title: Who gets prompt access to artemisinin-based combination therapy? A prospective community-based study in children from rural Kilosa, Tanzania.
abstract: BACKGROUND
  Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania.
  
  
  RESULTS
  In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8%) of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1) of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28). Caretakers from the better-off household (3rd-5th quintiles) were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76). The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500) compared to the better-offs (median Tsh 0).
  
  
  CONCLUSIONS
  Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where the burden of malaria is highest.
authors.affiliation: Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. dsimba@muhas.ac.tz
authors.forename: Daudi O
authors.initials: DO
authors.lastname: Simba
authors.forename: Marian
authors.initials: M
authors.lastname: Warsame
authors.forename: Deodatus
authors.initials: D
authors.lastname: Kakoko
authors.forename: Zakayo
authors.initials: Z
authors.lastname: Mrango
authors.forename: Goran
authors.initials: G
authors.lastname: Tomson
authors.forename: Zul
authors.initials: Z
authors.lastname: Premji
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
mesh_terms: D037621:Artemisinins / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use*; D002675:Child, Preschool; D003625:Data Collection / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006076:Government; D006268:Health Facilities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D013636:Tanzania; D013997:Time Factors
chemical_list: D037621:Artemisinins; C031327:artemisinin