Retail supply of malaria-related drugs in rural Tanzania: risks and opportunities
Retail supply of malaria-related drugs in rural Tanzania: risks and opportunities
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DOI：
10.1111/j.1365-3156.2004.01245.x
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发表时间：
2004-06-01
影响因子：
3.3
通讯作者：
Bloland, P
中科院分区：
文献类型：
--
作者：
Goodman, C;Kachur, SP;Bloland, P
目的了解坦桑尼亚农村地区发烧和疟疾药物在零售部门的可获得性，评估可能对公共卫生造成的影响，并确定政策干预的机会，以扩大有效治疗的覆盖面。方法采用结构化问卷对坦桑尼亚4个地区人口监测地区的药品零售商进行普查。结果药品由两类零售商库存：大量综合零售商(n=675)和相对较少的药店(n=43)。几乎所有的商店都有退烧药/止痛药。在库存药品的普通零售商中，有三分之一的人服用抗疟疾药物，通常只有氯喹。几乎所有的药店都有抗疟疾药物(98%)；几乎所有的药店都有氯喹，42%的库存奎宁，37%的磺胺乙胺和30%的阿莫地喹。有大量的抗疟疾品牌可供选择。人口比率表明与卫生设施相比，零售药品提供者的相对可获得性。药店工作人员通常长途跋涉从药品批发商或药店购买药品。一般零售商主要从当地的一般批发商购买药品，少数批发商在所有来源中所占比例较高。结论药品在大量的零售网点广泛销售。潜在的负面影响包括提供无效的药物、对品牌名称的混淆、抗疟疾药物的无控制使用，以及潜在联合疗法的组成部分作为单一疗法的可用性。另一方面，这一活跃和易于进入的零售市场为提高有效抗疟疾治疗的覆盖面提供了机会。针对所有药品零售商的干预措施可能成本高昂，难以持续，但有针对性的干预措施有两个有希望的点，那就是药店和选定的一般批发商。零售质量也可以通过对消费者进行教育，以及修改进入零售分销链的产品的化学质量、包装和价格来提高。
OBJECTIVES To characterize availability of fever and malaria medicines within the retail sector in rural Tanzania, assess the likely public health implications, and identify opportunities for policy interventions to increase the coverage of effective treatment.METHODS A census of retailers selling drugs was undertaken in the areas under demographic surveillance in four Tanzanian districts, using a structured questionnaire.RESULTS Drugs were stocked by two types of retailer: a large number of general retailers (n = 675) and a relatively small number of drug shops (n = 43). Almost all outlets stocked antipyretics/painkillers. One-third of general retailers stocking drugs had antimalarials, usually chloroquine alone. Almost all drug shops stocked antimalarials (98%); nearly all had chloroquine, 42% stocked quinine, 37% sulphadoxine-pyrimethamine and 30% amodiaquine. A large number of antimalarial brands were available. Population ratios indicate the relative accessibility of retail drug providers compared with health facilities. Drug shop staff generally travelled long distances to buy from drugs wholesalers or pharmacies. General retailers bought mainly from local general wholesalers, with a few general wholesalers accounting for a high proportion of all sources cired.CONCLUSIONS Drugs were widely available from a large number of retail outlets. Potential negative implications include provision of ineffective drugs, confusion Over brand names, uncontrolled use of antimalarials, and the availability of components of potential combination therapy regimens as monotherapies. On the other hand, this active and highly accessible retail market provides opportunities for improving the coverage of effective antimalarial treatment. Interventions targeted at all drug retailers are likely to be costly to deliver and difficult to sustain, but two promising points for targeted intervention are drug shops and selected general wholesalers. Retail quality may also be improved through consumer education, and modification of the chemical quality, packaging and price of products entering the retail distribution chain.