Malaria: Epidemiology - Reducing Malaria through Vector Control and Community Interventions
Access and targeting of malaria treatment: assessing policy impact of the Affordable Medicines Facility - malaria and roll out of parasitological diagnosis in three regions of Tanzania
11/12/2012 8:45:00 AM
, Rebecca Thomson
, Katia Bruxvoort
, Boniface Johanes
, Happy Nchimbi
, Admirabilis Kalolella
, Matthew Cairns
, Mark Taylor
, S. Patrick Kachur
, Catherine Goodman
Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of,
London School of Hygiene and Tropical Medicine, London, United Kingdom,
Centers for Disease Control and Prevention, Atlanta, GA, United States
Artemisinin-based combination therapy (ACT) is the first line antimalarial in most endemic countries, but there are concerns that access is poor, while targeting to patients with parasitemia is also highly inadequate. In Tanzania national implementation is underway of strategies to improve both access and targeting of ACTs. Access is being addressed through the Affordable Medicines Facility - malaria, whereby quality assured ACTs are heavily subsidised in the public and private sectors. Targeting is being addressed through provision of rapid diagnostic tests (RDTs) and enhanced microscopy in public health facilities. To evaluate the impact of these two interventions, we conducted large scale household surveys at baseline and follow up in three regions with varying malaria transmission (Mwanza, Mbeya and Mtwara, where parasite prevalence was 23.8%, 23.0% and 2.1% respectively in 2010).
In 2010 and 2012 we visited 80 randomly selected enumeration areas in each region. At baseline 5,428 households and 20,900 people were interviewed (follow up data collection is ongoing). All household members reporting fever in the past 14 days were asked about treatment obtained.
Of those with fever at baseline, 29.5% sought care at a drug store/pharmacy, 19.1% at a government health facility, 11.5% at a general retailer, and 11.7% at other sources. In Mbeya the proportions visiting government facilities and drug stores were almost equal, while in Mwanza many more people visited drug stores and in Mtwara government facilities were the most common source. The percentage of fevers treated at government facilities was 35.0% for children <5 years old and 14.6% for over 5s.
At baseline only 10.4% of people reporting fever obtained an ACT the same day or next day of fever onset (18.7% of under 5s and 7.7% of over 5s). Only 10.7% of people with fever received a blood test (19.6% in the wealthiest quintile and 4.2% in the poorest quintile). We will compare baseline findings with those from the endline to assess how access and targeting of drugs have been affected by these two key interventions, and to explore factors associated with ACT and diagnostic test use. These findings will allow exploration of the interaction of large scale access and targeting strategies at the community level, across all age groups, in diverse settings in terms of transmission and access to health care.
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