Buying coke online in Schellenberg

__________________________

📍 Verified store!

📍 Guarantees! Quality! Reviews!

__________________________

▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼

▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲

Buying coke online in Schellenberg

Test Page. Blown Film Cast Film Dummy Text - There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form, by injected humour Dummy Text - It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters. Select Application Blown Film Cast Film Dummy Text - There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form, by injected humour Dummy Text - It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. Injection Dummy Text - There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form, by injected humour Dummy Text - It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. Sections 1. Lorem Ipsum has been the industry's standard dummy text ever since the s Dummy Text - Lorem Ipsum is simply dummy text of the printing and typesetting industry. Select Application Automotive Seating Furnitures Mattress Cushing Coating Adhesive Sealnts Prepolymers Foamed and Non Foamed Rigid Viscoelastic Applications Flexible Applications Dummy Text - There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form, by injected humour Dummy Text - It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. Commissioning of all 26 plants. Share holders agreement. We are committed to providing you with a productive and privacy-friendly website experience. Like most websites you visit, we use cookies to provide you with a better service. Accept Cookies.

HRB National Drugs Library

Buying coke online in Schellenberg

Official websites use. Share sensitive information only on official, secure websites. Millions of individuals with malaria-like fevers purchase drugs from private retailers, but artemisinin-based combination therapies ACTs , the only effective treatment in regions with high levels of resistance to older drugs, are rarely obtained through these outlets due to their relatively high cost. To encourage scale up of ACTs, the Affordable Medicines Facility — malaria is being launched to subsidize their price. The Government of Tanzania and the Clinton Foundation piloted this subsidized distribution model in two Tanzanian districts to examine concerns about whether the intervention will successfully reach poor, rural communities. Stocking of ACTs and other antimalarial drugs in all retail shops was observed at baseline and in four subsequent surveys over 15 months. Exit interviews were conducted with antimalarial drug customers during each survey period. All shops and facilities were georeferenced, and variables related to population density and proximity to distribution hubs, roads, and other facilities were calculated. To understand the equity of impact, shops stocking ACTs and consumers buying them were compared to those that did not, according to geographic and socioeconomic variables. Patterning in ACT stocking and sales was evaluated against that of other common antimalarials to identify factors that may have impacted access. Qualitative data were used to assess motivations underlying stocking, distribution, and buying disparities. However, other antimalarial drugs displayed similar patterning, indicating the existence of underlying disparities in access to antimalarial drugs in general in these districts. As this subsidy model is scaled up across multiple countries, these results confirm the potential for increased ACT usage but suggest that additional efforts to increase access in remote areas will be needed for the scale-up to have equitable impact. However, artemisinin-based combination therapies ACTs , the only effective malaria treatment in regions with high levels of resistance to older antimalarial drugs, are very rarely obtained through these private retailers \[ 2 \]. The widespread development of resistance to cheaper antimalarial drugs means that a majority of individuals suffering from malaria worldwide are not receiving effective treatment. To encourage scale-up of ACT coverage, the global malaria community is launching the Affordable Medicines Facility — malaria AMFm to subsidize the price of ACTs at the point of production for distribution in the public and private sectors. However, concerns remain about whether the intervention will succeed in reaching poor, rural communities \[ 3 \]. To provide evidence to inform these discussions, the Government of Tanzania and the Clinton Foundation tested the model through a pilot program in two rural Tanzanian districts. The pilot demonstrated that ACTs could indeed lead to high uptake \[ 4 \]. This population of individuals receiving ineffective medications can be divided into those who purchased antimalarial or antipyretic drugs at a shop that did not carry ACTs, and second, those who shopped where ACTs were available, but who chose to purchase an antipyretic or another antimalarial instead. By the end of the study period, over a quarter of shops in the study districts continued not to stock ACTs. This analysis investigates drivers of subsidized ACT stocking and sales at the shop level and ACT purchase at the individual level through spatial analysis. Observed patterning in ACT stocking and sales is compared against that of other common antimalarial drugs to identify factors that may be specifically impacting access to the subsidized drugs. To help contextualize geographic patterns, qualitative data are presented to assess rationales underlying stocking, distribution, and