How sulfadoxine-pyrimethamine (SP) was perceived in some rural communities after phasing out chloroquine (CQ) as a first-line drug for uncomplicated malaria in Tanzania: lessons to learn towards moving from monotherapy to fixed combination therapy

Malaria is a leading cause of death in Sub-Saharan Africa. Tanzania changed its malaria treatment policy from chloroquine (CQ) to Sulphadoxine-Pyrimethamine (SP) as first line drug in August 2001. We wanted to assess the perception and behaviour about SP after phasing out chloroquine which was very popular, cheap, available, and was preferred by many people for self-medication in homes as it was considered to have minimal side effects. Focus Group Discussions (FGDs) were carried out after one year of the anti-malarial drug treatment policy change in the country. The FGD themes were on malaria for under-five children and other age groups, anti-malarial drug use through self-medications, specific experiences people had about SP drug for both mothers/guardians, men in the communities and health workers. A total of twelve FGDs were performed with mothers/guardians, men and health workers in the selected public health care facilities in the district. In the FGDs people feared adverse reactions from SP; its slow ability of reducing fever and self-treatment in this case was less reported from the mothers/guardians groups. However, SP was reported by health workers to be administered using the direct observation approach under supervision in their health care facilities. This was done in order to increase compliance as there were worries that some mothers were throwing away the drug if they were instructed by health workers to go and administer SP to their sick children at home. Based on this information, it is obvious that fear and negative perceptions about SP drug was common in the study setting. As evidence of this, there was less reported home-stocking and self-medication in the discussions for this particular recommended new first-line anti-malarial. The public has demonstrated a lack of confidence in SP. Furthermore, some health workers expressed obvious fear and negative perceptions towards the drug despite the fact that some FGDs with health workers considered the drug to be good and effective against malaria. Such negative perception towards SP highlights the need to start earlier sensitization and educational campaigns to the rural communities for a new drug program to ensure its success. Messages should clearly state what should be expected from the new drug (Coartem), before its introduction. This is important especially as Tanzania is expected to move towards the expensive but efficacious and effective fixed-combination (Coartem) anti-malarial therapy early next year (2006)

Feasibility and Coverage of Implementing Intermittent Preventive Treatment of Malaria in Pregnant women Contacting Private or Public Clinics in Tanzania: Experience-based Viewpoints of Health Managers in Mkuranga and Mufindi districts.

Evidence on healthcare managers' experience on operational feasibility of malaria intermittent preventive treatment for malaria during pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) in Africa is systematically inadequate. This paper elucidates the perspectives of District Council Health Management Team (CHMT)s regarding the feasibility of IPTp with SP strategy, including its acceptability and ability of district health care systems to cope with the contemporary and potential challenges. The study was conducted in Mkuranga and Mufindi districts. Data were collected between November 2005 and December 2007, involving focus group discussion (FGD) with Mufindi CHMT and in-depth interviews were conducted with few CHMT members in Mkuranga where it was difficult to summon all members for FGD. Participants in both districts acknowledged the IPTp strategy, considering the seriousness of malaria in pregnancy problem; government allocation of funds to support healthcare staff training programmes in focused antenatal care (fANC) issues, procuring essential drugs distributed to districts, staff remuneration, distribution of fANC guidelines, and administrative activities performed by CHMTs. The identified weaknesses include late arrival of funds from central level weakening CHMT's performance in health supervision, organising outreach clinics, distributing essential supplies, and delivery of IPTp services. Participants anticipated the public losing confidence in SP for IPTp after government announced artemither-lumefantrine (ALu) as the new first-line drug for uncomplicated malaria replacing SP. Role of private healthcare staff in IPTp services was acknowledged cautiously because CHMTs rarely supplied private clinics with SP for free delivery in fear that clients would be required to pay for the SP contrary to government policy. In Mufindi, the District Council showed a strong political support by supplementing ANC clinics with bottled water; in Mkuranga such support was not experienced. A combination of health facility understaffing, water scarcity and staff non-adherence to directly observed therapy instructions forced healthcare staff to allow clients to take SP at home. Need for investigating in improving adherence to IPTp administration was emphasised. High acceptability of the IPTp strategy at district level is meaningless unless necessary support is assured in terms of number, skills and motivation of caregivers and availability of essential supplies

