Adoption of the new antimalarial drug policy in Tanzania – a cross‐sectional study in the community

• Published in: Tropical medicine & international health Vol. 10; no. 10; pp. 1038 - 1046
• Main Authors: Eriksen, Jaran, Nsimba, Stephen E. D., Minzi, Omary M. S., Sanga, Anku J., Petzold, Max, Gustafsson, Lars L., Warsame, Marian Y., Tomson, Göran
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-10-2005; Blackwell Science; Blackwell Publishing Ltd
• Subjects: Antimalarials - therapeutic use; Artemisinins - therapeutic use; artemisinin‐based combination therapy; Biological and medical sciences; Child, Preschool; chloroquine; Chloroquine - blood; Chloroquine - therapeutic use; Cross-Sectional Studies; Drug Combinations; Drug policy; Drug therapy; Drug Therapy, Combination; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Health Policy; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - blood; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Male; Medical sciences; Medicin och hälsovetenskap; Parasitic diseases; Patient Acceptance of Health Care; policy change; policy cycle; Population Surveillance - methods; Protozoal diseases; Pyrimethamine - therapeutic use; Rural Health; Self Administration; Sesquiterpenes - therapeutic use; Sulfadoxine - blood; Sulfadoxine - therapeutic use; sulphadoxine/pyrimethamine; Tanzania; Tanzania - epidemiology; Africa; Tanzania; Sulfanilamide derivatives; Antimalarial; Protozoal disease; Artemisinin; chloroquine; Health policy; Cross sectional study; Tropical medicine; Antiinfectious; Sulfadoxine; Public health; Human; Drug combination; Malaria; policy cycle; Pyrimethamine; Tanzania; artemisinin-based combination therapy; policy change; Parasitosis; sulphadoxine/pyrimethamine; Infection; Chemotherapy; Treatment; Parasiticide; Antibacterial agent; Community
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2005.01486.x

Summary
Objective  To assess the diffusion of the change of first line antimalarial drug from chloroquine (CQ) to sulphadoxine/pyrimethamine (SP) at household level in a rural district of Tanzania less than a year after the policy implementation.
Methods  Caretakers in 729 households were interviewed on knowledge of the new policy, home stocking of antimalarials, home‐treatment practices of children younger than 5 years with fever, health‐seeking behaviour and experience of SP. SP and CQ levels in blood were analysed from 328 children younger than 5 years in the households. Twelve focus group discussions (FGD) were performed with mothers, fathers and health workers.
Results  About 51% of the population knew that SP was the first line antimalarial. Only 8% of mothers stocked antimalarials, and only 4% stated self‐treatment as the first action. We estimated that 84% of the children who had had fever during the last 4 weeks sought care at public health facilities. SP was detectable in 18% of the total child population and in 32% of those with reported fever, CQ in only 5% and 7%, respectively. The FGDs revealed negative perceptions of SP and fear of severe adverse reactions with mass media reported as key informant.
Conclusion  The policy had diffused to the communities in the sense that CQ had been changed to SP, which was well known as first line treatment. Moreover, there was a reported dramatic change from self‐treatment with CQ to seeking care at public health facilities where SP was given under observation.