buying disparities. The intervention was conducted in two rural districts of Tanzania: Maswa in Shinyanga region and Kongwa in Dodoma region. These districts were comparable in terms of key indicators including population per health facility, employment, prevalence of private drug shops, and bed net ownership. Socioeconomic status SES of households in both districts is below the national average as evidenced by comparison of key assets such as housing materials, toilet facilities, and availability of electricity \[ 7 \]. Private sector shops — particularly the part II drug stores called duka la dawa baridi DLDB — provide the majority of fever treatment in Tanzania \[ 8 \]. DLDB are required to be staffed by an individual with at least one year of health training, and are only allowed to sell over-the-counter OTC medicines, although research has shown that both of these requirements are often not met \[ 9 \]. Drug shops purchase supplies from regional drug wholesalers or pharmacies, which buy from other wholesalers or importers \[ 8 , 10 \]. In , Tanzania switched its national guidelines for first-line malaria treatment to ACT, specifically artemether-lumefantrine AL , with free distribution beginning in the public and non-governmental organization NGO sectors in December of that year. ACTs are classified as prescription-only medication, and currently are only consistently available in health facilities and registered part I pharmacies. The previous first-line treatment, SP, was adopted in but rapidly lost effectiveness \[ 11 \]. Details of the subsidy design are reported elsewhere \[ 4 \]. The wholesaler received no instructions other than to sell the ACTs to drug shops in the two intervention districts according to its standard practices, and it was made clear that the wholesaler would not be monitored or held accountable for its pricing, stocking, or other practices. To reflect potential information, education, and communication interventions that will accompany the AMFm, additional activities included a one-day training of DLDB attendants focused on malaria symptoms and ACT dispensing and dosing, and Population Services International activities emphasizing the importance and availability of ACTs, including local radio advertisements, wall paintings, and themed cultural shows. A suggested retail price of , , , and Tanzanian Shillings was marked on ACT packages distributed in Kongwa, but not in Maswa. Retail audits \[ 12 \] were used to collect data on stocking and sales of antimalarial drugs in all the DLDB that existed in the two districts over the course of the project. DLDB were initially identified through Tanzania Food and Drug Authority records, with unregistered DLDB captured through discussions with local informants and systematic physical reconnaissance throughout each district. Each audit involved visiting a DLDB twice at a one month interval. Collectors recorded the stock level of all antimalarial drugs present during each visit, and a short questionnaire was administered to the owner or attendant to determine the amount of each product newly purchased and disposed of e. Sales volumes were then calculated by comparing stock levels between the two visits and adding purchases and subtracting disposals. Data collectors also visited all public and NGO health facilities in each survey period to review ACT stocks and dispensing records. As with DLDB, all locations were georeferenced. Exit interviews were used to collect information on shoppers and their antimalarial drug choices. Data collectors positioned themselves near a DLDB and remained there for the full business day. Collectors maintained some distance from the DLDB to avoid disrupting normal business. All customers emerging were approached and asked to answer a short questionnaire about the products bought. Those purchasing drugs for malaria or fever were asked about the primary reason they selected the particular antimalarial or antipyretic drug they purchased, and the brand of the product was visually verified. Both retail audits and exit interviews were conducted a total of four times after the pilot subsidy began in October: November , and March, August, and November Finally, qualitative interviews with shop owners and wholesale distributors were conducted in November following the pilot program to contextualize the quantitative results. Thirty-four DLDB storeowners and four wholesale distributors were interviewed using a semi-structured interview guide. Storeowners were randomly selected from six DLDB groupings constructed according to the number of neighboring shops within 1 km. Distributors were selected by asking the national wholesaler to identify the principal agents it used to supply ACTs in the intervention districts. The structured interviews probed about ACT availability, stocking, pricing, and profitability, and supply of and demand for antimalarial drugs including the subsidized ACT. Interviews were mostly conducted in Kiswahili, transcribed, and then translated into English. Qualitative data were coded and analyzed using MaxQDA; the coding scheme was developed based on the key research questions and themes that were generated by the interviews. ArcGIS v9. Similarly, the average distance to the three nearest public or NGO facilities and the number within 1 km were computed along with the distance to the nearest facility that was ever found to be stocked with any ACTs and the nearest facility found to be always stocked with at least one dose of ACTs at each survey. The number of surveys in which the nearest facility to each