Health workers perceptions on chloroquine and sulfadoxine/sulfalene pyrimethamine monotherapies: implications for the change to combination therapy of artemether/lumefantrine in Tanzania.
OBJECTIVE
To describe, from health workers (HWs) perspectives, the potential and actual barriers to the implementation of the first change of policy from chloroquine (CQ) to Sulfadoxine / Sulfalane - Pyrimewthamine (SP) in preparation for the second change of policy to Artemisinin based Combination Therapies (ACTs).


METHODS
A descriptive cross-sectional survey of HWs using questionnaire interviews was carried out in public and private health facilities in Songea Urban district. The interview concerned awareness and knowledge on the commonly used antimalarial drugs as given in the new policy, focusing on SP use and the associated side effects as well as perceptions on the potency and safety of SP versus CQ and the perceived alternative antimalarial drugs to non-response or reaction to SP.


RESULTS
Awareness on the new policy was very high; 91.4% of HWs were aware that SP was the new drug. Although the majority of HWs (81.9%) reported using the new policy as soon as it was out, a significant percentage (76.2%) reported continued use of SP (P-value < 0.001). SP was perceived to have a low potency in that it was slow in fever clearance. A significant percentage (65.7%) of HWs reported a history of problems with SP use namely headaches and skin reactions. Quinine (QN) was significantly frequently mentioned as the perceived alternative drug to CQ (61.1%) and non-response (56.6%) or reaction (54.1%) to SP.


CONCLUSIONS
Findings show that SP was generally not preferred by HWs, and they continued to use CQ despite the evidence that it was no longer effective indicating that. HWs tend to maintain perceptions based on their experiences with drugs currently in use. Pertinent information, education and behaviour change communication strategies related to the change from SP to ACT should focus on the fact that the previous drug is no longer effective so as to induce consistent use of the new drug.
Tarimo
D S
DS
Department of Parasitology & Medical Entomology, School of Public Health & Social Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. dtarimo@muchs.ac.tz
Malekela
D A
DA
D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000494:pharmacology / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000494:pharmacology / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006291:Health Policy / Q000639:trends; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000494:pharmacology / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000494:pharmacology / Q000627:therapeutic use*; D013636:Tanzania / Q000453:epidemiology; D014504:Urban Health
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine