Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria
Expanding equitable coverage of appropriate malaria treatment is essential, but little is known about the relationship between socio-economic status or SES and treatment obtained. This paper presents data on the variation in malaria parasitaemia, reported fever, care-seeking, antimalarials obtained and household expenditure by SES, and assesses the implications for ensuring equitable and appropriate use of Antimalarial Combination Therapy ACT.
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 and 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.
Of individuals completing the detailed survey, 16% reported a fever episode in the previous two weeks. Individuals from the better-off third were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poorest thirds. Better treatment resulted in an average expenditure by the better-off two to three times greater than that in the poorest or middle thirds. This reflected greater use of NGO facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores.
The coverage of appropriate malaria treatment was low in all SES groups, but poorer groups were particularly disadvantaged. As countries switch to ACT, there is an urgent need to target distribution to ensure that the poorest groups fully benefit from these new and highly effective medicines.
Tropical Medicine and International Health (2006) 11 (3) 299-313 [doi: 10.1111/j.1365-3156.2006.01569.x]