Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania

doi:10.1186/1475-2875-5-109

Malaria Journal

Volume 5

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Hetzel MW
Msechu JJ
Goodman C
Lengeler C
Obrist B
Kachur SP
Makemba A
Nathan R
Schulze A
Mshinda H

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Hetzel MW
Msechu JJ
Goodman C
Lengeler C
Obrist B
Kachur SP
Makemba A
Nathan R
Schulze A
Mshinda H
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Research

Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania

Manuel W Hetzel¹^,2 , June J Msechu² , Catherine Goodman³ , Christian Lengeler¹ , Brigit Obrist¹ , S Patrick Kachur²^,4 , Ahmed Makemba² , Rose Nathan² , Alexander Schulze⁵ and Hassan Mshinda²

¹Department of Public Health and Epidemiology, Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland

²Ifakara Health Research and Development Centre, Ifakara, Tanzania

³Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK

⁴U. S. Public Health Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

⁵Novartis Foundation for Sustainable Development, Basel, Switzerland

author email corresponding author email

Malaria Journal 2006, 5:109doi:10.1186/1475-2875-5-109


Published:	14 November 2006

Abstract

Background

Malaria control strategies emphasize the need for prompt and effective treatment of malaria episodes. To increase treatment efficacy, Tanzania changed its first-line treatment from chloroquine to sulphadoxine-pyrimethamine (SP) in 2001. The effect of this policy change on the availability of antimalarials was studied in rural south-eastern Tanzania.

Methods

In 2001 and 2004, the study area was searched for commercial outlets selling drugs and their stocks were recorded. Household information was obtained from the local Demographic Surveillance System.

Results

From 2001 to 2004, the number of general shops stocking drugs increased by 15% and the number of drug stores nearly doubled. However, the proportion of general shops stocking antimalarials dropped markedly, resulting in an almost 50% decrease of antimalarial selling outlets. This led to more households being located farther from a treatment source. In 2004, five out of 25 studied villages with a total population of 13,506 (18%) had neither a health facility, nor a shop as source of malaria treatment.

Conclusion

While the change to SP resulted in a higher treatment efficacy, it also led to a decreased antimalarial availability in the study area. Although there was no apparent impact on overall antimalarial use, the decline in access may have disproportionately affected the poorest and most remote groups. In view of the imminent policy change to artemisinin-based combination therapy these issues need to be addressed urgently if the benefits of this new class of antimalarials are to be extended to the whole population.