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


CONCLUSIONS
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.
Hetzel
Manuel W
MW
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland. manuel.hetzel@unibas.ch
Msechu
June J
JJ
Goodman
Catherine
C
Lengeler
Christian
C
Obrist
Brigit
B
Kachur
S Patrick
SP
Makemba
Ahmed
A
Nathan
Rose
R
Schulze
Alexander
A
Mshinda
Hassan
H
D018712:Analgesics, Non-Narcotic / Q000600:supply & distribution; D000962:Antimalarials / Q000600:supply & distribution* / Q000627:therapeutic use; D002738:Chloroquine / Q000600:supply & distribution* / Q000627:therapeutic use; D004338:Drug Combinations; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology; D010594:Pharmacies / Q000639:trends; D011739:Pyrimethamine / Q000600:supply & distribution* / Q000627:therapeutic use; D013413:Sulfadoxine / Q000600:supply & distribution* / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology
D018712:Analgesics, Non-Narcotic; D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine