title: Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies.
abstract: BACKGROUND
  Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program.
  
  
  RESULTS
  A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4).
  
  
  CONCLUSIONS
  Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Briggs
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Admirabilis
authors.initials: A
authors.lastname: Kalolella
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Katia
authors.initials: K
authors.lastname: Bruxvoort
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Ryan
authors.initials: R
authors.lastname: Wiegand
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Gerard
authors.initials: G
authors.lastname: Lopez
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Charles
authors.initials: C
authors.lastname: Festo
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lyaruu
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Mitya
authors.initials: M
authors.lastname: Kenani
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Salim
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Kachur
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004359:Drug Therapy, Combination; D005260:Female; D005843:Geography; D006289:Health Planning Support / Q000706:statistics & numerical data*; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D008297:Male; D018512:Parasitemia / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care; D010594:Pharmacies / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
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