Medicines dispensers' knowledge on the implementation of an artemisinin-based combination therapy policy for the treatment of uncomplicated malaria in Tanzania

Objectives: In 2005, Tanzania changed its policy for uncomplicated malaria treatment from sulphadoxine–pyrimethamine (SP) to artemisinin-based combination therapy (ACT), specifically artemether–lumefantrine (ALU). SP remains the medicine of choice for intermittent preventive treatment in pregnancy (IPTp). There is a need to assess dispensers' knowledge regarding the treatment of uncomplicated malaria and IPTp in Tanzania given appreciable self-purchasing to improve future care. Methods: Descriptive cross-sectional design with structured questionnaires to capture quantitative data, with qualitative data captured using focus groups. The study was performed at 32 private pharmacies and 33 Accredited Drug Dispensing Outlets in the Nyamagana and Sengerema Districts in Tanzania, with 20 dispensers included in the qualitative discussions. Key findings: The knowledge level of dispensers in the private medicine outlets was variable. Most dispensers knew ALU was first-line treatment in uncomplicated malaria, however variable knowledge about taking ALU with fatty meals. Generally, dispensers had poor knowledge about dosing intervals for SP in IPTp and variable knowledge regarding treatments in the first trimester. Overall, 49% had good knowledge and 48% had moderate knowledge of ACT in uncomplicated malaria. There was a significant relationship between dispenser type and knowledge of ACT but no statistical relationship between the level of knowledge on IPTp and the dispenser. Conclusions: The majority of dispensers in private medicines outlets have good knowledge on ACT policy in the treatment of uncomplicated malaria; however, few dispensers had good knowledge on IPTp, which may contribute to irrational dispensing of SP. This needs addressing given the extent of self-purchasing in Tanzania.