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Social-economic factors, poor childhood upbringing and position of the regionbeing the gateway to other destinations in and outside the country which makes it easy to access drugs have all been cited as some of the reasons which are contributing to the problem. Currently, there are over beneficiaries attending these two centers at Tumbi center and other at Bagamoyo center. Victor Noah, In charge of Tumbi MAT Clinic says that the treatments in these clinics are delivered through directly observed therapy DOT , whereby beneficiaries are required to attend clinic daily to take medications. Individuals mostly enrolled for SUD treatments at MAT clinics are those around years of age though there are those who start engaging in drugs use as early as12 to 19 years of age. Apart from receiving treatment for drug addiction, beneficiaries are also receiving free vaccination for Covid Possibility of being infected with these diseases for individuals who are already in substance use is very high due to their tendency of sharing injections they use while taking drugs, which increases the risk of them being infected. Pre- MAT information and counselling to individuals who are already in opioid use disorder. The journey to fully recovering from substance use disorders usually take up to three years, and during this time most of the individuals face a lot of challenges including stigma from the society, and in some cases from people within their own families. This challenge has been one of the reasons for the beneficiaries to quit medications and return to addiction. This group needs psychological support and close supervision to enable them to remain in medications to full recovery. She says there is still negative perception on the use of Methadone treatments from their family members since they believe that the medications will result in them being infertile and even cause death. Social Workers conduct family therapy and reunions as well as visiting the families where necessary. There is also psychosocial therapy and counselling conducted individually and in groups to enhance the importance of behavioral change and adherence to Methadone treatments. In addition to that, all clients are linked back to CSOs for Methadone Anonymous sessions twice a week , psychosocial therapy and counselling, engaging into Income Generating Activities IGA , family therapy and home visits as well as other activities which help in continuum of care. Highlighting on the success of the project, he mentions that by December , retention at both Tumbi and Bagamoyo MAT clinics has remained above 74 percent. On the other hand, over beneficiaries were reunited with their families and have resumed their livelihood activities. In addition to that, on average each CSO enrolled a total of 32 clients and managed to trace back 20 defaulters per month. John Roman says the project also focuses on preventing the problem of SUD within communities and not treating individuals who are already affected alone. Hellen Swai, a Social Worker at Tumbi MAT clinic says that stable clients are encouraged to enhance their educational level to be able to employ themselves or get employed. In addition to that, with the help from the project, a total of 7 groups from beneficiaries were able to access loans released by the District Council. She testifies how being enrolled at the clinic has totally changed her life. We used to steal and assault people and force them to give us money. I used to go missing from home for a number of days and my family members totally lost hope in me. I was in and out of medications for quite a long time, which made me delay to recover. It was until I was enrolled at the MAT Tumbi clinic about two years ago that I started to be faithful in taking the medications and I started to recover. Being a past defaulter herself, she is now working with the project to trace defaulters and encouraging them to return to the clinics. Related Articles. Develop courses that meets market demand- Mwinyi 18 hours ago. Bunge committee urges lab, pharmacy services quality 3 days ago. Close Search for. Close Log In.

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

Bagamoyo buying Ecstasy

Official websites use. Share sensitive information only on official, secure websites. 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. During a comprehensive shop census in the districts of Kilombero and Ulanga, Tanzania, we interviewed shopkeepers about their knowledge of malaria and malaria treatment. A complementary mystery shoppers study was conducted in retail outlets in order to assess the vendors' drug selling practices. Both studies included drug stores as well as general shops. Shopkeepers in drug stores were able to name more malaria symptoms and were more knowledgeable about malaria treatment than their peers in general shops. 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. 