Assessing implementation of artemisinin based combination therapy policy in treatment of uncomplicated malaria among private medicines outlets in Mwanza region, Tanzania

Abstract

Background: A combination of Artemether-lumefantrine (ALu) is recommended by Tanzania MoHSW as first line therapy for uncomplicated malaria while Sulphadoxine–pyrimethamine (SP) is recommended only for intermittent preventive treatment during pregnancy. Despite the change of the policy, SP is still being dispensed by private medicine outlets for treatment of uncomplicated malaria. Objective: To assess implementation of artemisinin based combination therapy policy in treatment of malaria among private medicines outlets in Mwanza region, Tanzania. Methodology: The study was a descriptive cross-sectional study, to capture quantitative data using structured questionnaires and simulated clients. Qualitative data were captured using focus group discussion. The study population was private medicine outlets i.e Pharmacies and ADDOs located in Nyamagana and Sengerema District. Results: Knowledge level of dispensers in private medicine outlets on ACT policy for treatment of uncomplicated malaria was poor by 3.1% and good by 49.2%. Results revealed that 96.9% out of all medicines outlets participated in this study know that ALU is the first line medicine for treatment of uncomplicated malaria. During malaria patient simulation 9.7 % of outlets dispensed ALU to simulated client while 85.5% dispensed SP. Results showed that 90.6% of Pharmacies and 80% of ADDOs dispensed SP to simulated client even though SP is reserved for IPTp. Conclusion and Recommendations: The study concluded that majority of dispensers in private medicines outlets have moderate and good knowledge on ACT policy in treatment of uncomplicated malaria. However the knowledge does not predict the actual practice, SP is still dispensed for malaria treatment rather than being reserved for IPTp where patient demand for a single dose medicine is one of driving factor for irrational dispensing and use of SP. Therefore the study recommended that MoHSW and other stakeholders to conduct training and seminars for medicine dispensers of private outlets on malaria treatment and rational dispensing of anti malarial medicines.