Public Health Challenges for Implementing Malaria Treatment Policy Changes: A Pilot Study in Temeke District, Dar es Salaam, Tanzania

In January 2007 Artemisinin based Combination Therapy (ACT) replaced Sulfadoxine-Pyrimethamine (SP) as the first line drug for malaria in Tanzania, following WHO recommendations. SP had replaced chloroquine (CQ) in 2001; however, community involvement was minimal and a public outcry over SP's perceived side effects resulted. This paper describes the preliminary results of a community based project to assess residents' awareness and acceptability of the new therapy in Tanzania. A household survey was conducted in a peri-urban area of Dar es Salaam. Data were collected from members of 412 households with children under five just before the introduction of ACT. Respondents ranged in age from 16-65 years and were majority female. Three quarters of the households were aware that SP was in use as the first line drug for treating malaria. Less than half (48.1%) had accepted the change from CQ to SP when it was introduced. Less than 11% of the respondents were aware of the proposal to change SP to ACT. Of those knowledgeable of the change, the majority personally approved of it. Side effects of SP rather than its ineffectiveness were given as reasons for compliance with the proposed changes. More the 80% of the respondents preferred information on malaria therapy and associated issues to be given by health personnel. Radio was identified as the best channel for communication. Based on findings, it is recommended that the community be involved in decisions regarding changes in malaria therapy policy.