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Table 3 Summaries of statements made by different focus groups discussions (4 FGDs) with health workers about SP

From: How sulfadoxine-pyrimethamine (SP) was perceived in some rural communities after phasing out chloroquine (CQ) as a first-line drug for uncomplicated malaria in Tanzania: lessons to learn towards moving from monotherapy to fixed combination therapy

About SP Why switch to SP? How can the situation be improved? What's wrong with the media?
- Is a drug containing sulfadoxine and pyrimethamine.
- We know that some symptoms are caused by SP others not.
- Some mothers throw away SP tablets when we give them to administer for their sick children at home.
- So we decided to administer SP for all sick children at our facilities under supervision of a health worker.
- The drug delays relief of fever symptoms and people interpret it as side effects.
- We are not certain whether all these side effects being spoken about are really caused by SP or by other things? These rumours have created a lot of fear.
- It is true that SP causes skin rashes, itching, dizziness, headache and some body weakness. However, some people who are allergic to SP may react badly even die if no immediate help is given.
- The number of people using SP at our facilities is decreasing daily and as a result we are left with a lot of SP drugs every month.
- People claim to get side effects and even leading to sores, loss of appetite, skin colour changes to black as a charcoal in some individuals.
- Those who are given SP and they throw away they usually come back the next day or after two days complaining of malaria and that SP did not work.
- We try to educate and convince them about the drug, but some clients are difficult to understand
-People think that we are forcing them to use SP.
- People believe that as health workers we know everything of what is going on about the drug whether it is being on trial or not.
- When patients come to the facility, they choose the doctor they want if we happen to be two or more because they would like to be attended by some one they know they can convenience not to be prescribed SP.
- Some of them lie that I am allergic to SP so that they can be prescribed an alternative drug.
- Some Members of Parliament have also contributed to people's fear about SP because they have been questioning the Minister for Health about this drug during the parliament session.
-Some patients do not seem to trust the water we give them to swallow with the drug for their under-five children.
- Member of Parliament and other ordinary people should be educated about this drug.
- Some patients we see suggest to us that the sulphur content should be reduced from SP as they think this is the one which is causing all the side effects and making also the drug strong
- Others suggest that chloroquine should be brought back in use.
- The Ministry of Health should do more research to find out why the drug is too strong or what makes it be strong and other side effects – The drug needs to be taken together with Paracetamol which is an antipyretic to help reduce the fever.
- Educate the news writers or reporters about the drug so that they write proper messages.
- Families need counseling especially those who experience or had experienced SP side effects.
- Patients who get skin problems as a result of SP we give them hydrocortisone.
- We repeat the dose if the patient returns to us complaining of no improvement for the first time since we last gave SP.
- The sulphur content should be investigated more by experts.
- SP should remain in use but be improved.
- Patients should eat and drink a lot of water when taking or after have taken the drug.
- Less educated news writers magnify stories with SP side effects.
- These SP stories through media have caused a lot of fear and negative perception about the drug in the general population.
- Radio report that SP kills and some newspaper displays pictures of affected individuals and hence causing more fear to people when they see.
- Radio and newspaper are most of the time broadcasting problems related to SP with is not based on truth and no positive images about the drug.