Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

Abstract

BackgroundTo improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.MethodsThe study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.ResultsBetween 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)ConclusionsThe public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake.

Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective

“…Firstly, no patient in Ifakara reported using an artemisinin monotherapy although they were available in 10-20% of shops [27]. Secondly, the severe stockouts of SP, which were reported by health facilities in the study area in 2006 did not appear to have an impact on treatment since the proportion of patients who obtained the drug did not decrease as a result.…”

Child mortality patterns in rural Tanzania: an observational study on the impact of malaria control interventions

“…ITN household ownership increased steadily from 37% in 1997 to above 90% in 2005 and remained high thereafter. Dates for the two changes in first-line treatment policy for malaria were extracted from existing publications: August 2001 for the change from chloroquine to SP 23 and January 2007 for the change from SP to ALu 24 . The start date of the IMCI interventions was set in April 2002 (D. Maganga and M. Mawalla, Malaria and IMCI Focal Persons in 2002 in Kilombero and Ulanga Districts, respectively).…”

Community knowledge and attitudes on antibiotic use in Moshi Urban, Northern Tanzania: Findings from a cross sectional study

“…Medicines are more available to communities in the drug-specific retailers through the prescription-only and over-the-counter dispensing mechanisms (Battersby et al, 2003). The Tanzania Food, Drugs and Cosmetics Act (TFDA, 2003) has done recommendable efforts through the Tanzania"s accredited drug dispensing outlet (ADDO) program in training dispensers followed by regulation to achieve quality standards (Alba et al, 2010;Rutta et al, 2015), and registered over 3,500 functioning ADDOs in 2013 (HSSP-IV, 2015).…”