Governments in Africa are beginning to deploy expensive combination treatments for malaria, still the most frequent cause of childhood death on the continent. It is not clear whether these drugs should be made as widely available as possible through public and private sector channels where they can be easily obtained, or if they should be restricted to formal health facilities where their use can be regulated. Phase one (Year 1) of this work will complete an evaluation of the public health impact of delivering these medicines at health facilities only. In Phase two (Years 2-5), we propose to: 1. Compare morbidity & mortality benefits derived from either a community- or a facility-based management strategy for febrile illness, 2. Compare cost- effectiveness and other economic indicators of a community- or facility-based management strategy for febrile illness, 3. establish the effect of ACT deployment strategy on development/ spread of drug resistance, and 4. Compare sociobehavioral and policy indicators and implications of febrile illness and other common illnesses, especially pneumonia. This proposed evaluation will provide evidence needed to maximize the public health benefit that the introduction of these new medicines can effect. The evaluation will contribute directly to priority areas identified by CDC in """"""""Protecting the Nation's Health in an Era of Globalization"""""""", namely: 1. applied research on diseases of global importance, 2. application of proven public health tools, 3. global initiatives for disease control, and 4. public health training and capacity building. The overall research design is a population level comparison of the two strategies implemented as effectively as possible in a 3 district area in Tanzania. Unlike experimental research, this work will examine the two strategies in realistic settings of public health service provision in Africa. It relies on public and private sector partnership as well as linking public health practice with clinical recommendations and regulatory implementation. The evaluation is strengthened by a design that seeks evidence from multiple scientific disciplines in order to establish an adequate base of evidence.
