Browsing by Author "Goodman, Catherine"

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    Availability of Antimalarials after the Policy Change from Chloroquine to Sulphadoxine-Pyrimethamine in Rural Tanzania [MIM-MH-90794]
    (Elsevier, 2005) Hetzel, Manuel W.; Msechu, June J.; Lengeler, Christian; Obrist, Brigit; Goodman, Catherine; Makemba, Ahmed; Mponda, Haji; Sono, K.; Mshinda, Hassan
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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
    (BioMed Central, 2006) Hetzel, Manuel W.; Msechu, June J.; Goodman, Catherine; Lengeler, Christian; Obrist, Brigit; Kachur, Patrick S.; Makemba, Ahmed; Nathan, Rose; Schulze, Alexander; Mshinda, Hassan
    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.
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    Friend or Foe? Private Sector Sales of Anti-Malarial Drugs in Rural Tanzania
    (2005) Goodman, Catherine; Kachur, Patrick S.; Abdulla, Salim; Mwageni, Eleuther; Nyoni, Joyce E.; Schellenburg, J.; Mills, A.; Bloland, Peter
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    Retail Supply of Malaria-related Drugs in Rural Tanzania: Risks and Opportunities.
    (Wiley, 2004) Goodman, Catherine; Kachur, Patrick S.; Abdulla, Salim; Mwageni, Eleuther; Nyoni, Joyce E.; Schellenberg, Joanna A.; Mills, Anne; Bloland, Peter
    To characterize availability of fever and malaria medicines within the retail sector in rural Tanzania, assess the likely public health implications, and identify opportunities for policy interventions to increase the coverage of effective treatment. A census of retailers selling drugs was undertaken in the areas under demographic surveillance in four Tanzanian districts, using a structured questionnaire. Drugs were stocked by two types of retailer: a large number of general retailers (n = 675) and a relatively small number of drug shops (n = 43). Almost all outlets stocked antipyretics/painkillers. One-third of general retailers stocking drugs had antimalarials, usually chloroquine alone. Almost all drug shops stocked antimalarials (98%): nearly all had chloroquine, 42% stocked quinine, 37% sulphadoxine-pyrimethamine and 30% amodiaquine. A large number of antimalarial brands were available. Population ratios indicate the relative accessibility of retail drug providers compared with health facilities. Drug shop staff generally travelled long distances to buy from drugs wholesalers or pharmacies. General retailers bought mainly from local general wholesalers, with a few general wholesalers accounting for a high proportion of all sources cited. Drugs were widely available from a large number of retail outlets. Potential negative implications include provision of ineffective drugs, confusion over brand names, uncontrolled use of antimalarials, and the availability of components of potential combination therapy regimens as monotherapies. On the other hand, this active and highly accessible retail market provides opportunities for improving the coverage of effective antimalarial treatment. Interventions targeted at all drug retailers are likely to be costly to deliver and difficult to sustain, but two promising points for targeted intervention are drug shops and selected general wholesalers. Retail quality may also be improved through consumer education, and modification of the chemical quality, packaging and price of products entering the retail distribution chain.