Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Frontiers in Public Health

Public Health

Michael Emch¹  Ross M. Boyce²  Nobert Mumbere³  Edgar M. Mulogo³  Emmanuel Baguma³  Rabbison Muhindo³  James E. Herrington⁴  Suzanne Maman⁴  Clare Barrington⁵  Victoria Shelus⁵ 

[1] Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;

关键词: malaria case management;    malaria diagnosis;    drug shops;    private health sector;    rational drug use;   

DOI  :  10.3389/fpubh.2023.1140405

 received in 2023-01-09, accepted in 2023-03-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing.MethodsThe purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria.ResultsMost drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative.ConclusionsDespite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.

【 授权许可】

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Copyright © 2023 Shelus, Mumbere, Mulogo, Barrington, Baguma, Muhindo, Herrington, Emch, Maman and Boyce.