antimalarial treatment. Health system factors like these need to be tackled urgently in order to translate the high efficacy of newly introduced artemisinin-based combination therapy (ACT) into equitable community-effectiveness and health-impact.
Highlights
IntroductionAccess to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings
Malaria is still a leading child killer in sub-Saharan Africa
Local understanding of febrile illness The analysis of patterns of distress and perceived causes considered all children under the age of five years and adults over 12 years (194 in total)
Summary
Access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. As part of an integrated approach to malaria control, the World Health Organization promotes prompt access to effective treatment for all episodes of malaria [1]. As there is no onesize-fits-all solution, several strategies have been proposed and tested to improve access to malaria treatment. These include scaling-up home-based management [7,8], stronger involvement of the private sector [9,10], improving case-management in health facilities [11] as well as integrated approaches [12]. It is widely acknowledged that no malaria-control strategy can be successful and sustainable without an increased investment in the local health system through which the interventions are to be channelled [13,14,15]
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