Malaria treatment in the retail sector: Knowledge and practices of drug sellers in rural Tanzania

Hetzel, Manuel W., Dillip, Angel, Lengeler, Christian, Obrist, Brigit, Msechu, June J., Makemba, Ahmed M., Mshana, Christopher, Schulze, Alexander and Mshinda, Hassan (2008) Malaria treatment in the retail sector: Knowledge and practices of drug sellers in rural Tanzania. BMC Public Health, 8 157: 1-11. doi:10.1186/1471-2458-8-157

Author Hetzel, Manuel W.
Dillip, Angel
Lengeler, Christian
Obrist, Brigit
Msechu, June J.
Makemba, Ahmed M.
Mshana, Christopher
Schulze, Alexander
Mshinda, Hassan
Title Malaria treatment in the retail sector: Knowledge and practices of drug sellers in rural Tanzania
Journal name BMC Public Health   Check publisher's open access policy
ISSN 1471-2458
Publication date 2008-05-09
Sub-type Article (original research)
DOI 10.1186/1471-2458-8-157
Open Access Status DOI
Volume 8
Issue 157
Start page 1
End page 11
Total pages 11
Place of publication London, U.K
Publisher BioMed Central
Language eng
Formatted abstract
Background: Throughout Africa, the private retail sector has been recognised as an important source of antimalarial treatment, complementing formal health services. However, the quality of advice and treatment at private outlets is a widespread concern, especially with the introduction of artemisinin-based combination therapies (ACTs). As a result, ACTs are often deployed exclusively through public health facilities, potentially leading to poorer access among parts of the population. This research aimed at assessing the performance of the retail sector in rural Tanzania. Such information is urgently required to improve and broaden delivery channels for life-saving drugs.

Methods: During a comprehensive shop census in the districts of Kilombero and Ulanga, Tanzania, we interviewed 489 shopkeepers about their knowledge of malaria and malaria treatment. A complementary mystery shoppers study was conducted in 118 retail outlets in order to assess the vendors' drug selling practices. Both studies included drug stores as well as general shops.

Results: Shopkeepers in drug stores were able to name more malaria symptoms and were more knowledgeable about malaria treatment than their peers in general shops. In drug stores, 52% mentioned the correct child-dosage of sulphadoxine-pyrimethamine (SP) compared to only 3% in general shops. In drug stores, mystery shoppers were more likely to receive an appropriate treatment (OR = 9.6), but at an approximately seven times higher price. Overall, adults were more often sold an antimalarial than children (OR = 11.3). On the other hand, general shopkeepers were often ready to refer especially children to a higher level if they felt unable to manage the case.

Conclusion: The quality of malaria case-management in the retail sector is not satisfactory. Drug stores should be supported and empowered to provide correct malaria-treatment with drugs they are allowed to dispense. At the same time, the role of general shops as first contact points for malaria patients needs to be re-considered. Interventions to improve availability of ACTs in the retail sector are urgently required within the given legal framework.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Author's prepress title: "Malaria treatment in the retail sector: Drug sellers' knowledge and practices in rural Tanzania".

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 25 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 26 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 23 Sep 2011, 11:40:07 EST by Dr Manuel Hetzel on behalf of School of Public Health