Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys.
OBJECTIVE
To describe the state of the public and private malaria diagnostics market shortly after WHO updated its guidelines for testing all suspected malaria cases prior to treatment.


METHODS
Ten nationally representative cross-sectional cluster surveys were conducted in 2011 among public and private health facilities, community health workers and retail outlets (pharmacies and drug shops) in nine countries (Tanzania mainland and Zanzibar surveyed separately). Eligible outlets had antimalarials in stock on the day of interview or had stocked antimalarials in the past 3 months.


RESULTS
Three thousand four hundred and thirty-nine rapid diagnostic test (RDT) products from 39 manufacturers were audited among 12,197 outlets interviewed. Availability was typically highest in public health facilities, although availability in these facilities varied greatly across countries, from 15% in Nigeria to >90% in Madagascar and Cambodia. Private for-profit sector availability was 46% in Cambodia, 20% in Zambia, but low in other countries. Median retail prices for RDTs in the private for-profit sector ranged from $0.00 in Madagascar to $3.13 in Zambia. The reported number of RDTs used in the 7 days before the survey in public health facilities ranged from 3 (Benin) to 50 (Zambia).


CONCLUSIONS
Eighteen months after WHO updated its case management guidelines, RDT availability remained poor in the private sector in sub-Saharan Africa. Given the ongoing importance of the private sector as a source of fever treatment, the goal of universal diagnosis will not be achievable under current circumstances. These results constitute national baselines against which progress in scaling-up diagnostic tests can be assessed.
Malaria & Child Survival Department, Population Services International, Nairobi, Kenya.
Stephen
S
Poyer
Tanya
T
Shewchuk
Sarah
S
Tougher
Yazoume
Y
Ye
Andrea G
AG
Mann
Barbara A
BA
Willey
Rebecca
R
Thomson
John H
JH
Amuasi
Ruilin
R
Ren
Marilyn
M
Wamukoya
Mark
M
Taylor
Samuel Blay
SB
Nguah
Blessing
B
Mberu
Admirabilis
A
Kalolella
Elizabeth
E
Juma
Charles
C
Festo
Boniface
B
Johanes
Graciela
G
Diap
Katia
K
Bruxvoort
Daniel
D
Ansong
Kara
K
Hanson
Fred
F
Arnold
Catherine
C
Goodman
D000349:Africa; D001208:Asia; D003132:Commerce; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000191:economics*; D019353:Endemic Diseases; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D017149:Private Sector / Q000191:economics*; D017150:Public Sector / Q000191:economics*
Africa; Afrique; Malaria; malaria; paludisme; private sector; pruebas diagnósticas rápidas; public sector; rapid diagnostic tests; secteur privé; secteur public; sector privado; sector público; tests de diagnostic rapide; África