Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Malar J. 2010 Jun 15;9:163. doi: 10.1186/1475-2875-9-163.
The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment.
Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS) and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days.
Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%); an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%); higher treatment coverage with anti-malarials (86% to 96%) and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs). Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%). The availability of outlets (health facilities or drug shops) is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent.
An integrated approach aimed at improving understanding and treatment of malaria has led to tangible improvements in terms of people's actions for the treatment of malaria. However, progress was hindered by the low availability of the first-line treatment after the switch to ACT.
ACCESS 项目旨在了解和改善人们获得及时有效的疟疾治疗的途径。在 2004 年至 2008 年期间，该项目实施了一项社会营销活动，以促进寻求更好的治疗。为了改善私营零售部门获得治疗的途径，坦桑尼亚于 2006 年创建了一类新的零售药店，称为认证药品分销处（ADDO）。2007 年，坦桑尼亚将一线治疗药物从磺胺多辛-乙胺嘧啶（SP）改为青蒿琥酯-甲氟喹（ALu），并在卫生机构和 ADDO 提供补贴的 ALu。本研究在坦桑尼亚农村地区研究了这些干预措施对疟疾认知和治疗的影响。这些数据还可以调查获得治疗的决定因素。
2004 年、2006 年和 2008 年在伊法卡拉人口监测系统（DSS）的农村地区和伊法卡拉镇进行了三次治疗寻求调查。每个调查都包括大约 150 名在过去 14 天内患有发热的人。
治疗寻求和对疟疾的认识在基线时已经很高，但在 2004 年至 2008 年期间，出现了各种改善，包括：更好地了解疟疾的病因（从 62%增加到 84%）；五岁以上患者将卫生机构作为首选治疗方法的比例增加（从 27%增加到 52%）；抗疟药物治疗覆盖率更高（从 86%增加到 96%），抗疟药物使用更及时（80%至 93-97%的治疗在 24 小时内进行）。不幸的是，治疗政策的改变导致私营部门抗疟药物 ALu 的供应不足，因此，接受推荐的疟疾治疗的患者比例下降（从 85%降至 53%）。网点（卫生机构或药店）的供应情况是患者是否能及时获得有效治疗的最重要决定因素，而可负担性和可及性的作用则相对较小。
旨在改善对疟疾的认识和治疗的综合方法已使人们对治疗疟疾的行动产生了切实的改善。然而，一线治疗药物在改用 ACT 后供应不足，阻碍了进展。
