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Scientific title: Evaluation of the referral system implemented in registered drug shops, and impact on the public health systems in Uganda.

What did we know before this research?
Most malaria deaths occur within 48 hours after the first symptoms appear. In rural areas, where access to health centres is poor, home-based management of malaria can reduce mortality caused by the disease by up to 50%. This approach provides training to members of the community who are then able to give effective treatment near the patients’ home.

In order to maximise the coverage and impact of artemisinin-based combination therapies (ACT), these drugs should be available not only in health centres but also in programmes of home-based management of malaria. In fact, shops are very often the only source of treatment that patients visit, and up to 80% of malaria cases are not treated within the formal health sector.

What does this study add?
Currently there is a significant over-use of antimalarial drugs. This happens because many cases of fever are immediately treated as malaria even without a test or laboratory confirmation. Since ACT is generally more expensive than regular drugs, it is important that their use is restricted to people who are formally diagnosed. This can be done by using rapid diagnostic tests (RDT), which don’t require electricity or qualified health staff.

This is a qualitative study evaluating the trial “Improving the targeting of malaria treatment by introducing rapid diagnostic tests in drug shops”, which aims to contribute to the debate of involving private sector in delivering health services. It evaluates how drug shop vendors and their clients perceive rapid diagnostic tests and subsidised ACTs. It also aims to understand whether rapid diagnostic tests have an impact on how patients are referred from drug shops to health facilities – from the perspective of patients, drug shop sellers and health workers.

The research team
Principal Investigators

Dr Clare Chandler, London School of Hygiene & Tropical Medicine, UK

Dr. Anthony K Mbonye, Director of Health Services, Ministry of Health, Kampala, Uganda

Other Investigators

Dr Eleanor Hutchinson, London School of Hygiene & Tropical Medicine
Dr Siân Clarke, London School of Hygiene & Tropical Medicine
Dr Pascal Magnussen, Copenhagen University, Frederiksberg, Denmark
Dr Kristian Schultz Hansen, London School of Hygiene & Tropical Medicine

Latest on this research
Our analysis has shown that rapid diagnostic tests (RDTs) are popular among community members and drug shop vendors.

RDTs have limited impact on referral practices in drug shops but have a profound impact on the status of the drug shop vendors. Drug shops changed from being associated with risk and uncertainty to places in which clients perceive regulated, good quality care to be on offer.

The research suggests also that the introduction of RDTs into drug shops may have an impact on how patients seek treatment. Patients reported swapping visits from the public and private not for profit sectors to the retail sector.