Drug dispensing practices during implementation of artemisinin-based combination therapy at health facilities in rural Tanzania, 2002-2005Pratiques de distribution du medicament durant d'implementation du traitement de combinaison a base d'artemisinine dans les services de sante dans les zones rurales de Tanzanie, 2002-2005Practicas de dispensacion de medicamentos durante la implementacion de la terapia de combinacion basada en la artemisinina en centros sanitarios rurales de Tanzania, 2002-2005

Objective To assess the degree to which policy changes to artemisinin-based combination therapies (ACTs) as first-line treatment for uncomplicated malaria translate into effective ACT delivery. Methods Prospective observational study of drug dispensing practices at baseline and during the 3years following introduction of ACT with sulfadoxine-pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first-line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1month per quarter, documenting a total of 271953 patient encounters in the three districts. Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP+AS during the intervention period. Of patients who received SP+AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy. Conclusions The uptake of SP+AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.Original Abstract: Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les therapies de combinaison a base d'artemisinine (ACT) comme traitement de premiere ligne pour la malaria non compliquee, se traduisent par une delivrance effective de l'ACT. Methodes: Etude d'observation prospective sur les pratiques de distribution de medicament au debut et durant les 3 annees suivant l'introduction de l'ACT avec la sulfadoxine-pyrimethamine (SP) plus artesunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins ou la monotherapie SP est restee le traitement de premiere ligne. Les donnees demographiques et de distribution ont ete recueillies chez tous les patients dans les unites de distribution de certaines installations selectionnees, sur un mois par trimestre, representant un total de 271.953 entretiens avec des patients dans les trois districts. Resultats: A Rufiji, la proportion de patients ayant recu un diagnosti