Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005

Summary 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 3 years 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 1 month per quarter, documenting a total of 271 953 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. Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les thérapies de combinaison à base d’artémisinine (ACT) comme traitement de première ligne pour la malaria non compliquée, se traduisent par une délivrance effective de l’ACT. Méthodes: Étude d’observation prospective sur les pratiques de distribution de médicament au début et durant les 3 années suivant l’introduction de l’ACT avec la sulfadoxine‐pyriméthamine (SP) plus artésunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins où la monothérapie SP est restée le traitement de première ligne. Les données démographiques et de distribution ont été recueillies chez tous les patients dans les unités de distribution de certaines installations sélectionnées, sur un mois par trimestre, représentant un total de 271.953 entretiens avec des patients dans les trois districts. Résultats: À Rufiji, la proportion de patients ayant reçu un dia