Can Tanzania’s malaria control strategy profit from private drug sellers?

Many African countries are adopting malaria control policies based on artemisinin-containing combination treatment (ACT). What role can private sector drug sellers play? Research in Ikwiriri in Tanzania’s Coast Region shows that specialist drug stores could be key to expanding coverage of malaria treatment.

Malaria control in Tanzania relies on prompt, effective treatment of malaria among children under five. Specialist drug stores could be useful for expanding access to these drugs because they:

• often operate in rural centres lacking pharmacies
• sell medicines not available at general shops
• have staff members with some medical training
• are fewer in number and more stable than general stores.

But there are worries about safety and the potential for drug resistance if new ACTs are used unsupervised. To examine the potential role of these shops, researchers from the Ifakara Health Research and Development Centre, Tanzania observed 2,466 client visits to all ten drug stores in Ikwiriri. One in five visits were by or on behalf of people ill with fever or malaria. Of these, 293 were local residents who were interviewed, examined by a clinical officer and given a blood test for malaria.

The researchers found that:

• Only 50 (17 percent) bought an anti-malarial drug, most commonly a product containing sulfadoxine-pyrimethamine (SP). None bought products containing chloroquine or artemisinin derivatives. More than three quarters bought an anti-fever drug.
• Clinicians diagnosed malaria in 64 percent – by far the most common diagnosis, followed by acute respiratory infections, anaemia and gastroenteritis.
• Malaria parasites were found in blood from a quarter of patients, double the level in the local population but similar to the proportion among people with fever visiting health facilities.
• There was a mismatch between clinical and laboratory diagnoses of malaria, especially for people over five years old.
• The drug store was the first source of care for nearly three quarters of the customers. Only ten percent had already contacted a formal health facility.

Even in Ikwiriri, where health facilities have improved and highly effective ACTs are available free of charge, many people choose to visit drug stores for malaria treatment. So engaging drug sellers might be essential when introducing ACTs. The Tanzania Food and Drug Authority intends to replace drug stores with Accredited Drug Dispensing Outlets (ADDO), which will receive training, supervision and access to quality-assured products, including some prescription-only medicines, and will meet minimum standards. They could provide an opportunity for expanding access to affordable effective malaria treatment. To maximise the benefit from this, the researchers recommend:

• improving malaria diagnosis to reduce the over-diagnosis common with clinical assessment alone
• encouraging the sale of suitable doses of effective anti-malarial treatments at specialist drug stores, in place of or in addition to anti-fever drugs
• training ADDO staff to avoid potentially harmful practices, such as the inappropriate use of antibiotics and the sale of single drug therapies for malaria
• enhancing the appropriate availability of antibiotics for childhood pneumonia
• committing substantial resources to rolling out the ADDO scheme nationwide.

Source(s):
‘Prevalence of malaria parasitemia among clients seeking treatment for fever or malaria at drug stores in rural Tanzania 2004’, Tropical Medicine and International Health 11(4), pages 441-451, by Patrick Kachur, Jeffrey Schulden, Catherine A. Goodman, Herry Kassala, Berty Farida Elling, Rashid A. Khatib, Louise M. Causer, Saidi Mkikima, Salim Abdulla and Peter B. Bloland, 2006
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 12 September 2006

Further Information:
Patrick Kachur
CDC Malaria Programme in Tanzania
c/o Ifakara Health Research and Development Centre
PO Box 78373
Dar es Salaam
Tanzania

Tel: +255 22 2774714
Fax: + 255 22 2771714
Contact the contributor: skachur@cdc.gov

Ifakara Health Research and Development Centre, Tanzania

CDC/IHRDC Malaria Programme in Tanzania

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'Friend or foe? Private sector sales of anti-malarial drugs in rural Tanzania'

'Good economics – implementing cost-effective strategies against malaria'

'Matching policy with practice: effectively treating childhood fever in Kenya'

'Private sector drug retailers and malaria control in Kenya'

'Seeking treatment for childhood fevers in Tanzania'

'Be quick – seeking care for life threatening malaria in southern Tanzania'

'What mothers do: responses to childhood fever on the Kenyan Coast'