title: Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective.
abstract: BACKGROUND
  The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment.
  
  
  METHODS
  Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS) and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days.
  
  
  RESULTS
  Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%); an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%); higher treatment coverage with anti-malarials (86% to 96%) and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs). Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%). The availability of outlets (health facilities or drug shops) is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent.
  
  
  CONCLUSIONS
  An integrated approach aimed at improving understanding and treatment of malaria has led to tangible improvements in terms of people's actions for the treatment of malaria. However, progress was hindered by the low availability of the first-line treatment after the switch to ACT.
authors.affiliation: Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. sandra.alba@unibas.ch
authors.forename: Sandra
authors.initials: S
authors.lastname: Alba
authors.forename: Angel
authors.initials: A
authors.lastname: Dillip
authors.forename: Manuel W
authors.initials: MW
authors.lastname: Hetzel
authors.forename: Iddy
authors.initials: I
authors.lastname: Mayumana
authors.forename: Christopher
authors.initials: C
authors.lastname: Mshana
authors.forename: Ahmed
authors.initials: A
authors.lastname: Makemba
authors.forename: Mathew
authors.initials: M
authors.lastname: Alexander
authors.forename: Brigit
authors.initials: B
authors.lastname: Obrist
authors.forename: Alexander
authors.initials: A
authors.lastname: Schulze
authors.forename: Flora
authors.initials: F
authors.lastname: Kessy
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
mesh_terms: D000962:Antimalarials / Q000600:supply & distribution / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003132:Commerce; D003430:Cross-Sectional Studies; D003625:Data Collection; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D017149:Private Sector; D019035:Rural Health Services / Q000600:supply & distribution*; D012424:Rural Population; D040241:Social Marketing; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials