objective To investigate the variation in malaria parasitaemia, reported fever, care seeking,
antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the
implications for ensuring equitable and appropriate use of antimalarial combination therapy.
methods A total of 2500 households were surveyed in three rural districts in southern Tanzania in
mid-2001. Blood samples and data on SES were collected from all households. Half the households
completed a detailed questionnaire on care seeking and treatment costs. Households were categorised
into SES thirds based on an index of household wealth derived using principal components analysis.
results Of individuals completing the detailed survey, 16% reported a fever episode in the previous
2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly
more likely to obtain antimalarials than those in the middle or poor stratum. The better
treatment obtained by the better off led them to spend two to three times more than the middle and poor
third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were
the most expensive source of care, and higher expenditure at NGO facilities and drug stores.
conclusion The coverage of appropriate malaria treatment was low in all SES groups, but the two
poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy,
distribution must be targeted to ensure that the poorest groups fully benefit from these new and
highly effective medicines.