Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria

Summary Objective To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio‐economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. Methods A total of 2500 households were surveyed in three rural districts in southern Tanzania in mid‐2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis. Results Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better‐off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non‐governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. Conclusion The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines. Objectif Investiguer les variations dans la parasitémie de la malaria, les fièvres rapportées, les recours aux soins, les antimalariques obtenus et les dépenses des familles selon le statut socio‐économiques, et évaluer les implications dans l'assurance d'une utilisation équitable et appropriée de la thérapie antimalarique combinée. Méthodes 2500 familles ont étéétudiées dans 3 districts ruraux dans le sud de la Tanzanie au milieu de l'année 2001. Des échantillons de sang et les données sur le statut socio‐économique ont été collectés dans toutes les familles. Une moitié des participants a complété un questionnaire détaillé sur le recours aux soins et le coût des traitements. Les familles ont été reparties par catégories selon le statut socio‐économique sur base d'un index de richesse de famille dérivant d'analyse de composant principaux. Résultats 16% des individus a