Background: Artemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line
anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated
during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for
Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it
is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance.
The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town,
an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and
accreditation programme that will allow accredited drug shops to sell subsidized ALu.
Methods: All drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily
participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or
shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales
volume.
Results: All surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated
monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for
74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%).
Conclusions: In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not
reserved for IPTp, as stipulated in the national anti-malarial policy.
It is a major reason for concern that such drug-pressure in the community equals de facto intermittent
presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people
other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy.
Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to
train private drug dispensers.
Background
Anti-malarials have been widely available in private
shops for home-treatment for decades [1]. In Tanzania
drug shops known as duka la dawa baridi (DLDB),
although formally only licensed to sell over-the-counter
(OTC) drugs, frequently sell prescription-only antimalarials
for treatment of fever or malaria, and are
important providers,