title: Access to artesunate-amodiaquine, quinine and other anti-malarials: policy and markets in Burundi.
abstract: BACKGROUND
  Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To counter the increasing challenge of anti-malarial drug resistance and improve highly effective treatment Burundi adopted artesunate-amodiaquine (AS-AQ) as first-line treatment for uncomplicated Plasmodium falciparum malaria and oral quinine as second-line treatment in its national treatment policy in 2003. Uptake of this policy in the public, private and non-governmental (NGO) retail market sectors of Burundi is relatively unknown. This study was conducted to evaluate access to national policy recommended anti-malarials.
  
  
  METHODS
  Adapting a standardized methodology developed by Health Action International/World Health Organization (HAI/WHO), a cross-sectional survey of 70 (24 public, 36 private, and 10 NGO) medicine outlets was conducted in three regions of Burundi, representing different levels of transmission of malaria. The availability on day of the survey, the median prices, and affordability (in terms of number of days' wages to purchase treatment) of AS-AQ, quinine and other anti-malarials were calculated.
  
  
  RESULTS
  Anti-malarials were stocked in all outlets surveyed. AS-AQ was available in 87.5%, 33.3%, and 90% of public, private, and NGO retail outlets, respectively. Quinine was the most common anti-malarial found in all outlet types. Non-policy recommended anti-malarials were mainly found in the private outlets (38.9%) compared to public (4.2%) and NGO (0%) outlets. The median price of a course of AS-AQ was US$0.16 (200 Burundi Francs, FBu) for the public and NGO markets, and 3.5-fold higher in the private sector (US$0.56 or 700 FBu). Quinine tablets were similarly priced in the public (US$1.53 or 1,892.50 FBu), private and NGO sectors (both US$1.61 or 2,000 FBu). Non-policy anti-malarials were priced 50-fold higher than the price of AS-AQ in the public sector. A course of AS-AQ was affordable at 0.4 of a day's wage in the public and NGO sectors, whereas, it was equivalent to 1.5 days worth of wages in the private sector.
  
  
  CONCLUSIONS
  AS-AQ was widely available and affordable in the public and NGO markets of hard-to-reach post-conflict communities in Burundi. However greater accessibility and affordability of policy recommended anti-malarials in the private market sector is needed to improve country-wide policy uptake.
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, P,O, BOX KS 1934, Ghana. amuas001@umn.edu
authors.forename: John H
authors.initials: JH
authors.lastname: Amuasi
authors.forename: Graciela
authors.initials: G
authors.lastname: Diap
authors.forename: Samuel
authors.initials: S
authors.lastname: Blay-Nguah
authors.forename: Isaac
authors.initials: I
authors.lastname: Boakye
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Karikari
authors.forename: Baza
authors.initials: B
authors.lastname: Dismas
authors.forename: Jeanne
authors.initials: J
authors.lastname: Karenzo
authors.forename: Lievin
authors.initials: L
authors.lastname: Nsabiyumva
authors.forename: Karly S
authors.initials: KS
authors.lastname: Louie
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Kiechel
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002063:Burundi / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004363:Drug Utilization / Q000706:statistics & numerical data; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology*; D011803:Quinine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; D011803:Quinine