Assessment of availability of antimalarials and providers’ knowledge on malaria and antimalarials in private pharmaceutical outlets of Bushenyi District

Abstract

Introduction: Malaria is the leading cause of morbidity and mortality and the cause of significant economic losses in Uganda and Bushenyi District. As a response to increasing levels of antimalarial resistance National malaria treatment policy was changed in 2004. Better quality efficacious but expensive ACTs replaced cheaper Chloroquine and sulfadoxine/pyrimethamine as the first line treatment of malaria. Private pharmaceutical outlets serve up to 70% of medicine requirements in Uganda. Little is known about the availability of antimalarials and providers knowledge on malaria and antimalarials in private pharmaceutical outlets of Bushenyi district more particularly after the malaria treatment policy change. Objective: To assess the availability and cost of antimalarials as well as to examine providers’ knowledge of malaria and antimalarials in private pharmaceutical outlets of Bushenyi districtin order to identify the likely public health implications, and opportunities for policy interventions for improved access to effective treatment of malaria. Methods: A descriptive cross-sectional study, using structured questionnaires, covering all registered private pharmaceutical outlets in Bushenyi district was conducted in January and February 2009. Statistical Package for Social Sciences (SPSS) 11.5 and EPI Info 3.2 computer software were used to generate frequency tables on availability, price and providers’ knowledge of malaria and antimalarial medicines. Text, tables and figures were used to present proportions of pharmaceutical outlets against the above variables. Results: All the 148 pharmaceutical outlets that completed the interview had antimalarials in stock on the day of the interview. Thirty one outlets (21%) had ACTs. The main reasons for pharmaceutical outlets having no stocks of ACTs were the perceived high cost of ACTs and lack of demand by customers. Artemether (monotherapy) was the most expensive antimalarial with mean price of UGX 16,277 (sd 4,198), followed by ACTs with mean price of UGX 13,125 (sd 2,093). The cheapest antimalarial drug was chloroquine with mean price of UGX 833 (sd 208). Majority (93.2%) of the pharmaceutical outlets reported dispensing drugs on credit. About half of the private providers (76/148; 51%) believed ACTs were most effective antimalarials and 41.9% of providers knew ACTs as the recommended 1st line treatment for uncomplicated malaria. While 33.8% of the providers knew the correct dosage of ACTs 21% stocked ACTs and only 18.2% recommended the use of ACTs. An antimalarial medicine being more profitable (85.1%) and with consumer demand (81.1%) were the most commonly stated reasons for deciding antimalarials dispensed by outlet providers to their clients. Conclusions: While all the pharmaceutical outlets had stock of antimalarials, only a small proportion stocked ACTs. Provider knowledge about the recommended first line treatment for malaria was low and their decisions for choice of antimalarials to dispense were influenced by profit margins and consumer demand. Recommendations: Uganda Government should identify mechanisms to increase availability of ACTs in the private sector. Bushenyi District together with the Ministry of Health partners should actively involve providers in private pharmaceutical outlets in trainings and access to information on malaria and antimalarials in accordance with the National policy on malaria treatment. Efforts to limit or even ban importation, stocking and dispensing artemisinin monotherapies, non-artemisinin monotherapies and non-artemisinin combination therapies should be strengthened.