Obstacles to Prompt and Effective Malaria Treatment Lead to Low Community-Coverage in Two Rural Districts of Tanzania
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Date
2008
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BioMed Central
Abstract
Background: Malaria 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 costeffective
interventions.
Methods: We 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.
Results: After 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.
Conclusion: A 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 communityeffectiveness
and health-impact.
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Citation
Hetzel, M.W., Obrist, B., Lengeler, C., Msechu, J.J., Nathan, R., Dillip, A., Makemba, A.M., Mshana, C., Schulze, A. and Mshinda, H., 2008. Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania. BMC Public Health, 8(1), p.1.