Prevalence of malaria parasitemia among clients obtaining treatment for fever or malaria at drug stores in rural Tanzania
Abstract
Specialist drug stores could play a role in expanding coverage of effective malaria treatment to households in highly endemic areas. We conducted a follow-back study to determine the prevalence of malaria parasitemia and other common illnesses among drug shop clients in one rural community. We observed 2466 client visits selected from all 10 drug stores operating in the town of Ikwiriri between May 30 and August 31, 2004. Of these, 521 21.2% were made by or on behalf of persons ill with fever or malaria. 293 were eligible as residents of the surrounding 9 villages and agreed to participate in the study. Each patient was evaluated by a clinical officer and provided a blood sample for malaria on the day of the shop visit, either at the shop or at home. Only 50 17.1% visits by or on behalf of febrile patients resulted in the purchase of an antimalarial drug, while an antipyretic medication was obtained at a sizeable majority, 77.1% n=226 of encounters. Clinicians assigned a clinical diagnosis of malaria to over half 63.8% of the patients. Malaria parasites were identified in blood film samples from 24.2% 95% CI: 19.6, 29.5. This is double the parasite prevalence rate of 10.7% 95% CI: 8.6, 13.1 obtained from a household survey of 1004 healthy individuals selected from these villages at the same time. It is slightly lower, although not significantly, than the prevalence observed among 880 clients presenting with fever at health facilities in the district: 29.7% 95% CI: 23.0, 37.3. The prevalence of malaria parasitemia among children under 5 years whose families sought fever treatment from drug stores 42.1%; 95% CI: 31.4, 53.5 was equal to that of children presenting with fever at health facilities 42.5%; 95% CI: 25.0, 62.2. Drug stores are currently not providing malaria-specific treatment in the majority of cases where it might be warranted. Parasitologic findings indicate that drug store clients, especially children, are as likely to be infected with malaria as patients seeking care for similar illnesses at health facilities. Drug stores may be attractive partners to policy makers eager to engage the private retail sector in expanding coverage of malaria treatment
Citation
Tropical Medicine and International Health (2006) 11 (4) 441-451