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.
METHODS AND FINDINGS: 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.
