Drug dispensing practices during implementation of artemisinin-based combination therapy at health facilities in rural Tanzania, 2002-2005.


Thwing, JI; Njau, JD; Goodman, C; Munkondya, J; Kahigwa, E; Bloland, PB; Mkikima, S; Mills, A; Abdulla, S; Kachur, SP; (2011) Drug dispensing practices during implementation of artemisinin-based combination therapy at health facilities in rural Tanzania, 2002-2005. Tropical medicine & international health. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2010.02724.x

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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.

Item Type: Article
Faculty and Department: Academic Services & Administration > Academic Administration
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Malaria Centre
PubMed ID: 21226795
Web of Science ID: 287823500003
URI: http://researchonline.lshtm.ac.uk/id/eprint/1723

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