Abdulla, S

Ali, AS

Bloland, PB

Elling, BF

Kachur, SP

Khatib, RA

Njau, JD

English

Digital Library of the Tanzania Health Community

Prompt and effective treatment use for febrile illness: a comparison between two 
autonomous health administrations in Tanzania  
RA Khatib1, SP Kachur1,2, BF Elling1, AS Ali3, S Abdulla1, JD Njau1, PB Bloland2 
1Ifakara Health Research and Development Centre, Ifakara, TANZANIA 
2Centers for Disease Control and Prevention and US Public Health Service, Atlanta, UNITED STATES 
3Zanzibar Malaria Control Programme, Zanzibar, TANZANIA  
This work was completed as part of the Interdisciplinary Monitoring Project for Antimalarial Combination Therapy in 
Tanzania (IMPACT-Tz)--a collaborative implementation research platform resting on: Ifakara Health Research and 
Development Centre, Centers for Disease Control and Prevention (CDC),  National Malaria Control Programme, 
National Institute for Medical Research, Zanzibar Malaria Control Program, Muhimbili University College of Health 
Sciences and London School of Hygiene and Tropical Medicine.  It is implemented through the Council Health 
Management Teams of Rufiji, Kilombero, Ulanga, Morogoro, Mvomeru Districts and Zanzibar island.  Financial support 
for IMPACT-Tz comes primarily from the U.S. Agency for International Development, CDC and the Wellcome Trust. 
Interdisciplinary Monitoring Project for Antimalarial  
 
 
 
 
 
 
 
Combination Therapy in Tanzania 
Introduction 
 Mainland Tanzania and Zanzibar, two parts constituting the United 
Republic of Tanzania, operate two different and autonomous health 
administrations and delivery systems.  
 
 The mainland is vast and sparsely inhabited while Zanzibar is small 
but densely populated. 
 
 These  differences  are  an  advantage  for  residents  of  Zanzibar  in 
terms of geographic access to health care. 
 
 In 2002 and 2003 we conducted household surveys in both parts of 
the  country  to  assess  treatment  utilization  for  febrile  illnesses  at 
household level. 
 
 
Methods 
The survey covered three districts from mainland and two from 
Zanzibar. 
We selected total of 1,182 households from Zanzibar districts and 
2,377 from mainland. 
Every available and willing resident from each selected household 
was asked questions about his/her: 
Febrile illness occurring in the previous fourteen days. 
Medicine use for the reported febrile episodes. 
Types of health providers that had been visited for care.  
Other household information. 
Analysis are corrected for clustering both between individuals in the 
same household and between study sites and weighted to adjust 
for population sampling fractions. 
Zanzibaris were more likely to seek early treatment from health facilities than residents of 
mainland Tanzania. The change in treatment policy, 4 months after this study,  at health facilities 
will improve Zanzibaris’ prompt effective treatment rate. 
 
Despite  better  access  to  health  facilities,  home  and  community  management  remains  an  
important strategy for malaria treatment in Zanzibar as it is for mainland Tanzania. 
Interpretation 
Results 
Prompt antimalarial treatment 
The study identified 410 individuals in Zanzibar and 1,035 on the 
mainland who reported having experienced fever or malaria in the 
14 days prior to the survey. 
Recently febrile residents from Zanzibar reported using antimalarial 
drugs within 24 hours of the onset of fever more frequently at 30% 
than mainland residents at 20%. 
About 47% of those who sought treatment within 24 hours 
from Zanzibar were under-fives but the rate for mainland was 
39.5%. 
Women from mainland Tanzania used early treatment with 
antimalarials more often at 53.7% than from Zanzibar at 46%. 
Prompt and effective treatment 
 
 The  rate  for  mainlanders  was  significantly  higher  at  17.7% 
compared to Zanzibar at 7%. 
 
 However, more under-fives (46.7%) used prompt and effective 
care in Zanzibar than for mainland (41%). Not significant [NS]. 
 
 More men than women used effective treatment for malaria in 
time  on  the  isles  (51%).  In  contrast,  on  the  mainland  this 
practice was more common among women at 53.8%. [NS]. 
Figure 1: Sources of treatment for recent fever 
0
10
20
30
40
50
60
70
Mainland Zanzibar
health facilities retail sources other sources
Table 1: Factors associated with early treatment with 
antimalarials and early, effective treatment (multivariate) 
 
Variable 
 
Using any antimalarial 
within 24 hrs 
 
Using effective 
treatment within 24hrs 
Education of household 
head 
Adjusted OR=1.09 
(1.04, 1.14) 
Adjusted OR=1.09 
(1.03, 1.15) 
Sleeping under a bed net 
Adjusted OR=2.0 
(1.40, 2.84) 
Adjusted OR=2.08 
(1.40, 3.08) 
Under-five years 
Adjusted OR=1.42 
(1.05, 1.93) 
Adjusted OR=1.54 
(1.10 ,2.17) 
Being resident of 
Zanzibar 
Adjusted OR=2.48 
(1.74, 3.55) 
Adjusted OR=0.40 
(0.24, 0.67) 
Discussion 
 The ongoing use of Chloroquine during the time of survey may have contributed to lower rate of 
prompt use of effective treatment in Zanzibar.  It has since been replaced with a highly effective 
combination treatment: amodiaquine plus artesunate. 
 
 Health policy discouraging ordinary shops from stocking antimalarials may account for lower 
level of reliance on retail sources for malaria treatment in Zanzibar. 
 
 Educational level for heads of households, respondents’ reported use of bed nets, age below 
five years and being resident of Zanzibar were independently associated with use of antimalarial 
drugs and with prompt, effective treatment.  

Prompt and Effective Treatment use for Febrile Illness: A Comparison Between two Autonomous Health Administrations in Tanzania

Prompt and Effective Treatment use for Febrile Illness: A Comparison Between two Autonomous Health Administrations in Tanzania

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