DLDB was stocked was counted. Since DLDB might open or close during the study period, the number of surveys in which each DLDB was found to be open for business was counted as an additional variable that might relate to the health and viability of the shop. To estimate the real-world distance from each DLDB to the town where the regional wholesaler was located and from which ACT distribution initiated — in Kongwa, this hub was the town of Dodoma, while in Maswa it was Maswa Town — road-weighted distance was calculated as the sum of two figures: shortest-path distance from the hub to the road nearest the DLDB, plus straight-line distance from that road to the DLDB weighted six times as heavily as on-road distance to account for the meandering nature and poorer condition of these roads and therefore the slower speed of these segments of the trip \[ 14 \]. The weight of 6 was selected based on an assumption that travel by major road could proceed up to the speed limit of kph while travel off these roads could achieve a maximum of 20kph; other weights were employed for comparison and did not qualitatively change results data not shown. Finally, Normalized Difference Vegetation Index NDVI values calculated from satellite imagery \[ 15 \], which represent the amount of visible green vegetation, were given to each DLDB as a measure of the environment in which each shop was located. Log transformations were used to normalize variables that appeared heavily skewed after visual inspection of histograms. An index of SES was calculated through a principal component analysis of the 53 household asset variables collected in exit interviews \[ 16 \]. SES was rescaled so that the shopper with the lowest principal component score and thus lowest status received a value of 0 and the shopper with the highest score a value of Highest education status attained was considered as a numerical variable ranging from 0 no formal education to 6 university. Stocking patterns. DLDB were divided according to whether or not they were ever found to stock or have sold ACTs during any of the four audits following initiation of the subsidy. DLDB that were found to stock or sell ACTs were compared to those that did not in regards to geographic characteristics using t-tests Satterthwaite tests were used when variances were unequal and pooled tests otherwise or chi-square tests as appropriate. Each of the variables that were found to differ significantly between stocking and not stocking shops in these comparisons then were entered jointly into multivariate logistic regression to determine whether associations were independent. To examine whether differences in ACT stocking were unique to that subsidized antimalarial drug and its distribution network, these same methods were used to compare stocking of any SP or sulfamethoxypyrazine-pyrimethamine SMP product, as well as specifically for the two most commonly sold drug brands besides the subsidized ACT product, the generic drugs Orodar SP manufactured by Elys Chemical Industries Ltd of Kenya and Malafin SMP manufactured by Shelys Pharmaceuticals of Tanzania. Chi-square tests were used to examine whether stocking of ACTs and these other common antimalarial drugs was correlated. Buying patterns. To examine the population of shoppers reached by the subsidized ACT distribution network, the characteristics of individuals shopping at DLDB that stocked and did not stock ACTs were examined through the same statistical methods. Individual-level variables included SES, age, education, and gender of the shopper, the age and gender of the individual for whom the drug was being purchased, and rationale for buying the chosen drug. Finally, analysis was restricted to the set of DLDB that were found to have stocked or sold ACTs, and the characteristics of individuals who chose to purchase ACTs when they were available at those DLDB were compared to the characteristics of those who purchased other antimalarial drugs. To examine whether different characteristics of individuals were independent predictors of the drug purchased, these variables were entered into a multivariate regression model using the GENMOD procedure in SAS with a REPEATED statement to adjust for the correlation between customers shopping at the same store. ACT stocking. Of the DLDB ever surveyed in the two districts, 47 For 93 For example, the 47 DLDB that were never found to stock or sell ACTs in any of the four surveys were located in wards with average population density of DLDB that never stocked were found to be open for business during an average of 1. Distributions of geographic variables according to DLDB stocking status. No other variable in Figure 2 demonstrated a statistically significant association with stocking when controlling for these variables. SP stocking. In multivariate logistic regression, none of the variables depicted in Figure 2 demonstrated statistically significant associations with SP stocking when controlling for the number of surveys in which a shop was observed. During the four survey periods, retail audits indicated that Orodar and Malafin were purchased 22, and 8, times, respectively, compared to 37, treatments of ACT. There were 49 DLDB Joint stocking. In comparison, only This pattern held true for each of the individual SP products as well; Customer characteristics by stocking status of DLDB. The differences in shopper characteristics were consistent when comparing only those shopping in November with those in November These relationships were unchanged by additionally controlling for the spatial