CLIENTS' PERCEPTIONS ON SULFADOXINE - PYRIMETHAMINE (SP) USE AS THE 1ST LINE DRUG AND ALTERNATIVE DRUGS FOR THE TREATMENT OF UNCOMPLICATED MALARIA IN KIBAHA DISTRICT, TANZANIA

Objective: To assess clients' perceptions on Sulfadoxine / Sulfalene - Pyrimethamine (SP) use as the 1st line drug and perceived alternative drugs for the treatment of uncomplicated malaria.
Methods: Health facilities cross-sectional survey of 365 caregivers of underfives with fever was conducted in a malaria holoendemic area. Using semi-structured questionnaires, caregivers were interviewed to explore their perceptions on efficacy & safety of SP for the management of childhood malaria and the perceived alternative drugs to SP.
Results: Clients held the notion that childhood febrile episodes had gone down after the policy change; however, SP could fail to treat febrile episodes because of wrong diagnosis (not malaria) or ineffectiveness. There was the misconception that "SP" in the different names such as Fansidar (Sulfadoxie-Pyrimethamine) and Metakelfin (Sulfalene-Pyrimethamine) are different drugs inducing half of clients to perceive that Fansidar or Metakelfin should be used in case of "SP" failure. Fansidar was considered to have more side effects, mainly cutaneous reactions; raising concerns as clients associated the side effects with HIV / AIDS. Adherence to SP was inconsistent, as some clients preferred Quinine.
Conclusions: The notion that "Fansidar" and "Metakelfin" are different from SP and could be used in case of "SP" failure indicates the need for using chemical rather than trade names in prescribing antimalarial drugs. The success of a new antimalarial policy requires a countrywide monitoring and reporting side effects and a mechanism for allaying fears is put in place. Continuing education to health workers and clients is necessary for consistent adherence to a new policy.

Keywords
Malaria control, sulfadoxine-pyrimethamine (SP), clients' perceptions, Tanzania