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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania
BMC Public Health, Volume 8, Article 317, Year 2008
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Description
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 cost-effective 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 community- effectiveness and health-impact. © 2008 Hetzel et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2564938/bin/1471-2458-8-317-S1.xls
https://efashare.b-cdn.net/share/pmc/articles/PMC2564938/bin/1471-2458-8-317-S2.pdf
Authors & Co-Authors
Hetzel, Manuel W.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Tanzania, Ifakara
Ifakara Health Institute
Papua new Guinea, Goroka
Papua new Guinea Institute of Medical Research
Obrist, Brigit
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Lengeler, Christian H.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Msechu, June J.
Tanzania, Ifakara
Ifakara Health Institute
Nathan, Rose
Tanzania, Ifakara
Ifakara Health Institute
Dillip, Angel
Tanzania, Ifakara
Ifakara Health Institute
Makemba, Ahmed M.
Tanzania, Ifakara
Ifakara Health Institute
Mshana, Christopher
Tanzania, Ifakara
Ifakara Health Institute
Schulze, Alexander
Switzerland, Basel
Novartis International ag
Mshinda, Hassan M.
Tanzania, Ifakara
Ifakara Health Institute
Statistics
Citations: 77
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1186/1471-2458-8-317
e-ISSN:
14712458
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Tanzania