Adoption of the new antimalarial drug policy in Tanzania--a cross-sectional study in the community.
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.


CONCLUSIONS
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.
Eriksen
Jaran
J
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden. jaran.Eriksen@labmed.ki.se
Nsimba
Stephen E D
SE
Minzi
Omary M S
OM
Sanga
Anku J
AJ
Petzold
Max
M
Gustafsson
Lars L
LL
Warsame
Marian Y
MY
Tomson
Göran
G
D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D002675:Child, Preschool; D002738:Chloroquine / Q000097:blood / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance / Q000379:methods; D011739:Pyrimethamine / Q000627:therapeutic use; D012423:Rural Health; D012646:Self Administration; D012717:Sesquiterpenes / Q000627:therapeutic use; D013413:Sulfadoxine / Q000097:blood / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D011739:Pyrimethamine