Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2010 Aug 10;5(8):e12104. doi: 10.1371/journal.pone.0012104.
Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania.
In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8%) of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1) of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28). Caretakers from the better-off household (3rd-5th quintiles) were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76). The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500) compared to the better-offs (median Tsh 0).
Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where the burden of malaria is highest.
有效的、及时的病例管理仍然是疟疾控制的基本支柱之一。坦桑尼亚引入了青蒿素联合疗法（ACT）治疗无并发症疟疾；然而，由于成本高，该政策的改变受到 ACT 供应有限的挑战。本研究旨在确定影响农村 Kilosa 地区发热儿童及时获得 ACT 的因素。
在 2008 年进行的一项基于社区的研究中，随机选择了 1235 名五岁以下的儿童进行为期六个月的每周随访。使用结构化问卷，询问儿童看护者过去七天内儿童发热史，以及治疗措施，包括时间、使用的药物和治疗来源。还获得了看护者对疟疾的认识以及社会经济和人口统计学数据。在随访的儿童中，约有一半至少有一次发热。不到一半（44.8%）的发热儿童被送往政府机构。近三分之一（37.6%；95%CI 33.1-42.1）的发热儿童能够及时获得 ACT。到政府机构就诊是最重要的因素，使及时获得 ACT 的可能性增加了 18 倍（OR 17.7；95%CI 10.55-29.54；调整后的 OR 16.9；95%CI 10.06-28.28）。来自较富裕家庭（第三至第五五分位数）的看护者更有可能到政府机构就诊（OR 3.66；95%CI 2.56-5.24；调整后的 OR 1.80；95%CI 1.18-2.76）。贫困人群获得的大多数抗疟药物无效[86.0%；295/343]，但他们支付的费用更高（中位数 Tsh 500），而不是较富裕人群（中位数 Tsh 0）。
发热儿童及时获得 ACT 的比例低得令人无法接受，主要原因是大多数看护者就诊的地方，补贴的 ACT 供应有限。迫切需要加快实施战略，确保在疟疾负担最高的偏远农村地区以负担得起的价格提供 ACT。
