The malaria testing and treatment landscape in mainland Tanzania, 2016

• Published in: Malaria journal 2017-04, Vol.16 (1), p.202-202, Article 202
• Main Authors: Michael, Daniel, Mkunde, Sigsbert Patila
• Format: Article
• Language: English
• Subjects: Accreditation; ACT; Anti-malarial markets; Antimalarials - therapeutic use; Artemisinin; Artemisinins - therapeutic use; Artesunate; Availability; Bans; Case management; Commerce - statistics & numerical data; Communication; Diagnosis; Diagnostic Tests, Routine - utilization; Drug Combinations; Drug dosages; Drug stores; Government policy; Health facilities; Health Services Accessibility - statistics & numerical data; Hospitals; Human diseases; Humans; Malaria; Malaria - diagnosis; Malaria - drug therapy; Microscopy; Morbidity; Policies; Polls & surveys; Pregnancy; Private sector; Private Sector - statistics & numerical data; Public health; Public policy; Public sector; Public Sector - statistics & numerical data; Pyrimethamine; Quality; Quality-assured artemisinin combination therapy; Rapid diagnostic testing; Subsidies; Sulfadoxine; Surveying; Tanzania; Testing; Vector-borne diseases; Womens health
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-017-1819-7

Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and price of anti-malarials and malaria diagnosis in 2016. A nationally-representative malaria outlet survey was conducted between 18th May and 2nd July, 2016. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all anti-malarials, malaria rapid (RDT) diagnostic tests and microscopy. A total of 5867 outlets were included in the nationally representative survey, across both public and private sectors. In the public sector, availability of malaria testing was 92.3% and quality-assured (QA) ACT was 89.1% among all screened outlets. Sulfadoxine-pyrimethamine (SP) was stocked by 51.8% of the public sector and injectable artesunate was found in 71.4% of all screened public health facilities. Among anti-malarial private-sector stockists, availability of testing was 15.7, and 65.1% had QA ACT available. The public sector accounted for 83.4% of the total market share for malaria diagnostics. The private sector accounted for 63.9% of the total anti-malarial market, and anti-malarials were most commonly distributed through accredited drug dispensing outlets (ADDOs) (39.0%), duka la dawa baridi (DLDBs) (13.3%) and pharmacies (6.7%). QA ACT comprised 33.1% of the national market share (12.2% public sector and 20.9% private sector). SP accounted for 53.3% of the total market for anti-malarials across both private and public sectors (31.3 and 22.0% of the total market, respectively). The median price per adult equivalent treatment dose (AETD) of QA ACT in the private sector was $1.40, almost 1.5 times more expensive than the median price per AETD of SP ($1.05). In the private sector, 79.3% of providers perceived ACT to be the most effective treatment for uncomplicated malaria for ad