2. Jaran Eriksen MD, PhD Student International Health (IHCAR) & Clinical Pharmacology Karolinska Institute, Stockholm, Sweden

3. Household adoption of the new antimalarial drug policy in Tanzania – implications for future policy changes

4. Malaria Treatment in Africa  Chloroquine (CQ) effective for 50 years  Spread of resistance  WHO recommendations: policy change when resistance >25%  Policy changes to sulfadoxine/pyrimethamine (SP)

5. Malaria Treatment Policy in Tanzania  1999: sentinel sites:  Average CQ resistance 42%  Average SP resistance 6%  Interim policy change august 2001:  SP 1 st line  Amodiaquine 2 nd line  Quinine 3 rd line

6. Tanzanian Policy implementation  Training workshops  Seminars  Publications in local newspapers  Poster campaign  Ref: Mbuyazi GM. The role of research in changing antimalarial drug policy in Tanzania: the alliance for health policy and systems research, NIMR, Tanzania, Jan 2003

7. Objectives  Assess the adoption of the new malaria treatment policy in a rural district of Tanzania  Drug pressure  Drug availability  Treatment seeking practices  Knowledge of policy  Perceptions of SP

8. Materials and Methods  Kibaha district, Tanzania  Household interviews (n=779)  Blood samples (n=336)  Focus Groups Discussions (FGDs) (n=12, with mothers, fathers and health care professionals)

9. Results  Good knowledge of policy change  Dramatic shift in behaviour:  Self-treatment  Seeking care at health facilities  SP given under direct observation  Fear of SP side-effects/mass media influence

10. Results  41% knew SP as 1 st line treatment  10% of mothers stocked antimalarials  5% stated self-treatment as first action  Children with reported fever within last 4 weeks:  32% had SP in blood  6% had CQ in blood

11. Lessons Learned  Triangulation (blood samples, interviews and FGDs) validated shift in care-seeking practices including use of new 1 st line drug  Tanzanian policy shift strategy successful in terms of changes in actual practice

12. Implications for Policy Implementations  For rational use of drugs more balanced mass media information needed  The dramatic shift in care-seeking indicates possibilities for future policy change to Artemisinin-based Combination Therapy (ACT)

13. Research Needed  Efficacy of SP given with other drugs after policy change/ efficacy of ACT  Health effects of changed behaviour is unclear  Treatment in home/community vs. formal health care and its effects on compliance