Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies.

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. 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).\ud 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

Client Demographics and Health-Seeking Behaviors Stratified by Region.

<p><b><i>*</i></b><i>Weighted proportions differed significantly between regions.</i></p

Client Recruitment.

<p>Client Recruitment.</p

Proportion of Clients With and Without Malaria Purchasing Antimalarials and Other Medications, Stratified by Region.

<p><i>*Proportion differed significantly by malaria status, in at least one region.</i></p

Drug Shop and Drug Shop Attendant Characteristics Stratified by Region.

†<p><i>At least one person working in the shop received the training described.</i></p><p><b><i>*</i></b><i>Weighted proportions differed significantly between regions.</i></p

Map showing Mwanza and Mtwara Regions (Tanzania HMIS, 2008).

<p>Reference: Tanzania Comission for AIDS (2008). Tanzania HIV/AIDS and Malaria Indicatory Survey 2007–08. Dar es Salaam, Tanzania.</p

Total Number of Participants with and without Malaria Parasitemia based on Laboratory (RDT, Microscopy and PCR) Results.

<p>*Malaria parasitemia positive was defined as either concordant RDT and microscopy positive (75) or PCR positive (26) for discordant results. Malaria parasitemia negative was defined as either microscopy negative without discordance (632) or PCR negative (44) for discordant results.</p

Predictors of ACT Purchase (n = 763).

<p>Predictors of ACT Purchase (n = 763).</p

ACT Purchase Among Clients with Malaria Parasitemia Stratified by Age and Region.

<p>*Proportions differed significantly between regions.</p

Malaria Parasitemia among Clients Who Purchased ACTs Stratified by Age and Region.

<p>*Proportions differed significantly between regions.</p