title: Drug dispensing practices during implementation of artemisinin-based combination therapy at health facilities in rural Tanzania, 2002-2005.
abstract: OBJECTIVE
  To assess the degree to which policy changes to artemisinin-based combination therapies (ACTs) as first-line treatment for uncomplicated malaria translate into effective ACT delivery.
  
  
  METHODS
  Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine-pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first-line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271, 953 patient encounters in the three districts.
  
  
  RESULTS
  In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
  
  
  CONCLUSIONS
  The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
authors.affiliation: Centers for Disease Control, Atlanta, GA, USA. jthwing@cdc.gov
authors.forename: J I
authors.initials: JI
authors.lastname: Thwing
authors.forename: J D
authors.initials: JD
authors.lastname: Njau
authors.forename: C
authors.initials: C
authors.lastname: Goodman
authors.forename: J
authors.initials: J
authors.lastname: Munkondya
authors.forename: E
authors.initials: E
authors.lastname: Kahigwa
authors.forename: P B
authors.initials: PB
authors.lastname: Bloland
authors.forename: S
authors.initials: S
authors.lastname: Mkikima
authors.forename: A
authors.initials: A
authors.lastname: Mills
authors.forename: S
authors.initials: S
authors.lastname: Abdulla
authors.forename: S P
authors.initials: SP
authors.lastname: Kachur
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use*; D000077332:Artesunate; D019090:Case Management / Q000458:organization & administration; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011739:Pyrimethamine / Q000191:economics / Q000627:therapeutic use; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data*; D013413:Sulfadoxine / Q000191:economics / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D011739:Pyrimethamine