0 Recommendations

How do do they get parenteral antimalaria drugs? Private sector drug shops frequently dispense parenteral anti-malarials in a rural region of Western Uganda

By Pierre Bush, PhD Moderator | 27 Aug, 2018

Dear Colleagues,
Would you like to discuss this issue? How do unregulated drug shops get parenteral anti-malaria drugs?It appears that in western Uganda, people who are feeling ill and suspect that they have malaria can purchase parenteral antimalaria drugs in unregulated drug shops!

See below Wang & Bwambale et al. (2018).

Abstract:
Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria.
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.
 
Country:
Uganda.
Medical Treatment:
anti malarials




Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria.
 
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.
 
Country:
Uganda.
Medical Treatment:
anti malarials

Attached resource:

Replies

 

Ahishakiye Alain Replied at 10:11 PM, 27 Aug 2018

Ihis is an interesting article. To control the drug management for good efficiency as we do in Rwanda where I'm working is something to considere. Many thanks dear Senior Dr Pierre Bush.

Pierre Bush, PhD Moderator Replied at 10:40 PM, 27 Aug 2018

Yes Alain:
I am sure that in Rwanda there is no way a person can buy an injectable anti-malarial medicine without a medical prescription. I am equally certain that all the stores (pharmacies and drug stores) are acredidated/regulated. Something the northen neighbors should copy from you. Otherwise, eliminating malaria will be a long shot in the great lakes region.
Thank you for your quick contribution.

Seraphine Adibaku Replied at 3:47 AM, 28 Aug 2018

There are a myriad of issues that need to e addressed regarding the
revelations in this study. These include licencing and regulation,
inspection and supervision as well as staffing of the drug shops.
The National Drug Authority (NDA) in Uganda has the mandate of inspection,
licencing and regulation of the pharmaceutical industry. However staffing
of NDA is very thin and rural parts of the country largely fall short of
the required services of NDA. The lowest deployment of staff of NDA are at
regional level covering 10 or more districts. At the district level those
functions are delegated to a District Assistant Drugs Inspector (DADI) a
role often assigned to a dispenser of a general hospital or Heath Centre IV
by the District Health Officer; who affords very little time for those
delegated functions. As a result numerous drug shops operate without
licensing and outside the required regulations including daily operations
being handled by unqualified persons. Even where there is a qualified
person officially registered as the supervisor of the drug shop such a
person is in most cases a full time staff of a health facility in the area
and has no time to attend to the daily operations. These are the underlying
weaknesses leading to such findings as in this study. The Drug shops obtain
their drug supplies majorly from registered pharmacies found mainly in the
cities. These pharmacies driven by the desire to sell and make profits sell
anything they have in stock without any restrictions as to who or what
facility they are selling to. To a lesser extent some illegal drug inflows
may come through pilferage from the public facilities where the majority of
supervisors/owners of the drug shops are officially employed or sold to the
drug shops by those who pilfer the items.
While the study indicates drug shops as the major source where respondents
purchased parenteral antimalarials it is also a fact that very often the
drug shops actually administer these parenterals to patients against all
regulations.
This is just one of the numerous challenges faced by the health system in
Uganda and a holistic approach to fixing all the health system domains is
called for.

--
*Dr. Seraphine Adibaku*

*Public Health Specialist & Malaria ExpertPlot 661 Kabuuka Road,
Bukasa-Muyenga, Kampala.*
Plot 19 Opiro Road, Moyo Town Council.
P.O. Box 279, Moyo, Uganda.
Tel: +256 772507245/ 753507245.
Email:

Skype: seraphine.adibaku1

"*It always seems impossible until it's done*" - N.R. Mandela

pascal verhoeven Replied at 9:06 AM, 28 Aug 2018

Here is where the spanner goes into the works: "....*District Assistant
Drugs Inspector (DADI) a **role often assigned to a dispenser of a general
hospital or Health Centre IV **by the District Health Officer*"
The latter [DHO] is probably accountable in the system to the minister for
the very tangible availability of (affordable/cheap) medicines to
population and not accountable for the, less tangible quality.

the best deterrent agains poor quality meds is making quality medicines
available in the facilities at all times. Which is in Uganda the mandate of
the National Meds Stores if i am correct,

p.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.