Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study

Abstract

This study investigated unlicensed drug outlets' practices for the management of malaria in the rural district of Butaleja, Uganda. A qualitative design using semistructured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education, but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy (ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed vendors to improve the management of childhood malaria.

Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study

“…In some instances, many purchased only partial treatment regimens because this is all that they could afford. Consequently, in Butaleja District where the majority of informal outlets are managed by untrained vendors and have unreliable ACT stocks, case management routinely falls short of the national malaria treatment guidelines 5,25,27,50,60,61. Despite the government’s assurance of free access to diagnostics and medications at public facilities, this and other studies demonstrate that national policies in many such regions are not translated at the community level 5,23,25,43,47,53,62,63.…”

“…While not yet implemented in Butaleja, some districts in Uganda have a network of level I HCs comprised of volunteer CHWs at the village level trained to deliver integrated community case management (iCCM) (K Mweru, MD, District Officer, personal communication, April 2011). With no pharmacies and a few licensed drug shops located mainly in town centers and market areas, many households are reliant on the predominant informal (unlicensed) drug outlets for health care and western medicines 23,25,27. For the purpose of this study, informal retail drug outlets are defined as mobile or stationary commercial settings, such as markets and shops, which sell antimalarials but are not registered with any government regulatory body and operate outside the purview of regulation, registration, or oversight by the government or other health or professional institutions 28…”

“…While anecdotal data suggests this measure improved malaria case management, as with other CHW programs, this initiative was unsustainable due to the lack of government funding and support. In Butaleja where there are no pharmacies, licensed private drug shops are scarce, the private clinics unaffordable, and a sustainable model of iCCM yet to be implemented, households continue to rely on the informal (unlicensed) private sector which makes up approximately 82% of the private-for-profit drug outlets 27,29-31. To-date, there is limited literature on key challenges and influencing factors at the community and household level in Butaleja to inform sustainable solutions that can translate health policies into practice.…”

Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening

“…The availability of quality medicines is critical for promoting trust among users and improving health outcomes. A study by [ 30 ] showed that there are more 84.3% PFP provider drug outlets compared to 13.0% public providers. Many of these PFP facilities are unlicensed and unsupervised by the relevant authorities [ 12 ].…”

Formal and informal medicine retailers in Sub-Saharan Africa: a scoping review of research trends

“…45,50,51 Several recommendations are suggested, such as: the provision of continuing training, supervision, and monitoring from the government; an enhanced collaboration with healthcare workers (including for referrals); a greater compliance with national policies and guidelines that also need to be better disseminated; a better access to proper information; and the need for community awareness whose demand is a strong determinant of medicine retailers' service provision practices. [52][53][54][55][56][57][58][59][60] Two other focuses reinforce the attention paid to medicine retailers within the health systems: profession and regulation, and impact studies. With 79 studies, these two focuses accounted for approximately a quarter of the included studies (27%).…”