Malaria treatment in the retail sector: knowledge and practices of drug sellers in rural Tanzania.
BACKGROUND
Throughout Africa, the private retail sector has been recognised as an important source of antimalarial treatment, complementing formal health services. However, the quality of advice and treatment at private outlets is a widespread concern, especially with the introduction of artemisinin-based combination therapies (ACTs). As a result, ACTs are often deployed exclusively through public health facilities, potentially leading to poorer access among parts of the population. This research aimed at assessing the performance of the retail sector in rural Tanzania. Such information is urgently required to improve and broaden delivery channels for life-saving drugs.


METHODS
During a comprehensive shop census in the districts of Kilombero and Ulanga, Tanzania, we interviewed 489 shopkeepers about their knowledge of malaria and malaria treatment. A complementary mystery shoppers study was conducted in 118 retail outlets in order to assess the vendors' drug selling practices. Both studies included drug stores as well as general shops.


RESULTS
Shopkeepers in drug stores were able to name more malaria symptoms and were more knowledgeable about malaria treatment than their peers in general shops. In drug stores, 52% mentioned the correct child-dosage of sulphadoxine-pyrimethamine (SP) compared to only 3% in general shops. In drug stores, mystery shoppers were more likely to receive an appropriate treatment (OR = 9.6), but at an approximately seven times higher price. Overall, adults were more often sold an antimalarial than children (OR = 11.3). On the other hand, general shopkeepers were often ready to refer especially children to a higher level if they felt unable to manage the case.


CONCLUSIONS
The quality of malaria case-management in the retail sector is not satisfactory. Drug stores should be supported and empowered to provide correct malaria-treatment with drugs they are allowed to dispense. At the same time, the role of general shops as first contact points for malaria patients needs to be re-considered. Interventions to improve availability of ACTs in the retail sector are urgently required within the given legal framework.
Hetzel
Manuel W
MW
Dept. of Public Health and Epidemiology, Swiss Tropical Institute, PO Box, CH-4002 Basel, Switzerland. manuel.hetzel@unibas.ch
Dillip
Angel
A
Lengeler
Christian
C
Obrist
Brigit
B
Msechu
June J
JJ
Makemba
Ahmed M
AM
Mshana
Christopher
C
Schulze
Alexander
A
Mshinda
Hassan
H
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D019090:Case Management; D002648:Child; D003132:Commerce; D004522:Educational Status; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008288:Malaria / Q000188:drug therapy*; D010594:Pharmacies; D017064:Process Assessment, Health Care; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D013636:Tanzania
D000962:Antimalarials