modern care (Mtango et al., 1992), and better than for all deaths in the same area during the same period when 20 percent of all-cause deaths had no prior health-seeking events (Tanzania Essential Health Interventions Project and Ministry of Health of Tanzania, 2002).

With belief systems for malaria treatment-seeking now firmly on the side of modern care, there is obviously something still failing in the transaction to obtain this care, or in the quality of the care and referral once it is accessed. TEHIP is continuing to refine the information from this study, and will be analyzing the narrative portion of the verbal autopsy questionnaires to look at some specific aspects of the health care received, including:

  • delay in seeking modern care (e.g., tried to treat at home without antimalarials, no transport, beliefs, poor recognition of severity, lack of confidence in modern care, no power to decide, insufficient finances);

  • delay in receiving modern care (e.g., after working hours, weekends, long queues, satisfaction); and

  • ineffective modern care (e.g., poor communication, no referral, drugs not available, abusive health worker, non-compliant providers, poor adherence of patients).

All of these factors could have contributed to failed treatment. The study, as yet, can provide no direct information on the possible contribution of drug resistant malaria to these deaths.

The current results suggest that policies and efforts aimed at improving early recognition of symptoms and danger signs at home, prompt treatment or treatment-seeking, compliance with the full course of treatment, and the quality of the antimalarial available are highly justified.

REFERENCES

De Savigny D, Mwageni E, Mayombana C, Masanja H, Minhaj A, Momburi D, Mkilindi Y, Mbuya C, Kasale H, and Reid G. 2003. Care seeking patterns in fatal malaria: Evidence from Tanzania. Paper commissioned by the Institute of Medicine.


MARA Collaboration. 2003. MARA LITe for Africa CD version 3.0.0. South Africa: Medical Research Council of South Africa.

Mtango FDE, Neuvians D, Broome CV, Hightower AW, Pio A. 1992. Risk factors for deaths in children under 5 years old in Bagamoyo District, Tanzania. Tropical Medicine and Parasitology 43(4):229-233.


Oberlander L, Elverdan B. 2000. Malaria in the United Republic of Tanzania: Cultural considerations and health-seeking behaviour. Bulletin of the World Health Organization 78(11):1352-1357.


Tanzania Essential Health Interventions Project, Ministry of Health of Tanzania. 2002. Burden of Disease Profile 2001—Coastal Zone. Dar es Salaam: Ministry of Health of Tanzania.



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