Saving Children's Lives in the Lake Zone of Tanzania through Improved Malaria Medicine Management

 {Photo credit: Brooke Huskey/MSH.}Suzanna Tungu, a pharmacy assistant in an outpatient pharmacy at the Shinyanga Regional Hospital in Tanzania. Susanna receives capacity building support and on-the-job training from her supervisor, Luciano Lorde, who was trained by the Tibu Homa project in supply chain management.Photo credit: Brooke Huskey/MSH.

Tanzania is among six countries with the highest malaria morbidity and mortality in the world. It is estimated that malaria kills 60,000 to 80,000 of the 10 to 12 million people who fall ill from the disease each year in the country. Children are particularly vulnerable to malaria. Though the overall under-five mortality rate is improving in Tanzania—it declined by 28 percent between 2003 and 2010—it remains high in the Lake Zone at 120 deaths per 1,000 live births, according to the 2010 Tanzania Demographic Health Survey (TDHS). A lack of successful child survival interventions, including malaria control efforts, in the region contribute to the problem.

To address this gap, the US Agency for International Development (USAID)-funded Tibu Homa (“treat fever” in Swahili) project, in coordination with the Government of Tanzania, is working to ensure that effective commodities and medicines for the diagnosis and treatment of malaria are available and health workers are trained in their use throughout the Lake Region.

With support from the project’s lead partner, University Research Co., LLC (URC), Management Sciences for Health (MSH) is training health workers in supply chain management (focusing on documentation of consumption data), conducting monthly logistic mentorship and supportive supervision, and revitalizing medicine and therapeutic committees at the facility level.

The project is also training health workers to shift from presumptive treatment of malaria to treatment only after diagnostic confirmation, which should lead to lower utilization and greater availability of anti-malarial medications at Tibu Homa-supported facilities.

Are Tibu Homa interventions improving availability of ACTs?

In June 2012, the project found that the availability of artemisinin-based combination therapy (ACT), the preferred treatment for malaria, as well as other medicines used to treat febrile (fever) illnesses, had greatly improved at both public and private facilities supported by the project after six months of project support. In January 2012, only 11 percent of public facilities and 32 percent of private facilities had ACTs in stock and had not had stock outs in the previous seven days. Six months later (in June 2012), the proportion of facilities that had ACTs in stock had risen from 11 to 83 percent of public facilities; and from 32 to 75 percent of private facilities.

To test the hypothesis that improvements in the availability of medicines and diagnostics in the Lake Zone are due to the project’s interventions, Tibu Homa compared data from facilities that received Tibu Homa support with a comparison (control) group of facilities that had been identified for intervention, but not yet reached.

The team looked at the patient records of 3,169 children under five years of age (1,632 in intervention facilities, 1,537 in the control facilities) who presented with fever in the four weeks prior to the survey. Data showed a significantly higher proportion of children were treated within 24 hours after the onset of fever in the intervention facilities compared to those treated in the comparison facilities. Similarly, more children were tested for malaria in the intervention facilities than comparison facilities.

Study findings also showed that the availability of febrile illness medicines and supplies was better in facilities supported by Tibu Homa compared to those not supported by the project. Intervention facilities were 4.5 times more likely than those in the control group to have five or more key febrile-illness-related medicines in stock on the day of visit and were 2.9 times more likely than those in the control group to have ten or more essential febrile illness related medicines available.

This study shows that facility-level interventions are key for improving access to medicines and saving lives. Tibu Homa is confident that training health workers, conducting monthly logistic mentorship and supportive supervision, and revitalizing medicine and therapeutic committees at the facility level has improved availability of malaria and fever medicines and supplies in the supported facilities.