title: Perception of chloroquine efficacy and alternative treatments for uncomplicated malaria in children in a holoendemic area of Tanzania: implications for the change of treatment policy.
abstract: Prior to policy change from chloroquine (CQ) to sulphadoxine/pyrimethamine (S/P; Fansidar) we assessed the perception of CQ efficacy and the alternative treatment options for malaria in children among parents/guardians (N=527) of under-fives attending first level health facilities on account of fever. It was hypothesized that the long experience with CQ and its antipyretic effect (lacking in S/P) might impede acceptance of S/P for wider use as first-line drug. Malarial fevers in children were most commonly treated with CQ (92.8%), followed by quinine (60.7%) and S/P (28.7%). A 63.2% knew the reasons for non-response to antimalarial treatment, and only 50% were aware that CQ could fail to treat malaria, and 57.1% knew alternative treatment options, namely quinine (52.2%) and S/P (20.5%). Generally, decreased efficacy of CQ had been noticed, and quinine was prescribed for both suspected and proven CQ failures in first level health facilities and the district hospital. S/P was judged to be more effective than quinine, but too strong for children, and was the least known drug in the study area. All formulations of S/P cost more per dose for a child and an adult than CQ. The implications of these findings on the change of malaria treatment policy are discussed.
authors.affiliation: Department of International Health, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. donatht@hotmail.com
authors.forename: D S
authors.initials: DS
authors.lastname: Tarimo
authors.forename: J N
authors.initials: JN
authors.lastname: Minjas
authors.forename: I C
authors.initials: IC
authors.lastname: Bygbjerg
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D002675:Child, Preschool; D002738:Chloroquine / Q000191:economics / Q000627:therapeutic use*; D004338:Drug Combinations; D019353:Endemic Diseases; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D011739:Pyrimethamine / Q000191:economics / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000191:economics / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine