Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies

PLoS One. 2014 Apr 14;9(4):e94074. doi: 10.1371/journal.pone.0094074. eCollection 2014.


Background: Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program.

Method and findings: A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4).

Conclusion: Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Antimalarials / economics
  • Antimalarials / therapeutic use*
  • Artemisinins / economics
  • Artemisinins / therapeutic use*
  • Child
  • Child, Preschool
  • Demography
  • Drug Therapy, Combination
  • Female
  • Geography
  • Health Planning Support / statistics & numerical data*
  • Humans
  • Malaria / drug therapy*
  • Malaria / economics
  • Malaria / epidemiology*
  • Male
  • Parasitemia / drug therapy
  • Parasitemia / economics
  • Parasitemia / epidemiology*
  • Patient Acceptance of Health Care
  • Pharmacies / economics
  • Pharmacies / statistics & numerical data*
  • Prevalence
  • Tanzania / epidemiology
  • Young Adult


  • Antimalarials
  • Artemisinins
  • artemisinin

Grants and funding

This research was completed under a cooperative agreement between the US Centers for Disease Control and Prevention (CDC) and Ifakara Health Institute (IHI). Additional support was provided by the ACT Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine (LSHTM). Investigators from the CDC, IHI, and LSHTM were involved in protocol development, data collection, data analysis, and preparation of this manuscript for publication.