Private sector drug shops frequently dispense parenteral anti-malarials in a rural region of Western Uganda

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Abstract

Background

Malaria is a leading cause of paediatric morbidity and mortality in Uganda. More than half of febrile children in rural areas initially seek care at private clinics and drug shops. These shops are generally unregulated and the quality of clinical care is variable, with the potential for misdiagnosis and the development of drug resistance. There is thus an urgent need to identify rural drug shops and coordinate their malaria treatment efforts with those of the public sector. The objective of the study was to identify all drug shops in the Bugoye sub-county of Western Uganda and assess their anti-malarial dispensing practices.

Methods

This study is a cross-sectional survey of drug shops in a rural sub-county of Western Uganda. In the first phase, shop locations, licensing and shopkeeper’s qualifications, and supply and pricing of anti-malarials were characterized. In the second phase, the proportion of anti-malarials dispensed by private drug shops was compared to public health facilities.

Results

A total of 48 drug shops were identified. Only one drug shop (1 of 48, 2%) was licensed with the sub-county’s records office. The drug shops stocked a variety of anti-malarials, including first-line therapies and less effective agents (e.g., sulfadoxine/pyrimethamine). Almost all drug shops (45 of 48, 94%) provided parenteral anti-malarials. Of the 3900 individuals who received anti-malarials during the study, 2080 (53.3%) purchased anti-malarials through the private sector compared to 1820 (46.7%) who obtained anti-malarials through the public sector. Drug shops were the primary source of parenteral anti-malarials. Inadequate dosing of anti-malarials was more common in drug shops.

Conclusions

Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria. Strengthening malaria case management and incorporating drug shops in future interventions is necessary to optimize malaria control efforts in the sub-county, and in similarly endemic regions.

Electronic supplementary material

The online version of this article (10.1186/s12936-018-2454-7) contains supplementary material, which is available to authorized users.

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Most cited references 22

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What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

May Sudhinaraset, Matthew Ingram, Heather Lofthouse … (2013)

Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed.

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Utilization of public or private health care providers by febrile children after user fee removal in Uganda

Elizeus Rutebemberwa, George Pariyo, Stefan Peterson … (2009)

Background Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five. Methods Structured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga – Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics. Results Of those who sought care outside the home, 62.7% (286/456) had first gone to drug shops/private clinics and 33.1% (151/456) first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10 – 3.89) and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84 – 18.26) or experienced (OR 1.93; 95% CI 1.07 – 3.48). Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08 – 0.52). Conclusion Private providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.

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Private and public health care in rural areas of Uganda

Joseph Konde-Lule, Sheba Gitta, Anne Lindfors … (2010)

Background In many low and middle income countries, the private sector is increasingly becoming an important source of health care, filling gaps where no or little public health care is available. However, knowledge on the private sector providers is limited The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda. Methods The study was carried out in three rural districts. Methods included (1) mapping of health care providers; (2) a household survey to determine morbidity and health care utilization; (3) a health facility survey to assess quality of care; (4) focus group discussions to get qualitative information on providers and provider choice; and (5) key informant interviews to further explore service characteristics. Results 95.7% of all 445 facilities surveyed were private while 4.3% were public. Traditional practitioners and general merchandise shops that sold medicines comprised 77.1% of all providers. They had limited infrastructure and skills but were often located in the villages and therefore easily accessible. Among the formal providers there were 4 times as many private for profit providers than public, 76 versus 18. However, most of the private units were one-person drug shops. In the household survey, 2580 persons were interviewed. 1097 (42%) had experienced illness during the preceding month. Care was sought in 54.1% of the cases. 35.6% were given self-treatment and in 10.3% no action was taken. Of the episodes for which people sought care at a health care facility, 37.0% visited a public health care provider, 39.7% a for profit provider, 11.8% a private not for profit provider, and 10.6% a traditional practitioner. Private for profit facilities were the most popular for ambulatory health care, while public facilities were preferred for more serious conditions and for hospitalization. Traditional practitioners were many but saw relatively few patients. They were mostly used for social problems and limited medical specific conditions. Conclusions Private providers play a major role in health care delivery in rural Uganda; reaching a wide client base. Traditional practitioners are many but have as much a social as a medical function in the community. The significance of the private health care sector points to the need to establish a policy that addresses quality and affordability issues and creates a strong regulatory environment for private practice in sub-Saharan Africa.

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Author and article information

Contributors

Lawrence T. Wang:

ORCID: http://orcid.org/0000-0002-8026-8044

510.284.7002 , ltwang@ucsd.edu

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar. J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 22 August 2018

Publication date PMC-release: 22 August 2018

Publication date Collection: 2018

Volume: 17

Electronic Location Identifier: 305

Affiliations

[1 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, School of Medicine, , University of California San Diego, ; 9500 Gilman Drive, La Jolla, CA 92093 USA

[2 ]GRID grid.415705.2, Bugoye Level III Health Centre, , Uganda Ministry of Health, ; Bugoye, Kasese District, Western Region Uganda

[3 ]ISNI 0000000122483208, GRID grid.10698.36, Department of Geography, , University of North Carolina at Chapel Hill, ; Campus Box 3220, Chapel Hill, NC 27599 USA

[4 ]ISNI 0000000122483208, GRID grid.10698.36, Division of General Medicine & Clinical Epidemiology, , University of North Carolina at Chapel Hill, ; 5039 Old Clinic Building, CB 7110, Chapel Hill, 27599 USA

[5 ]ISNI 0000 0001 0232 6272, GRID grid.33440.30, Department of Community Health, , Mbarara University of Science & Technology, ; P.O. Box 1410, Mbarara, Uganda

[6 ]ISNI 000000041936877X, GRID grid.5386.8, Department of Emergency Medicine, , Weill Cornell Medical College, ; 525 East 68th Street, New York, NY 10065 USA

[7 ]ISNI 0000000122483208, GRID grid.10698.36, Division of Infectious Diseases, , University of North Carolina at Chapel Hill, ; 130 Mason Farm Road, Chapel Hill, NC 27599 USA

Author information

Lawrence T. Wang http://orcid.org/0000-0002-8026-8044

Article

Publisher ID: 2454

DOI: 10.1186/s12936-018-2454-7

PMC ID: 6106765

PubMed ID: 30134987

SO-VID: e44df090-36e7-49ff-8830-769aa0ad4731

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 February 2018

Date accepted : 10 August 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: T32 AI007151

Award ID: K23 MH111409

Award Recipient : Radhika Sundararajan Ross M. Boyce

Funded by: FundRef http://dx.doi.org/10.13039/100007911, University of California, San Diego;

Award ID: Global Health Academic Concentration

Award Recipient : Lawrence T. Wang

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria,health-seeking behaviors,private sector,anti-malarials,parenteral drugs

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria, health-seeking behaviors, private sector, anti-malarials, parenteral drugs

Private sector drug shops frequently dispense parenteral anti-malarials in a rural region of Western Uganda

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SDG 3: Good Health and Well-Being

Most cited references 22

What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

Utilization of public or private health care providers by febrile children after user fee removal in Uganda

Private and public health care in rural areas of Uganda

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