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. Treatment-seeking behaviour for malaria in sub-Saharan Africa is complex, often involving several steps and actors, depending on the local health system, society and culture \[ 1 , 2 \]. As a result of poor access to and often poor performance of formal health services, presumptive treatment of malaria episodes at home has become a widespread option \[ 3 , 4 \]. The home-management of malaria HMM strategy of the WHO is promoting interventions to improve antimalarial drug use outside the formal health services as a complementary option to improve access to prompt and effective treatment at community level \[ 5 \]. In most places, the private retail sector has been identified as an important source of drugs close to people's homes \[ 6 - 8 \]. However, the regimens dispensed by private retailers are often inadequate with regard to the type of drug and their dosage \[ 9 - 11 \]. In order to increase community-wide effectiveness of antimalarial treatment, the popularity of home-management and the quality of treatment obtained from commercial shops need to be better addressed. Considerable improvement in case-management has been shown to be possible as a result of training private retailers in general shops \[ 12 \] and in drug stores \[ 13 \]. In Tanzania, the private retail sector plays a central role in the provision of malaria treatment, partly complementing health facility services where these are unable to deliver \[ 14 \]. Yet, poor quality of care, shortage of skilled providers, stock-outs of essential drugs, and long waiting times \[ 16 , 17 \] may drive patients to seek care or at least buy drugs from more expensive non-governmental facilities, or from shops. The Tanzanian retail sector for drugs includes two types of licensed drug stores as well as general shops. Fully-fledged pharmacies are allowed to sell all prescription medicines and need to be headed by a pharmacist. Part II drug stores in Swahili: Duka la Dawa Baridi need to be headed by a person with basic medical or health-related training and can be found in towns and larger villages. In practice however, they dispense a much wider variety of medicines. This usually includes certain antimalarials, all of which are prescription-only medicines except for oral amodiaquine \[ 19 \]. In , registered part II drug stores were operating in Tanzania \[ 18 \]. The legal situation regarding drug sales in general shops was unclear \[ 20 \]. It appeared that, while they were not allowed to stock any drugs, they were often selling common OTC medicines, such as painkillers Figure 1. Examples of a part II drug store left and a general shop right. Both shop types are providers of malaria treatment in rural Tanzania. The studies presented here made use of selected key indicators in a mixed methods approach to compare factual knowledge with every-day practices of private drug retailers in treating cases of malaria in two Tanzanian districts. The research aimed to provide an assessment of the quality of malaria case-management in shops in order to inform interventions targeted at the retail sector. We included retailers in drug stores as well as general shops in order to get a comprehensive picture of the quality of treatment and advice that can be obtained from shops. This information is particularly important in the light of ongoing discussions on suitable distribution channels for artemisinin-based combination therapies ACT. The studies were carried out within the frame of a project to improve access to prompt and effective malaria treatment in rural Tanzania ACCESS Programme \[ 21 \]. A systematic shop census and a complementary study using mystery shoppers were conducted in the districts of Kilombero and Ulanga, Morogoro Region, south-eastern Tanzania. The mid population of the DSS was 74, and Ifakara had a population of 45, in the population census \[ 23 \]. Malaria is highly endemic in the area, accounting for roughly half of all outpatient visits in rural health facilities. The study area is described in more detail elsewhere \[ 21 \]. Previous studies in the same setting found a range of easily accessible commercial outlets frequently selling drugs for fever episodes \[ 8 \]. In , 29 part II drug stores and general shops stocking drugs were counted and chloroquine was found to be completely replaced on the market by sulphadoxine-pyrimethamine SP and amodiaquine \[ 24 \]. At the time of the surveys, SP was the recommended first-line treatment for uncomplicated malaria; amodiaquine and quinine were second-line and third-line treatment, respectively. Quinine was the drug of choice for severe malaria \[ 25 \]. All antimalarials were prescription-only medicines and could therefore legally be sold only in the one registered pharmacy located in Ifakara town. However, part II drug stores which were found in some villages were generally tolerated to stock and sell antimalarials. General shops were not allowed to stock any prescription drugs, which was reflected in the low availability of antimalarials reported elsewhere \[ 24 \]. Between May and June , all commercial outlets in the DSS area and Ifakara town were visited in order to investigate the availability of antimalarial drugs in the retail sector. The detailed methodology of this census, as well as the results on drug availability have been published elsewhere \[ 24 \]. This paper makes use of additional information on shopkeepers' knowledge of malaria and its treatment, collected during the same survey. Interviews were carried out with shopkeepers or acting drug vendors if the shopkeepers were not present. They were asked to name signs and symptoms of 'malaria' and to explain the recommended treatment of 'uncomplicated malaria' in children of two years of age and adults. We used the terms 'malaria' and 'uncomplicated malaria' in Swahili: malaria isiyo kali in the same was as they were used in information materials produced by the National Malaria Control Programme. In addition, the interviewers recorded information on the estimated number of customers per day. The results of the census were complemented in September and October by 'mystery shoppers', simulated clients who purchased drugs for predefined malaria case-scenarios. The sample size was defined mainly on the basis of operational considerations. The sample was drawn per village and weighed by village size. A back-up