The malaria testing and treatment landscape in mainland Tanzania, 2016

Abstract

Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and price of anti-malarials and malaria diagnosis in 2016. A nationally-representative malaria outlet survey was conducted between 18th May and 2nd July, 2016. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all anti-malarials, malaria rapid (RDT) diagnostic tests and microscopy. A total of 5867 outlets were included in the nationally representative survey, across both public and private sectors. In the public sector, availability of malaria testing was 92.3% and quality-assured (QA) ACT was 89.1% among all screened outlets. Sulfadoxine–pyrimethamine (SP) was stocked by 51.8% of the public sector and injectable artesunate was found in 71.4% of all screened public health facilities. Among anti-malarial private-sector stockists, availability of testing was 15.7, and 65.1% had QA ACT available. The public sector accounted for 83.4% of the total market share for malaria diagnostics. The private sector accounted for 63.9% of the total anti-malarial market, and anti-malarials were most commonly distributed through accredited drug dispensing outlets (ADDOs) (39.0%), duka la dawa baridi (DLDBs) (13.3%) and pharmacies (6.7%). QA ACT comprised 33.1% of the national market share (12.2% public sector and 20.9% private sector). SP accounted for 53.3% of the total market for anti-malarials across both private and public sectors (31.3 and 22.0% of the total market, respectively). The median price per adult equivalent treatment dose (AETD) of QA ACT in the private sector was $1.40, almost 1.5 times more expensive than the median price per AETD of SP ($1.05). In the private sector, 79.3% of providers perceived ACT to be the most effective treatment for uncomplicated malaria for adults and 88.4% perceived this for children. While public sector preparedness for appropriate malaria testing and case management is showing encouraging signs, QA ACT availability and market share in the private sector continues to be sub-optimal for most outlet types. Furthermore, it is concerning that SP continues to predominate in the anti-malarial market. The reasons for this remain unclear, but are likely to be in part related to price, availability and provider knowledge or preferences. Continued efforts to implement government policy around malaria diagnosis and case management should be encouraged.

DOI: 10.1186/s12936-017-1819-7

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@inproceedings{Akulayi2017TheMT, title={The malaria testing and treatment landscape in mainland Tanzania, 2016}, author={Louis Akulayi and Angela Alum and Andrew P Andrada and Julie Archer and Ekundayo D. Arogundade and Erick Auko and Abdul Razak Badru and Katie Bates and Paul Bouanchaud and Meghan Bruce and Katia J Bruxvoort and Peter Buyungo and Angela J Camilleri and Emily D. Carter and Steven Francis Chapman and Nikki Charman and Desmond Chavasse and Robyn A. Cyr and Kevin Duff and Gylsain Guedegbe and Keith Esch and Illah Evance and Anna C. Fulton and Hellen Gataaka and Tarryn Haslam and Emily S Harris and Christine H. Hong and Catharine A. Hurley and Whitney Isenhower and Enid Kaabunga and Baraka D. Kaaya and Esther Kabui and Beth B Kangwana and Lason Kapata and Henry Kaula and Gloria Kigo and Irene Kyomuhangi and Aliza Lailari and Sandra LeFevre and Megan Littrell and Greta Martin and Daniel I. Michael and Erik Monroe and God{\'e}froid Mpanya and Felton Mpasela and Felix Mulama and Anne Musuva and Julius Ngigi and Edward Ngoma and Marjorie Norman and Bernard Nyauchi and Kathryn Ann O’Connell and Carolyne Ochieng and Edna Ogada and Linda Ongwenyi and Ricki Orford and Saysana Phanalasy and Stephen Poyer and Justin Rahariniaina and Jacky Raharinjatovo and Lanto Razafindralambo and Solofo Razakamiadana and Christina Riley and John L. Rodgers and Andria Rusk and Tanya Shewchuk and Simon Sensalire and Julianna Z Smith and Phok Sochea and Tsione Solomon and Raymond K. Sudoi and Martine Esther Tassiba and Katherine Thanel and Rachel L. Thompson and Mitsuru Toda and Chinazo N Ujuju and Marie-Alix Valensi and Vamsi Vasireddy and Cynthia Whitman and Cyprien E Zinsou and Sigsbert Patila Mkunde}, booktitle={Malaria Journal}, year={2017} }