Socio-demographic characteristics of study participants
Exit interviews were conducted among a total of 1114 participants from 37 drug outlets visited in the four districts. Of these 54.9% (611/1114) were males, and over a third 37.7% (420/1114) were peasant farmers. The average age was 31.5 ± 0.5 years. The median cost of ‘Green leaf ACT’ (QAACT) in the drug outlets was USD 0.97 (0.83, 1.1). The majority, 82.9% (924/1114) of study participants who visited the drug outlets had fever, headache, fatigue, and joint pains (Table 1).
Access to quality assured artemisinin combination therapy (QAACT) antimalarial agents
Majority, 97.2% (1083/1114) of the participants purchased ACT anti-malarial agents. Less than a third of the drug outlet clients (27.7%:309/1114) purchased QAACTs. Over half, 62.5% (193/309) of the QAACTs were accessed from private pharmacies. A majority, 72.8% (225/309) of the study participants who purchased QAACTs did not have a prescription. More than a half, 56.9% (173/309) of the participants reported finding QAACT agents expensive. A majority, 82.5% (255/309) of the respondents reported being able to purchase a full dose of QAACTs. Among participants who obtained QAACT, Combiart brand was the most, 45.1% (139/308) perceived as highly efficacious. Over half, 57.5% (177/309) of the participants who obtained QAACT had a laboratory diagnosis of malaria. Most, 82.7% (253/309) of the respondents obtained full oral dose of QAACTs (3-day treatment). Of the participants who did not receive a full 3-day dose of the artemisinin-based combinations, on average purchased seven tablets (less than 1 day’s dose) instead of the recommended 24 tablets for the full 3-day adult dose.
The most common brands of artemisinin-based combinations obtained by the study participants include Lariact 15.6% (156/1114), Artefan 14% (152/1114), and Co-mether 12.8% (139/1114). The choice of which ACT to purchase from the drug outlets was guided by the perceived efficacy, 75.8% (819/1114) and cost/affordability, 18.1% (196/1114).
For participants who did not have a prescription, purchasing a particular ACT was mostly based on previous experience 48.2% (418/1114), and recommendation from the pharmacist/dispenser 42% (368/1114).
Self-reported efficacy of artemisinin-based combination therapy (ACT) by the private drug outlet clients
Nearly a third, 26.6% (296/1114) of the study participants reported persistence of malaria symptoms even after taking a full oral dose (3-day treatment) of ACT. The reported actions taken when malaria symptoms fail to resolve following ACT include going back to the health facility for further management 40.6% (119/296), purchasing a different artemisinin-based combination 37.7% (110/296) and purchasing the same artemisinin-based combination 22.5% (65/296). On average study participants reported purchasing artemisinin-based combinations for managing malaria symptoms at least twice (2) in the last three months prior to survey date.
Determinants of access to QAACTs in private drug outlets in Uganda
From bivariate analysis, the factors significantly associated with accessing QAACTs among the study participants include drug shop (p < 0.001), attaining post primary level of education (p = 0.003), being a businessperson (p < 0.001), not purchased full oral dose of ACTs (3-day treatment) (p = 0.004), not finding the ACT expensive (p < 0.001) and not having a prescription (p = 0.007).
From multivariable analysis, individuals who obtained their ACT anti-malarials from drug shops had 26% decreased prevalence of purchasing a QAACT compared to those who went to the pharmacies (aPR = 0.74; 95%CI 0.60–0.91). Participants who did not purchase full oral dose of ACT were 51% less likely to purchase a QAACT compared to those who purchased full oral dose of ACT (aPR = 0.49; 95%CI 0.33,0.73). Drug outlet clients who did not find the ACT expensive were 24% more likely to purchase a QAACT compared to those who found ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49). Individuals who did not have a prescription were 24% less likely to purchase QAACTs from the drug outlets compared to those who had a prescription (aPR = 0.76; 95%CI 0.63, 0.92). Participants who attained post primary education were 29% more likely to purchase a QAACT compared to those with no formal education (aPR = 1.29; 95%CI 1.07, 1.56). Business respondents were 24% more likely to purchase QAACT compared to peasant farmers (aPR = 1.24; 95%CI 1.02, 1.50) (Table 2).
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