National Malaria Centre of Cambodia Rational Pharmaceutical Management Plus Program World Health Organization European Commission Cambodian Malaria Control Programme Wellcome Trust Mahidol Oxford Trop. Med. Research Programme WHO Community drug use practices in malaria in Cambodia: a cr oss-sectional study

Part One The drug situation on the Cambodian-Thai border Boukheng Thavrin

First treatment sought by provider type (n=1277)

Percentage visiting government facilities for treatment

Patient Self Medication Patient requested specific drug product (according to providers) Public Health facilities: 0% of patients Village based private providers: 25% –75% of patients rely on village provider recommendations –Important for targeting education and training Market based private providers: 50%

Treatment seeking for fever 7% did not seek modern treatment 93% sought a modern treatment by the end of the third day –45% sought a modern treatment on the first day of illness

Availability of Blood Test Services (provider report)

Household antimalarial use (first treatment)

Government Facility Stock

Market Facility Stock

Village Facility Stock

First Line Treatment Received

Mean cost for treatments sought Single treatment: 3000 Riel Two treatments: 10,000 Riel Three treatments: 13,000 Riel Range of single treatment costs: zero to 552,500 Riel (US$138)

Summary Persons with fever seek treatment within 3 days of symptoms The majority of persons with fever seek private medical treatment Village providers are an important source of treatment recommendations When treatment is unsuccessful, patients seek care in the public sector

Summary (2) 60% of market and village providers offered no blood tests 11% of patients received recommended pre-packaged treatments First line treatment was available in the public sector, but was rare in other settings Artesunate & quinine monotherapies were the most common treatments received