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SALEABILITY OF ANTIMALARIALS IN PRIVATE DRUG SHOPS IN MUHEZA, TANZANIA

Saturday, 20th of August 2011

There's many a slip 'twixt the cup and the lip. Those who take comfort in the issuance of national policies on malaria drug treatment may take discomfort from this article from Tanzania,  available in full at
http://www.malariajournal.com/content/pdf/1475-2875-10-238.pdf

My first experience with private sector marketing of antimalarials was my 1976 purchase, in a  private pharmacy in Bangkok, of imported chloroquine. The package insert, from the British manufacturer, informed the reader, in Thai and English, that the chloroquine was ‘effective against all forms of malaria.’ This was five years after the WHO/Thailand studies on chloroquine resistant falciparum malaria, with MoH switchover to from chloroquine to 
S-P as the first line treatment for confirmed falciparum malaria.

The more things change, the more they remain the same.

Good reading.

BD

Malaria Journal 2011, 10:238 doi:10.1186/1475-2875-10-238

Published: 15 August 2011

Abstract (provisional)

Background

Artemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance. The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidized ALu.

Methods

All drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume.

Results

All surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for 74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%).

Conclusions

In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for IPTp, as stipulated in the national anti-malarial policy. It is a major reason for concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy. Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to train private drug dispensers.