sample was drawn to compensate for shops that would be closed or could not be visited for other reasons. In addition, all 19 drug stores from the DSS area and 10 from Ifakara town were added to the sample. The scenarios were developed based on the list of common signs and symptoms of mild malaria in the guidelines of the National Malaria Control Programme \[ 25 \]. All scenarios did explicitly exclude signs of convulsions or unconsciousness, which would be an indication for severe disease. Mystery shoppers were trained to report only the above listed symptoms to the vendors in the shops. For the child-scenarios, the mystery shoppers would carry their children when visiting the shops, if at all possible. Local DSS field staff recruited mystery shoppers from the villages in which the respective shops were located. On the day of the study, the mystery shoppers were trained by project staff on how to approach a shop, and which symptoms to report or not report. Mystery shoppers were asked to visit one selected shop and ask for treatment based on the aforementioned case-scenario. After completing their assignment, they were interviewed by project staff about what exactly happened when they visited the shops, what they had told the shopkeeper, and what advice and drugs they were given. Interviews were tape-recorded and later transcribed. Drugs and remaining money were collected, types and amount of drugs recorded, and the mystery shoppers were paid a small allowance for their collaboration. Generic and brand names if possible , as well as amount and price of the drugs obtained by the mystery shoppers were entered in a Microsoft Access database Microsoft Corp. While mystery shoppers were fully informed and asked for informed consent, the nature of this study did not allow informing the shopkeepers in advance and asking them for consent to participate. To protect shopkeepers' privacy, no names of staff were recorded and names of shops were never mentioned in connection with the study's results. For the shop census, informed consent was obtained from shopkeepers as described in detail in the aforementioned publication. The sample for this analysis included interviews with shopkeepers of 29 part II drug stores and general shops, all of which stocked drugs the day of the interview. General shopkeepers had on average a lower education than their peers in drug stores 7 vs. Generally, shopkeepers of general shops seemed to be significantly less aware of malaria symptoms. They mentioned all of the recorded symptoms less frequently than shopkeepers of drug stores. Out of 15 symptoms associated with malaria, shopkeepers in drug stores mentioned on average 4. If asked for 'severe malaria' in Swahili: malaria kali , a similar picture arose. Shopkeepers of drugs stores had significantly better knowledge of malaria treatment, as shown in Table 2. In general shops this percentage was significantly lower. No shopkeeper mentioned traditional treatment, or that the episode should not be treated at all. Shopkeepers were asked for situations in which they would refer a customer to another outlet or a health facility. A total of 20 part II drug stores and 98 general shops were visited by mystery shoppers. General shops comprised all sorts of outlets, from permanent modern shops to temporary stalls. Case-scenarios were distributed as shown in Figure 2. Flow-chart of mystery shoppers study. Refer to main text for details. SP and amodiaquine were sold most often. Antimalarials were usually sold together with paracetamol, a practice which is recommended for SP in the national guidelines \[ 25 \]. No antimalarials other than SP, amodiaquine or quinine were dispensed and only two drug stores sold an antibiotic. About half of the antimalarial dosages were sold together with paracetamol. Two general shop sold an antibiotic Table 4. On average, drug stores sold more products per client than general shops, which often had only paracetamol on offer. Univariate and multivariate models were fitted to assess factors related to obtaining an antimalarial and obtaining an antimalarial treatment according to Tanzanian guidelines. Adjusted for the confounding effect of age group i. There was no significant difference in this outcome between shops located in the villages or in Ifakara town. Univariate and multivariate logistic regression analysis of the relationship between any antimalarial drug obtained and selected predictors all visited shops. In order to assess whether the observed difference in antimalarial dispensing was due to a lower availability of drugs in general shops, the same analysis was carried out only with shops that had dispensed any drugs at all. If a drug was sold, mystery shoppers were in both types of shops equally likely to receive an antipyretic drug. Again, the same analysis was carried out only for those shops that had dispensed an antimalarial. In this case, drug stores did not dispense SP or SP with paracetamol more often than general shops. In a multivariate linear regression model we assessed the effect of the age group case scenario A, B, C , the number of products sold, the shop type and the location Ifakara vs. DSS on the price charged to the mystery shoppers. The accuracy of the dosages was judged from the amount of drugs the mystery shoppers obtained and from their accounts of the advice they were given by the shopkeepers. For two amodiaquine doses, no dosage information was available. Quinine tablets and syrup doses were all wrongly dosed. With the low number of samples no relevant comparison could be made between the appropriateness of the dosages and the shop types. On the other hand, all amodiaquine dosages which