Health worker's adherence to the new malaria treatment policy in Songea urban, Tanzania

Tanzania made a policy change to replace chloroquine with sulfadoxine - pyrimethamine (SP) since August, 2001. However, the long experience (>50 years) with chloroquine coupled with its anti-inflammatory and antipyretic effects that are lacking in SP might potentially make SP less readily acceptable by both prescribers and patients hence compromising adherence to the new policy. The study assessed health workers adherence to the new policy focussing on health workers awareness on the new antimalarial drug policy, knowledge on contra-indications, indications, potential side effects of the antimalarial drugs and necessary precautions, as well as their perceptions and practices regarding the new policy. A descriptive cross-sectional survey was conducted in Songea Urgan District using structured open-ended questionnaire and interviews supplemented with participant observations in public and private health facilities. Awareness of the new policy was 95.2%, knowledge on 1st line drug 91.4%, 2nd line 53.3% and 3rd line 63.8%. Knowledge on SP indications and contra-indications was significantly high (91.4%). SP was perceived to be not as effective as chloroquine in clinical response (53.3% versus 46.7%). Amodiaquine was less preferred and was mentioned at a frequency of 42.9% as the perceived second line drug. Quinine was significantly preferred than amodiaquine in the treatment of non-response to SP, both from interviews and prescriptions. The findings show that there was an erratic adherence to the new malaria treatment policy, and clearly there is a gap between the knowledge of the health workers on the new policy and their practices. Therefore information, education and communication (IEC) messages should address identified knowledge and practice gaps and be accompanied with behavioural change communication (BCC) strategies. There is a need to ensure a strict adherence to the indications for quinine use by inducing health workers to be familiar with amodiaquine as an alternative drug to non-response or contraindications to SP, and as a second line drug.