Exploring malaria case mangement of underfive children at households and public primary health care facilities in Kibaha district, Tanzania

Background: Chloroquine (CQ) was the first line drug for treating malaria in Tanzania until 2001 when it was replaced with sulfadoxine/pyrimethamine (SP). The first four studies (I -IV) were conducted before the policy change, and the last one (V) after. Aim: To explore different aspects of malaria case management of underfives in households and at primary health care facilities in the Kibaha district. Materials and methods: Four cross-sectional studies (I, II, IV & V) were carried out 1997-2002. Household surveys were conducted before (II) and after (V) the policy shift. Study I used 16 Focus Group Discussions (FGDs), 10 with mothers/guardians of underfives visiting health facilities and 6 with health workers. In study 11, interviews using questionnaires were done with heads of households and mothers/guardians of underfives in 1000 households. Antimalarial drug inventory at 59 drug stores was recorded. Study III in a laboratory experiment, assessed the quality and bioavailability of a sugarcoated CQ and an ordinary CQ brand in 20 healthy adult volunteers using high performance liquid chromatography (HPLC). Study IV was a survey at all 10 public health facilities in the Kibaha district. Mothers/guardians (n=652) with underfives seeking care were interviewed. Capillary blood samples from the children were analysed for CQ using HPLC. The performance of care providers was assessed through observations and the examination of treatment books. In study V, within a year after the policy shift, interviews using questionnaires were done with heads of households and mothers/guardians in 729 households. Capillary blood samples from 336 children were analysed for CQ and SP using HPLC. Twelve FGDs were carried out with mothers/guardians of underfives (4), fathers (4) and health workers (4). Results: Mothers/guardians in most FGDs (1) believed that convulsions (degedege) were caused by "evil spirits" and should be treated by traditional methods such as urinating on the sick child or fuming with elephant dung smoke. Grandmothers and traditional healers were stated first contact for care. CQ was stocked in one third of the households and drug stores were stated main source of antimalarials (11). No significant difference was found in the pharmacokinetic parameters between the two selected CQ formulations (III). In the facility survey (IV), mothers/guardians reported providing home treatment for their children with antipyretics (57%) and/or CQ (22%). Average consultation time was 3.8 minutes and 61% were not physically examined. Whereas 71 % were diagnosed with malaria, only 38% had detectable malaria parasites. Ninety seven percent of all the children had detectable CQ blood levels prior to the consultation. The post policy shift household survey (V) revealed a high awareness of SP being the first line drug, but low stocking of antimalarials (10%). The majority of mothers/guardians (76%) stated seeking care in public facilities and obtaining SP. SP and CQ drug levels from underfives reported to seek care within 4 weeks were 32% and 6% respectively. Few mothers/guardians of underfives knew the correct paediatric dose regimen of SP. Negative perceptions of SP were common and especially mothers/guardians and fathers expressed fear of adverse reactions stating mass media as key informants. Conclusion: Major changes in drug stocking, self-treatment and care seeking were noted in household surveys conducted before and after the policy shift. Both households and facilities need to be included in multi-faceted interventions for improved malaria care. Both perceptions about degedege and where SP should be made available are critical issues

Tobacco Advertisements And Promotion Industry On Smoking In Tanzania: A Review Of Negative Public Health Implications For Current And Future Generations

<p>Summary</p> <p>Smoking places a burden on the health care system in developed countries but even more so in the already compromised health services in developing countries. The promotion of tobacco is a root cause of continued consumption even after highlighting the effects. The main aim of this news analysis is to discuss various strategies used by the tobacco industry in promoting tobacco use in Tanzania.</p

Tobacco Advertisements And Promotion Industry On Smoking In Tanzania: A Review Of Negative Public Health Implications For Current And Future Generations

Smoking places a burden on the health care system in developed countries but even more so in the already compromised health services in developing countries. The promotion of tobacco is a root cause of continued consumption even after highlighting the effects. The main aim of this news analysis is to discuss various strategies used by the tobacco industry in promoting tobacco use in Tanzania