characteristics of the DLDB locations at which individuals were shopping. Comparison of shopper characteristics according to the stocking status of DLDB at which they shopped. Customer characteristics by drug choice. Individuals buying antimalarials were older, buying drugs for younger recipients, wealthier, and better educated than were individuals buying antipyretics. Socioeconomic status. SES varied both according to the stocking status of the store at which the consumer was shopping and according to the type of drug purchased Figure 3. Distribution of socioeconomic status by stocking status and drug choice. Stocking and shopping rationales. Price was indicated as a reason for buying ACTs for Finally, customers buying ACTs were slightly more likely to have done so because of a recommendation from a seller; Of the two interviews conducted at DLDBs never stocking ACTs, rationales for the lack of the subsidized drugs included a perceived lack of demand and a lack of knowledge:. According to a representative from the wholesaler, drugs were often sold to shopkeepers on credit, so DLDB could not receive more stock until they had paid off what they owed. Therefore, they preferred drugs and products they could sell quickly so they could restock and sell more. Statements citing the importance of the speed of product movement were heard from about half of DLDB shop owners:. However, promotions and advertisements on the radio increased awareness of ACTs, and thus were perceived to have increased the desirability for DLDB to stock them in both Kongwa and Maswa:. The results of this investigation both highlight the potential for a subsidy introduced at the top of the private sector supply chain to greatly increase access to effective antimalarial drugs and underscore its reliance upon existing supply chains that currently do not reach all individuals in rural regions. Subsidized drugs were purchased by a majority of customers shopping at stores that stocked them \[ 4 \] yet disparities in the accessibility of ACTs persisted. As this model is scaled-up to a national level across Africa, it is clear that a deeper understanding of antimalarial drug supply chains and additional interventions that target their behavior will be needed in order to achieve the goal of dramatically increasing ACT access among all those obtaining treatment at private shops. The two most popular products besides ACTs, although from the same general drug class, manifested widely different stocking patterns. Malafin stocking displayed highly similar geographic patterning to the subsidized ACTs, while stocking of Orodar did not vary by remoteness. There were thus potentially identifiable factors that enabled Orodar to reach rural populations more consistently and equitably than Malafin or subsidized ACTs. Within one year, more shops in the study area stocked the subsidized ACTs than the established products Malafin and Orodar, yet it remains unclear whether subsidized ACTs can rise to the generalized geographic availability of Orodar given more time. Alternatively, the observed differences may be due to fundamentally dissimilar delivery or promotional mechanisms that must be overcome. This understanding is particularly critical for the scale-up of the subsidy since the independent evaluation of the first phase of the AMFm will be of a similarly short time period less than 18 months of implementation and thus will be unable to decipher the role of medium- or long-term market factors. It is possible that different supply chains played an important role in the different patterns observed, though specific characteristics were not captured by this study. Statements by interviewed shopkeepers confirmed that the same wholesaler who distributed the subsidized ACTs was also distributing Malafin, although it is unknown whether Orodar was sold through the same channels. Price was undoubtedly also a driver: Orodar is a significantly cheaper product exit interviewees paid an average of Counter to local opinion that locally-produced drugs are available more broadly than international ones, Malafin is manufactured in Tanzania while Orodar is produced in Kenya. No data are available on other potential contributing factors including comparative marketing of the products or the amount of time each has been available on the market. Broader analysis of existing supply chains and antimalarial brands should be a priority in preparing for and assessing the scale-up of the subsidy through the AMFm. Even if subsidized ACTs are able to achieve the reach of Orodar, this analysis suggests that there will be a set of very remote outlets that will be particularly challenging to consistently supply. Of 24 individuals buying drugs for fever who were captured by exit interviews, 18 The available data indicate two potential causes for the inconsistent supply to these shops. First, they are more remote, more than twice as far, on average, from public health or NGO facilities. Second, they were in operation less, existing in an average of 1. Both have important implications for potential interventions to reach these shops and their customers; the first suggests the need for supplementation of the inherent market incentives for reaching these areas \[ 17 \], while the second demonstrates the potential for increased frequency of education \[ 18 \] and product promotion activities \[ 10 \]. Education programs or advertisements thus could play an important role in improving this component of the supply chain \[ 18 \]. Shops that were not observed consistently open for business throughout