Access to quality assured artemisinin-based combination therapies and associated factors among selected private drug outlet clients in Uganda

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Abstract Background: Malaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based agents. This affects access to effective treatment predisposing patients to unwanted outcomes such as resistance development and adverse drug events. The study investigated access to quality assured artemisinin-based combination therapy (QAACT) agents among private drug-outlet clients in Uganda. Methods: This was a cross sectional study where exit interviews were conducted among randomly selected private drug outlet clients in high and low malaria transmission settings in Uganda. The study adapted World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance. Results: A total of 1114 exit interviews were conducted among systematically sampled private drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an ACT antimalarial from the drug outlets. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained antimalarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a quality assured artemisinin-based combination therapy (QAACT). Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing QAACT antimalarial agent among drug outlet clients include type of drug outlet visited (aPR=0.74; 95%CI: 0.6, 0.91), not obtaining full dose (3-day treatment) of ACTs (aPR=0.49; 95%CI: 0.33, 0.73), not finding the ACTs expensive (aPR=1.24; 95%CI: 1.03, 1.49), post primary education (aPR=1.29; 95%CI: 1.07,1.56), business occupation (aPR=1.24; 95%CI: 1.02,1.50) and not having a prescription (aPR=0.76; 95%CI: 0.63, 0.92). Conclusion: Less than a third of the private drug outlet clients obtained a quality assured artemisinin-based combination therapy for management of malaria symptoms. Individuals who did not find ACTs to be expensive were more likely to obtain a QAACT antimalarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of quality assured ACTs antimalarial agents under the current private sector copayment mechanism.

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