The availability and use of anti-malarial drugs in households in Kibaha district, Tanzania

A cross-sectional study was conducted in Kibaha district of the Coast region in Tanzania, to investigate the availabili ty of antimalarial drugs in households. This included the source, proportion of stocking, how they stored and used for malaria treatment. Mothers of under-fives were interviewed on how their under-five children get treated when they have malaria. Prescribing habits of the drug-sellers from the villages where household survey was done were also investigated. A Swahili questionnaire was used for the interview. A study sample was obtained by a mUltistage sampling technique. Out of 8 wards 2 were picked randomly Tumbi and Mlandizi. Five villages were picked randomly as well, three from Tumbi and two from Mlandizi. In each village a list of ten cell leaders was made and in total 75 ten cell leaders were selected randomly and their households included in the study. A total of 1000 households, which was 5% of all households in the district according to the 1988 Census (Bureau of Statistics, 1989 were included in the study. The interviewees were 1000 heads of households, 515 mothers of underfives and 249 members who were sick with malaria during the last month prior to the interview. i The study found that 32.6% of the households do keep antimalarials and the stocking of drugs among other things was found to be determined by distance to the nearest health facility, household size, number of underfives, employment status, educational status and age of the head of the household. Although 91.8% of the interviewees reported their nearest health facility was publicly owned which provide either free or cheap medical services, 55% of the interviewees had not visited those facilities for more than 6 months despite the fact that they reported to have fallen ill in that period. This is because in most of the time, pu~lic health facilities have a shortage of drugs. It was also found that 65.7% of respondents practice self medication, and the sources of their drugs are 79.7% from drug-stores, 19.7% ordinary shops, 0.2% from health personnel and 0.5% from other sources. For mothers or the caretakers of underfives, 51.8% of them were found to keep drugs for their children. Educational status of the mother was the key determinant in keeping drugs at home, and Chloroquine syrup was the commonest antimalarial given to underfives. ii .. - - -- -- Only 18.6% of mothers were found to give their children the correct dose of chloroquine, the remaining either gave under-dose or overdose. Some did not know their children weight or gave inappropriate dose schedule like two or three times a day. Hence, it was found that management of malaria in underfives was insufficient and improper. On expiring dates of drugs, only 17.6% of respondents knew the expiring dates of the drugs they used. Of those who did not know about the expiry dates, 80.4% agreed that it was important to know it. Majority of respondents knew that expired drugs could either be poisonous or could not cure the disease. Some of the drugs were found to have been stored for a long period (up to 6 months). Majority of drug sellers (78%) had primary education and 51% were below 20 years of age. About 47.1% of drug-sellers in ordinary shops gave under-dose to their clients while 25.5% gave only two tablets of chloroquine, and that was regarded as a sufficient dose. The client was more likely to get a wrong dose of chloroquine if he bought it from ordinary shops than from drug stores. It is recommended that the Ministry of Health should be strict on regulations governing drug stores and pharmacies when registering them, and regularly inspect staff who work in them. Such staff should be qualified at least with a iii certificate in pharmaceutics. The Ministry should also organize a seminar on correct management of malaria with chloroquine for shopkeepers who sell over the counter drugs. Through mass media people should be educated on dangers of self medication and importance of knowing the expiry dates of the drugs before taking them. Studies should be initiated by Ministry of health to look into the proportion of patients who get drugs and those who get only prescriptions when they visit health facilities. This will help to show the magnitude of drug shortages in health facilities. Also there is a need to know if patients are getting correct information on drugs dosages