Dept. Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Malar J. 2010 Jun 15;9:164. doi: 10.1186/1475-2875-9-164.
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. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.
The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.
Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)
The public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake.
为了改善私营零售部门的治疗途径，坦桑尼亚创建了一类新的零售药店，称为认证药品分销点（ADDO）。2007 年，坦桑尼亚将其一线抗疟治疗药物从磺胺多辛-乙胺嘧啶（SP）改为青蒿琥酯-甲氟喹（ALu）。在卫生机构和 ADDO 中都提供了补贴的 ALu。本研究在坦桑尼亚农村地区研究了这些干预措施对获得疟疾治疗的影响。
该研究在基洛姆贝罗和乌兰加人口动态监测系统（DSS）的村庄以及伊法卡拉镇进行。数据收集包括：1）每年对销售药品的药店进行普查；2）每月收集公共卫生设施中抗疟药物供应情况的数据；3）对所有公立、教会和私营机构的零售药店进行审计，以衡量抗疟药物的销售量。数据由 DSS 人口数据补充。
2004 年至 2008 年间，疟疾治疗的可及性大大提高，抗疟治疗剂量的分发量增加了 78%。在药店的供应情况（2004 年每 1000 人有 0.24 家药店，2008 年增加到 0.39 家）和可及性（2004 年距离药店 5 公里以内的家庭比例为 71%，2008 年增加到 87%）方面取得了显著改善。尽管可负担性没有提高，但这导致市场份额从 2005 年抗疟药物销售的 49%增加到 2008 年的 59%。从 SP 到 ALu 的治疗政策改变导致在 ALu 推出前的几个月卫生机构的 SP 库存严重短缺（仅有 40%的月份有库存），但 SP 在药店的广泛供应弥补了这一短缺。在 ALu 推出后，公共卫生机构的药物库存水平相对较高（80%以上的月份有库存），但药物只能在 30%的药店找到，而普通药店则找不到。这导致该药物的总体利用率较低（所有抗疟药物销售的 19%）。
公共卫生和私营零售部门是坦桑尼亚农村地区重要的互补治疗来源。确保私营零售部门有 ALu 供应对于其成功采用至关重要。
