title: Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved?
abstract: Medicine sellers are widely used for fever and malaria treatment in sub-Saharan Africa, but concerns surround the appropriateness of drugs and information provided. Because there is increasing interest in improving their services, we reviewed the literature on their characteristics and interventions to improve their malaria-related practices. Sixteen interventions were identified, involving a mixture of training/capacity building, demand generation, quality assurance, and creating an enabling environment. Although evidence is insufficient to prove which approaches are superior, tentative conclusions were possible. Interventions increased rates of appropriate treatment, and medicine sellers were willing to participate. Features of successful interventions included a comprehensive situation analysis of the legal and market environment; buy-in from medicine sellers, community members and government; use of a combination of approaches; and maintenance of training and supervision. Interventions must be adapted to include artemisinin-based combination therapies, and their sustainability and potential to operate at a national level should be further explored.
authors.affiliation: Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom. catherine.goodman@lshtm.ac.uk
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
authors.forename: William
authors.initials: W
authors.lastname: Brieger
authors.forename: Alasdair
authors.initials: A
authors.lastname: Unwin
authors.forename: Anne
authors.initials: A
authors.lastname: Mills
authors.forename: Sylvia
authors.initials: S
authors.lastname: Meek
authors.forename: George
authors.initials: G
authors.lastname: Greer
mesh_terms: D017954:Africa South of the Sahara; D000962:Antimalarials / Q000191:economics / Q000592:standards*; D003157:Community Pharmacy Services / Q000592:standards*; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000191:economics; D004366:Nonprescription Drugs / Q000191:economics / Q000592:standards*; D012651:Self Medication / Q000379:methods
chemical_list: D000962:Antimalarials; D004366:Nonprescription Drugs