TY - JOUR
T1 - Who gets prompt access to artemisinin-based combination therapy? A prospective community-based study in children from rural kilosa, Tanzania
AU - Simba, Daudi O.
AU - Warsame, Marian
AU - Kakoko, Deodatus
AU - Mrango, Zakayo
AU - Tomson, Goran
AU - Premji, Zul
AU - Petzold, Max
N1 - Funding Information:
In Tanzania, malaria which is the leading cause of morbidity and mortality accounts for over 40% of out-patient attendances and 36% of all death in under fives [National Malaria Control Programme - Medium term malaria strategic plan, 2008–2013]. Tanzania accommodated the malaria treatment policy change for uncomplicated malaria from sulphadoxine-pyrimethamine (SP) to ACT in October 2006 [Ministry of health and social welfare, National guideline for malaria diagnosis and treatment, 2006]. However, procurement of ACT is mainly through the support of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and caters for ACT provision by government and not-for-profit private health facilities, which include Faith Based Organisation [FBO] facilities. In the former, free services are provided to under-fives, whereas in the latter, a considerable fee is charged, even if the ACT is free. Furthermore, most treatment for malaria is provided outside the formal healthcare sector, usually by shopkeepers where treatment is often inappropriate . Recently, the country introduced an ‘Accredited Drug Dispensing Outlet’ (ADDO) system in which drug stores that normally sell non-prescription medications are licensed to sell a selected number of prescription-only pharmaceuticals, including the recommended ACT, that is, artemether-lumefantrine (ALu). Tanzania is one of the countries invited by the Affordable Medicine Facility for malaria [AMFm] to implement a new global health initiative that aims to lower ACT prices that will benefit even the private sector.
PY - 2010
Y1 - 2010
N2 - Background: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. Methods and Findings: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8%) of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1) of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28). Caretakers from the better-off household (3rd-5th quintiles) were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76). The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500) compared to the better-offs (median Tsh 0). Conclusions: Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where the burden of malaria is highest.
AB - Background: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. Methods and Findings: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8%) of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1) of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28). Caretakers from the better-off household (3rd-5th quintiles) were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76). The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500) compared to the better-offs (median Tsh 0). Conclusions: Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where the burden of malaria is highest.
UR - http://www.scopus.com/inward/record.url?scp=77957773813&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0012104
DO - 10.1371/journal.pone.0012104
M3 - Article
C2 - 20856897
AN - SCOPUS:77957773813
SN - 1932-6203
VL - 5
JO - PLoS ONE
JF - PLoS ONE
IS - 8
M1 - e12104
ER -