were sold in drug stores and for which the dosage information was available were correct while those sold in general shops were under-dosed. In all of these drug stores the mystery shoppers were advised to seek treatment or advice from a health facility. The private retail sector plays a central role in the provision of malaria treatment in Tanzania. Yet, poor quality of care, shortage of skilled providers, stock-outs of essential drugs, and long waiting times \[ 16 , 17 \] are challenges which may drive patients to seek care or at least buy drugs from more expensive non-governmental facilities, or from drug stores. The private retail sector may complement health facility services where the facilities are unable to deliver \[ 14 \]. In the studies presented here, drug stores were more frequently visited for drugs than general shops. However, general shops are important first contact points of patients with a network of treatment providers. They are numerous even in small villages and often more easily accessible than drug stores or health facilities \[ 24 \]. While not being legally allowed to dispense antimalarial drugs, they are recognised in the national policy as one component of the health care delivery structure \[ 25 , 26 \]. Yet, their relatively poor knowledge of malaria and its appropriate treatment supports the ban of antimalarial drugs from these outlets. In part, this may be explained by the parallel use of homa as a term to describe a less severe febrile illness or general malaise \[ 27 , 28 \]. Knowing the correct treatment was clearly a function of the shopkeeper's education, which in general shops was lower than in drug stores. Drug stores on the other hand are the lowest level of providers which is generally tolerated to dispense prescription-only antimalarial drugs. Unfortunately, they often do not reach out into small villages or remote areas \[ 24 \]. Shopkeepers in drug stores were more knowledgeable about malaria-related symptoms and malaria treatment than their counterparts in general shops. This was correlated with basic medical or health-related training, a prerequisite for shopkeepers of licensed part II drug stores \[ 29 \]. In order to get a realistic picture of drug-sellers' performance, we used mystery shoppers; an approach which has been applied frequently in market research, but rarely in a public health context \[ 30 , 31 \]. The main challenge of applying this methodology in a rural setting, which is to find capable mystery shoppers within a certain village, was tackled with the help of knowledgeable village-based DSS field staff. Daily shopkeepers' practices clearly reflected their level of understanding of appropriate treatment, the current drug regulations, as well as the low antimalarial availability in general shops \[ 24 \]. Antipyretics were frequently sold in both, drug stores and general shops. While many shopkeepers in drug stores knew that SP was the recommended treatment for children and adults, in practise, amodiaquine and quinine were sold as often as SP. This may to some extent reflect that amodiaquine was slightly more readily available in drug stores and, according to anecdotal evidence, quinine was popular as it was often regarded a strong and powerful medicine \[ 24 \]. Overall, it was more likely that a mystery shopper received an antimalarial or even SP in a drug store. However, drug stores did not adhere better to the guidelines than general shops. In part, this may be attributed to the larger choice of products in drug stores. Mere non-availability may also be a reason why no other antimalarials than SP, amodiaquine and quinine were sold, along with the fact that with the cash provided by the researchers, the mystery shoppers would not have been able to purchase expensive drugs such as artemisinin mono therapies or ACT \[ 32 \]. Altogether, adults would more readily be dispensed an antimalarial than children. This is interesting in the light of findings from a cross-sectional community-survey in which adults would be treated more frequently with shop bought drugs while children were more often brought to a health facility \[ 14 \]. This may give some indications of provider-side influences on treatment-seeking behaviour. The latter was also found in another study in the same area, where more expensive treatments were obtained from non-governmental organisation NGO facilities and drug stores, usually by people from the better-off socio-economic stratum \[ 33 \]. Private retailers may commonly be perceived as being mainly business-driven in their behaviour. In this study we found that in theory, more than half of all shopkeepers said they would refer severely ill patients and general shopkeepers commonly regarded referral as best option for young children. The awareness of shopkeepers that certain cases need to be dealt with at a higher level may be a good entry point for interventions targeted at the retailer level. Several projects targeting private drug retailers, have already counted on the ability and willingness of shopkeepers to refer severe or complicated cases to an appropriate facility \[ 13 , 34 \]. The importance of the retail sector as a source of malaria treatment and care complementary to health facility has been recognised internationally \[ 35 \] and within Tanzania \[ 26 \]. However, the major concern regarding the private sector has been inadequacy of the treatments offered by often untrained or not sufficiently trained shopkeepers \[ 3 , 34 , 36 \]. This issue has re-emerged in the discussions about appropriate delivery channels for ACTs. Defining the role of each type of retailer present in a health system within the frame of