Hassan, Farida

Kalage, Rose

Khatib, Rashid

Roth Allen, Denise

English

Digital Library of the Tanzania Health Community

 
 
 
What are Community Members Saying About Artemether-Lumefantrine?  
Qualitative findings from the Two Demographic Surveillance Systems in Tanzania. 
 Rose Kalage1, Farida Hassan1, Rashid Khatib1, and Denise Roth Allen2 
1Ifakara Health Institute, Dar-es-Salaam, United Republic of Tanzania, 2Centers for Disease Control and Prevention, Atlanta, GA, United States. 
  
 
  
  
 
 
 
   Background 
The INDEPTH Effectiveness and Safety Studies (INESS) platform is a multidisciplinary phase IV effectiveness and safety study currently underway in two demographic surveillance system (DSS) sites in 
Tanzania. These include the Rufiji DSS and the combined Kilombero/Ulanga DSS.  As part of the baseline data collection activities, we collected qualitative data in four focus communities during the 2010 
peak malaria  season to explore community perceptions of Artemether-Lumefantrine (ALu), Tanzania’s first- line antimalarial treatment. 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
Methods 
Site Selection 
Two communities per DSS area were purposively selected based on their 
distance from a health centre: 
• One community located < 5km from a health centre 
• One community located >5km from a health centre 
 
Data Collection 
Three qualitative data collection methods were used:  
 Focus Group Discussions (FGD) 
Purpose:  
To explore community perceptions of malaria and its treatment. 
 
Participant selection: 
 Random selection of village hamlets (with replacement) 
• 1 hamlet for male FGD 
• 1 hamlet for female FGD 
• Hamlet leader helps with FGD recruitment 
 
 Illness Narrative Interviews (INI) 
Purpose:  
To examine people’s actual experiences with a suspected malaria 
episode that they or a child < 5 years old experienced in the past two 
weeks.  
 
Participant selection: A two-stage process 
 Random selection of hamlet for INI recruitment 
 Household starting point selected by spin of a bottle in center of 
hamlet 
• Team visits every household going in a rightward direction until 
2 adult males, 2 adult females, 2 caretakers of under-fives, and 
2 pregnant women have been interviewed. 
 
 In-Depth Interviews (IDI) 
Purpose:  
To explore providers’ malaria diagnosis and treatment behaviors 
(health workers and drug shop vendors). 
 
Participant Selection 
 Based on information from FGD and INI about where they seek 
care  
• Drug shops and health facilities frequented by community 
members 
 
    Interview Tallies 
 
 
 
 
 
 
 
 
 
 
 
Data Analysis 
• All interviews are digitally recorded, transcribed, and translated into 
English 
• Final transcripts and notes imported into qualitative data analysis 
software package (NVivo8) for coding and content analysis 
  
 
 
 
 
 
 
 
 
 
 
 
T 
 Results  
 ALu was the most preferred drug, followed by SP and SP-branded products 
 
 Monotherapies were still being used for malaria treatment 
 
 Most perceived ALu to be an effective malaria treatment with minimal side effects.  
 
 “ALU is good. First you do not get tired and you recover fast. Right after you take the first dose, even if  you were seriously ill 
you become active and you can sleep, (aha) different from quinine. When you take it (aha) the condition become more serious 
(aha)”.                                                                                                                                             Female FGD Respondent, K/U DSS 
                                                                                                                                               
 
Me sir, I see that in general “dawa ya mseto” [Alu] is effective because it is even dominant in our health facilities. Other types 
of drugs are available in the drug shops.  If you go there and you have malaria, well they give you another medicine.  He gives 
you Metakelfin, but if you go to the health facility they must give you “dawa mseto”. They really help us a lot. 
                                                                                                                                                                                  Male FGD Respondent, K/U DSS 
 
“It does not itch the body, when you take it the body remains normal”                                           Male FGD Respondent, Rufiji DSS 
 
                                                                                                                                                
“Yes, and it treats well and ends your problem. Once you finish the dose it means you are cured. But for some other drugs, 
you may use and even finish the whole dose, yet you continue feeling the same and you have to switch to other drugs. With 
ALu, the way my body is, once I finish the dose, the malaria is gone.”                                           Male INI Respondent, Rufiji DSS 
 
                                                                                                                                                
M: Why do you say that ALU is much better? 
R: Aah, for now myself I have not received any complaint  that they have caused any side effects to  a person and among the 
majority who are taking them, very few have come back to say that  I have felt this condition.  From the beginning up to this 
minute, they are very few. So maybe if you have treated ten people, one or two have come back.  
                                                                                                                                                        Health Worker, K/U DSS 
 
 However, some respondents perceived ALu as ineffective due to unresolved symptoms after completing a full 
dose. 
“Like me my child (yes) I took him the day before yesterday, he has used that drug but he still has fever until this minute 
(ahaa) mmh.”                                                                                                                              Female FGD Respondent, K/U DSS 
 
                                                                                                                                                     
“The other day  I was sick  with malaria  I tried those ALu,  I have finished  the whole dose but still it did not help.” 
                                                                                                                                                    Male FGD Respondent, K/U DSS 
 
 Many FGD and INI respondents spoke about a drug’s ability to effectively treat malaria in terms of its 
compatibility with an individual’s body or blood. 
 
“You will look at  your body, the drug that likes you.”                                                                 Female FGD Respondent, Rufiji DSS 
 
“Honestly, all drugs are good but it depends on the blood of the person (mh). One person’s blood likes ALu (mh), another 
one likes Amodiaquine (mh), another one Quinine”                                                                  Female FGD Respondent, K/U DSS 
                                                                                                                                            
 
“I have said since I started, the drugs for my blood are these ALu because ALu receives me well (Why?) Because when I 
take ALu when I am sick (yes) from malaria if I take ALu,  it does not bring me problems.”                                                                           
                                                                                                                                                             Male INI Respondent , K/U DSS 
 
Conclusions 
 ALu is the most preferred drug for malaria treatment and it does not cause side effects during use. However, 
negative perceptions about its effectiveness were also common. These negative perceptions might change  if  
restrictions  limiting its use  to confirmed cases  only are put in place.  
  Using monotherapies for uncomplicated malaria treatment should be discouraged by educating the 
community on current malaria treatment policy and guidelines. 
 People’s perceptions and experiences with antimalarial treatments affect their willingness to use them. 
Documenting these perceptions can provide important input for the implementation of future treatment policies 
when new antimalarial treatments come on-line.  
 
Study team conducts a FGD with 
community  members. 
Study  team member conducts an 
INI with an adult male. 
LB-2105 
Contact information: 
Ifakara Health Institute 
P.O. Box 78373 
Dar es Salaam, Tanzania 
www.ihi.or.tz 
Study team member conducts an IDI 
with a drug shop vendor. 

\ud
What are Community Members Saying About Artemether-Lumefantrine? Qualitative findings from the Two Demographic Surveillance Systems in Tanzania.\ud

\ud What are Community Members Saying About Artemether-Lumefantrine? Qualitative findings from the Two Demographic Surveillance Systems in Tanzania.\ud

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