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Prácticas de dispensación de medicamentos durante la implementación de la terapia de combinación basada en la artemisinina en centros sanitarios rurales de Tanzania, 2002–2005
Author(s) -
Thwing J. I.,
Njau J. D.,
Goodman C.,
Munkondya J.,
Kahigwa E.,
Bloland P. B.,
Mkikima S.,
Mills A.,
Abdulla S.,
Kachur S. P.
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02724.x
Subject(s) - medicine , artemisinin , artesunate , tanzania , malaria , combination therapy , artemether/lumefantrine , lumefantrine , pediatrics , sulfadoxine , plasmodium falciparum , pyrimethamine , environmental science , environmental planning , immunology
Summary Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery. Methods Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine–pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first‐line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271 953 patient encounters in the three districts. Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy. Conclusions The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.