their capabilities and the given legal context is an important first step in improving quality and access. Part II drug stores which are the largest network of licensed drug-retailers in Tanzania \[ 18 \] are licensed to sell only OTC drugs, to which none of the recommended antimalarials belongs. Kachur et al. Considering this demand for antimalarial treatments, there is a need to make efficacious antimalarial drugs available in drug stores. In reality this is usually tolerated by the authorities who recognise the lack of alternatives. In order to improve the quality of services in drug stores, specialised training for drug vendors may be a valid option for improving management of malaria-cases, as has been shown in other areas \[ 12 \]. The mere definition of educational prerequisites as currently the case for part II shops may only lure health workers away from health facilities to a more profitable business in the retail sector. Yet, training alone is unlikely to improve performance if not coupled with appropriate means of rewarding the shopkeepers for good practices \[ 36 , 38 \]. These approaches are combined in a project that upgrades part II shops and potentially general shops to Accredited Drug Dispensing Outlets ADDO and that is currently being implemented in selected districts in Tanzania \[ 13 , 37 \]. The role of general shops should not be the dispensing of prescription medicines. Yet, due to their importance as easily accessible first contact point for malaria patients, they should not be completely left aside when targeting the private sector. There are several options to strengthen their role in the health sector. Firstly, they could be upgraded to drug retailers e. ADDOs if appropriately trained, thereby increasing the population coverage with antimalarial providers. Secondly, general shopkeepers could be trained on the appropriate first aid for malaria cases with OTC medicines and subsequent referral to a higher level. Considering that general shops may manage malaria cases only with antipyretics, particularly in places where they are the nearest provider, targeted information or training may decrease the number of inappropriately managed cases at the lowest level. The social pressure exerted on shopkeepers by communities' expectations on their performance should not be under-estimated. In our study, a considerable number of shopkeepers did without business in favour of referring the patient to a drug store or a health facility. Including all levels of formal and informal health care providers is feasible within the existing legal framework and guided by the national malaria control policy. Alternative approaches including lowest level shops may be a step forward in improving access for people living in remote areas or deprived villages which so far lack any provider of antimalarial medicines \[ 24 \]. Private retailers play an important role in the provision of prompt and effective malaria treatment, complementing the services of formal health facilities. Yet, the quality of case-management in the retail sector leaves much room for improvement. Drug stores should be empowered and encouraged to provide correct malaria-treatment with drugs they are legally allowed to dispense. At the same time, the role of general shops as important first contact points for malaria patients needs to be re-considered within the given legal framework. Interventions on shop-level should consider all types of private retailers. While antimalarial medicines, such as ACTs ought to be dispensed only by qualified personnel, general shopkeepers may acquire sufficient knowledge to properly recognise malaria cases and refer them to a trained provider. MWH was responsible for all aspects of the shop census, contributed to the development of the mystery shoppers study, selected the sample, analysed the data together with AD and wrote the manuscript in collaboration with the other authors. JJM prepared the mystery shoppers research plan and data collection activities, and supervised the field-work. CL and BO conceived the research questions and contributed to the design of both studies and the discussion of the manuscript. AM and CM provided support during field-work and contributed to the discussion of the findings. AS and HM contributed to the research questions and the study design. All authors read and approved the final manuscript. We thank all the shopkeepers for in part unknowingly participating in our surveys. We appreciated the support from local leaders and DSS staff in tracing the sampled outlets and finding mystery shoppers in the field. Many thanks go to our shop survey team and to all mystery shoppers. We very much acknowledge the commitment of our shop survey supervisor Saidi King'eng'ena who did an excellent job in coordinating the field work and coding and checking the questionnaires. As a library, NLM provides access to scientific literature. BMC Public Health. Box, CH Basel, Switzerland. Box 53, Ifakara, Tanzania. Find articles by Manuel W Hetzel. Find articles by Angel Dillip. Christian Lengeler 1 Dept. Find articles by Christian Lengeler. Brigit Obrist 1 Dept. Find articles by Brigit Obrist. Find articles by June J Msechu. Find articles by Ahmed M Makemba. Find articles by Christopher Mshana. Find articles by Alexander Schulze. Find articles by Hassan Mshinda. Received Dec 17; Accepted May 9; Collection date Open in a new tab. Fever 86 68—96 60 56—65 0. Changed behaviour 24 10—44 17 14—21 0. Linear regression model of predictors of higher expenditures for antimalarial drugs. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Child aged two years with uncomplicated malaria.

Bagamoyo buying Ecstasy