Hassan, Farida

Kalage, Rose

Khatib, Rashid

Roth Allen, Denise

English

Digital Library of the Tanzania Health Community

Local Perspectives on Barriers to Effective Malaria Treatment in Rural Tanzania: 
Qualitative Results from the INDEPTH Effectiveness and Safety Studies Platform 
(INESS) 
Background and Objectives: 
We present qualitative data from the INDEPTH Effectiveness and Safety Studies platform (INESS) in Tanzania to examine the contextual factors affecting people’s timely 
access to effectives malaria treatment. INESS which was conducted in the Rufiji and Kilombero/Ulanga health and demographic surveillance system (DSS) sites in 2010, 
is a longitudinal evidence base for the assessment of safe and efficacious drugs in real life settings. The main objective of the INESS qualitative data is to provide each 
HDSS site with qualitative information about the social, cultural, and behavioral factors affecting the uptake and adherence to ACTs.  
Methods:  
Site selection 
Two DSS areas 
• Rufiji  DSS 
• Ifakara  DSS (Kilombero/Ulanga ) 
 
Community selection 
Two communities per  DSS area were purposively selected based on their 
proximity to the health center: 
• 1 community located < 5km from the health center 
• 1 community located > 5 km from the health center 
 
Data collection  
Four qualitative data collection methods were used: 
• 4 -Seasonal Calendars to document seasonal factors that may shape 
malaria related perceptions and behaviors in the community. 
• 8-Focus Group Discussion (FGD) to explore community members’ 
perceptions of malaria and its treatment 
• 28 -Illness Narrative Interviews (INI)  to examine people’s actual  
experience with a suspected malaria  episode that they  or a child <5 
years of age experienced in the past two weeks. 
• 15-In-Depth Interviews (IDI) with providers to explore providers’ malaria 
diagnosis and treatment behaviors (health workers and drug shop 
vendors). 
 Results:  
• Community members perceived antimalarial drugs stock outs to occur 
throughout the year, usually during the second half of each month. 
• Perceptions of when community members were most likely to experience 
other barriers to care (i.e. bad roads, limited cash on hand) coincided with 
the months they perceived malaria to be most common. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•High  treatment costs at health facilities was cited as the main barrier to seeking 
care within twenty-four hours: 
“Sometimes you do not have money. When you get  money  you take the patient there to the hospital.  
Now, sometimes your condition is poor,  you can stay with your child three or four days (yes) he just stays 
and he suffers. You do not get services and you do not have opportunities to get money. 
                                                                                                                                              (Female FGD, Rufiji) 
 
• Lack of malaria diagnostic tools in the health facilities was the problem in both  
communities. Community members complained about being diagnosed by clinical 
symptoms. However, none of the drug shops were selling or using malaria rapid 
diagnostic tests: 
“Eeh, he  just examined me by using the eyes.  He  did not conduct any test.  He just looked at me and 
followed the explanations I was giving.  He prescribed these tablets for me to use, ALu.”                                                                           
                              (Female INI, KU) 
 
• It was noted that the decision making  process for the treatment of their recent 
malaria episode was shaped by the strength of symptoms and cash on hand: 
“Well, there is nothing else, because based on my illness and the way I was suffering, I decided to go 
straight away to the health facility.”  
                                                                                                                                              (Male INI, Rufiji) 
 
•  Long distance to the health facility was also cited as a barrier to malaria 
treatment in communities located far from the health facilities  
"Because in our village we do not have what, we do not have a hospital nearby. This        
affects us a lot if the child gets sick or a pregnant woman we suffer a lot to go to Nyambunda from 
here.” 
                                                                                                                                              (Caretaker INI, Rufiji) 
 
• As a result of a chronic shortage of ALu, adults were sometimes given ALu dosage 
packets for children: 
“I am trying  to go through this order.  We asked  for all types of ALu, for adults, children, above five 
years  (mmm). I mean  a pack of six tablets, twelve, eighteen and twenty four (mmm). But  the drugs 
that came is the six pack only, you will see that all these others have not come (have not come). Now, 
imagine an adult has come, you do not have a  pack of twenty four tablets. You have to  give  him the six 
tablets pack, so you will see that  he  carries a big parcel.”  
                                                                                                                                           (Health worker, Rufiji) 
 
• Wait time at health facilities was also mentioned as a barrier to care.  Many INI 
and FGD respondents mentioned spending long periods of time (one to three 
hours) waiting for treatment during week days:  
 “Yes, you wait for a long time especially on Mondays and Tuesdays there are long queues.”   
                                                                                                                                           (Female INI, KU) 
 
Conclusions: 
• Lack of diagnostic tools, drug shortages, limited cash supplies, and long wait 
times at health facilities continue to be obstacles to accessing timely malaria 
treatment in rural Tanzania. 
Acknowledgements  
The INESS Tanzania Team and the INDEPTH Network for their support.  
 
T 
 Farida Hassan1, Rose Kalage1,, Rashid Khatib1, S Denise Roth Allen2 
1. Ifakara Health Institute, Po Box 78373, Dar es Salaam, Tanzania 
2.Centers for Disease control and Prevention, Atlanta GA, United States 
INI with a female care taker 
IDI with a health worker 
FGD with adult males 
LB 2104 
Contact information: 
Ifakara Health Institute 
P.O. Box 78373 
Dar es Salaam, Tanzania 
www.ihi.or.tz 

Local Perspectives on Barriers to Effective Malaria Treatment in Rural Tanzania: Qualitative Results from the INDEPTH Effectiveness and Safety Studies Platform

Local Perspectives on Barriers to Effective Malaria Treatment in Rural Tanzania: Qualitative Results from the INDEPTH Effectiveness and Safety Studies Platform

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