the year likely were unstable, smaller, and had more volatile stocks. These unstable shops were less likely to stock all of the observed antimalarials, including ACTs. The transitory nature of these shops will make it difficult to provide their owners with the necessary training and education surrounding ACTs, so programs supporting the AMFm may need to consider repeated or periodic programs rather than one-time approaches. Alternatively, it may be more effective to increase access to the formal public sector or engage community health workers in such remote regions \[ 19 \]. Customers who bought ACTs when given the opportunity to do so were significantly more likely to state that the drugs were most effective, while those who bought non-ACTs were more likely to explain that they preferred to buy familiar medications. These results indicate that education and advertising interventions may prove successful in increasing the probability that customers will buy ACTs when given the opportunity, and ACT purchasing may increase over time without further intervention as individuals become accustomed to the product. The SES of individuals who chose to purchase ACTs when they were stocked was found to be slightly lower than that for individuals choosing to purchase other antimalarial drugs. This difference is attributable to the lower price of the subsidized drugs, which likely made them more accessible. It is important to note that even the less rural individuals reached by this intervention were still quite poor. The majority of customers It is likely that a similar subsidy may prove even more effective in wealthier, more urban districts. This analysis has a number of limitations. First, this investigation sought only to examine whether an AMFm-like subsidy would succeed in improving access to ACTs equitably, but it was not designed to evaluate whether such a subsidy constitutes the most appropriate approach; for example, controversy over whether the AMFm will complement the public health system or divert patients from it \[ 20 \] is not addressed here. This study broadly attempted to capture the most critical variables known to influence drug usage, but it is possible that other important factors were not encompassed. Only DLDB were included in this analysis, so other informal private sector actors were not captured; however, previous studies have indicated that these informal shops are less important sources of anti-malarials in rural Tanzania \[ 21 \]. The four follow-up surveys of stocking and sales represent only snapshots and as such cannot capture the dynamic nature of patterning. For example, there was enormous turn-over in the DLDB that were found to exist over the course of the year; about a quarter of DLDB only existed during a single survey. Finally, it is possible that the repeated interviews of shop-keepers to assess stocking and sales may have influenced their decision-making, although the absence of ACT uptake in the control district indicates that this bias is unlikely to affect qualitative interpretation of these results. Nevertheless, the patterns observed here provide insight into how a number of varied factors may interact to influence the potential successes and challenges that may occur following the launch of the global ACT subsidy. This research indicates that scale-up of an ACT subsidy to national or global levels has the potential to increase ACT uptake in poor rural areas, but spatial and socioeconomic variation is likely to remain in stocking and sales. Given the launch of the AMFm in , and its potential to effect unprecedented changes in the private sector antimalarial market, it is vital to improve understanding of how these drugs will flow through existing supply chains. In-depth analysis of essential differences in the distribution and use of the most commonly available alternative products such as those discussed here should begin immediately. These results engender cautious optimism that the subsidy will succeed in adding effective drugs into the marketplace at prices in line with older medications, but they emphasize the need to better understand if and how supply chains will need to be augmented or supplemented in order to optimize the impact of the initiative. Performing spatial analyses like those conducted here on an ongoing basis as a component of the monitoring and evaluation of the AMFm may help ensure that inequities in access to treatment are recognized and addressed. JMC conducted the geographic and statistical analyses and drafted the manuscript. KS and IG conducted and analyzed the qualitative analyses. All authors read and approved the final manuscript. We thank those who conducted the surveys, the shop-keepers and customers who participated, and Rebecca Morgan for her assistance with the qualitative analysis. Thanks to Kara Hanson and the participants of the CREHS workshop on scaling up health services for their valuable suggestions on this manuscript. As a library, NLM provides access to scientific literature. A pharmacy too far? Find articles by Justin M Cohen. Find articles by Oliver Sabot. Find articles by Kate Sabot. Find articles by Megumi Gordon. Find articles by Isaac Gross. Find articles by David Bishop. Find articles by Moses Odhiambo. Find articles by Yahya Ipuge. Find articles by Lorrayne Ward. Find articles by Alex Mwita. Find articles by Catherine Goodman. Characteristics of drug shops and their customers over the four post-subsidy surveys. Open in a new tab. 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.

Buying coke online in Schellenberg