Prevalence of malaria parasitemia among clients seeking treatment for fever or malaria at drug stores in rural Tanzania 2004.
OBJECTIVE
To determine the prevalence of malaria parasitemia and other common illnesses among drug store clients in one rural community, with a view to the potential role of specialist drug stores in expanding coverage of effective malaria treatment to households in highly endemic areas.


METHODS
Follow-back study of 2466 client visits selected from all 10 drug stores operating in the town of Ikwiriri between May 30 and August 31 2004. Of these, 521 (21.2%) were made by or on behalf of persons ill with fever or malaria. Two hundred and ninety three were eligible as residents of the surrounding nine villages and all agreed to participate in the study. Each patient was evaluated by a clinical officer and provided a blood sample for malaria on the day of the shop visit, either at the shop or at home.


RESULTS
Only 50 (17.1%) visits by or on behalf of febrile patients resulted in the purchase of an antimalarial drug, while an antipyretic medication was obtained at 226 visits (77.1%). Clinicians diagnosed malaria in 63.8% of patients. Malaria parasites were identified in blood film samples from 24.2% (95% CI: 19.6, 29.5). This is double the parasite prevalence rate of 10.7% (95% CI: 8.6, 13.1) obtained from a household survey of 1004 healthy individuals selected from these villages at the same time. It is not significantly lower than the prevalence observed among 880 clients presenting with fever at health facilities in the district: 29.7% (95% CI: 23.0, 37.3). The prevalence of malaria parasitemia among children younger than 5 years whose families sought fever treatment from drug stores (42.1%; 95% CI: 31.4, 53.5) was equal to that of children presenting with fever at health facilities (42.5%; 95% CI: 25.0, 62.2).


CONCLUSIONS
Currently, drug store clients do not obtain malaria-specific treatment in the majority of cases where it might be warranted. Parasitological findings indicate that drug store clients, especially children, are as likely to be infected with malaria as patients seeking care for similar illnesses at health facilities. Drug stores may be attractive partners for policy makers eager to engage the private retail sector in expanding coverage of malaria treatment.
Patrick Kachur
S
S
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. skachur@cdc.gov
Schulden
Jeffrey
J
Goodman
Catherine A
CA
Kassala
Herry
H
Elling
Berty Farida
BF
Khatib
Rashid A
RA
Causer
Louise M
LM
Mkikima
Saidi
S
Abdulla
Salim
S
Bloland
Peter B
PB
D000328:Adult; D000655:Amodiaquine / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use; D002675:Child, Preschool; D004338:Drug Combinations; D019353:Endemic Diseases; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care; D010594:Pharmacies / Q000706:statistics & numerical data*; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use; D012423:Rural Health; D013413:Sulfadoxine / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D011739:Pyrimethamine