Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1140405/full |
| _version_ | 1797858352429006848 |
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| author | Victoria Shelus Victoria Shelus Nobert Mumbere Edgar M. Mulogo Clare Barrington Clare Barrington Emmanuel Baguma Rabbison Muhindo James E. Herrington Michael Emch Michael Emch Michael Emch Suzanne Maman Ross M. Boyce Ross M. Boyce Ross M. Boyce |
| author_facet | Victoria Shelus Victoria Shelus Nobert Mumbere Edgar M. Mulogo Clare Barrington Clare Barrington Emmanuel Baguma Rabbison Muhindo James E. Herrington Michael Emch Michael Emch Michael Emch Suzanne Maman Ross M. Boyce Ross M. Boyce Ross M. Boyce |
| author_sort | Victoria Shelus |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T21:12:02Z |
| format | Article |
| id | doaj.art-74390da1331246aabb5d0d34686e9da2 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-09T21:12:02Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-74390da1331246aabb5d0d34686e9da22023-03-28T16:59:13ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-03-011110.3389/fpubh.2023.11404051140405Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural UgandaVictoria Shelus0Victoria Shelus1Nobert Mumbere2Edgar M. Mulogo3Clare Barrington4Clare Barrington5Emmanuel Baguma6Rabbison Muhindo7James E. Herrington8Michael Emch9Michael Emch10Michael Emch11Suzanne Maman12Ross M. Boyce13Ross M. Boyce14Ross M. Boyce15Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaDepartment of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaDepartment of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesInstitute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesBackgroundThe 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.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1140405/fullmalaria case managementmalaria diagnosisdrug shopsprivate health sectorrational drug use |
| spellingShingle | Victoria Shelus Victoria Shelus Nobert Mumbere Edgar M. Mulogo Clare Barrington Clare Barrington Emmanuel Baguma Rabbison Muhindo James E. Herrington Michael Emch Michael Emch Michael Emch Suzanne Maman Ross M. Boyce Ross M. Boyce Ross M. Boyce 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 malaria case management malaria diagnosis drug shops private health sector rational drug use |
| title | Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda |
| title_full | Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda |
| title_fullStr | Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda |
| title_full_unstemmed | Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda |
| title_short | Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda |
| title_sort | private sector antimalarial sales a decade after test and treat a cross sectional study of drug shop clients in rural uganda |
| topic | malaria case management malaria diagnosis drug shops private health sector rational drug use |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1140405/full |
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