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Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania.

Hetzel, M. W., Msechu, J. J., Goodman, C., Lengeler, C., Obrist, B., Kachur, S. P., Makemba, A., Nathan, R., Schulze, A. and Mshinda, H. (2006) Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania. Malaria journal, 5 (109). pp. 1-12. ISSN 1475-2875 (In Press)

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Abstract

BACKGROUND

Malaria 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.

METHODS

In 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.

RESULTS

From 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.

CONCLUSION

While 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.

Item Type: Article
Keywords: Malaria, antimalarials, chloroquine, sulphadoxine-pyrimethamine, Kilombero, Health Policy
Subjects: Malaria > Surveillance, monitoring, evaluation
Malaria > Diagnosis & treatment
Divisions: Ifakara Health Institute > Biomedical
Depositing User: Mr Joseph Madata
Date Deposited: 26 Jul 2012 08:54
Last Modified: 16 Aug 2012 15:57
URI: http://ihi.eprints.org/id/eprint/238

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