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      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 30

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          Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved?

          Medicine sellers are widely used for fever and malaria treatment in sub-Saharan Africa, but concerns surround the appropriateness of drugs and information provided. Because there is increasing interest in improving their services, we reviewed the literature on their characteristics and interventions to improve their malaria-related practices. Sixteen interventions were identified, involving a mixture of training/capacity building, demand generation, quality assurance, and creating an enabling environment. Although evidence is insufficient to prove which approaches are superior, tentative conclusions were possible. Interventions increased rates of appropriate treatment, and medicine sellers were willing to participate. Features of successful interventions included a comprehensive situation analysis of the legal and market environment; buy-in from medicine sellers, community members and government; use of a combination of approaches; and maintenance of training and supervision. Interventions must be adapted to include artemisinin-based combination therapies, and their sustainability and potential to operate at a national level should be further explored.
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            What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

            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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              Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts.

              Malaria remains one of the leading health problems of the developing world, and Uganda bears a particularly large burden from the disease. Our understanding is limited by a lack of reliable data, but it is clear that the prevalence of malaria infection, incidence of disease, and mortality from severe malaria all remain very high. Uganda has made progress in implementing key malaria control measures, in particular distribution of insecticide-impregnated bednets, indoor residual spraying of insecticides, utilization of artemisinin-based combination therapy to treat uncomplicated malaria, and provision of intermittent preventive therapy for pregnant women. However, despite enthusiasm regarding the potential for the elimination of malaria in other areas, there is no convincing evidence that the burden of malaria has decreased in Uganda in recent years. Major challenges to malaria control in Uganda include very high malaria transmission intensity, inadequate health care resources, a weak health system, inadequate understanding of malaria epidemiology and the impact of control interventions, increasing resistance of parasites to drugs and of mosquitoes to insecticides, inappropriate case management, inadequate utilization of drugs to prevent malaria, and inadequate epidemic preparedness and response. Despite these challenges, prospects for the control of malaria have improved, and with attention to underlying challenges, progress toward the control of malaria in Uganda can be expected. Copyright © 2011 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                510.284.7002 , ltwang@ucsd.edu
                Journal
                Malar J
                Malar. J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                22 August 2018
                22 August 2018
                2018
                : 17
                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
                Article
                2454
                10.1186/s12936-018-2454-7
                6106765
                30134987
                © The Author(s) 2018

                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.

                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 :
                Funded by: FundRef http://dx.doi.org/10.13039/100007911, University of California, San Diego;
                Award ID: Global Health Academic Concentration
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

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