DR Congo outlet report 2013
The 2013 outlet survey (OS) conducted in the DRC showed the following:
The majority of antimalarial-stocking outlets across urban and rural areas were drug stores. However, while drug stores accounted for 75%-80% of antimalarial-stocking outlets in urban areas of Kinshasa and Katanga, they accounted for 54%-68% of outlets in rural areas. Health facilities accounted for a larger fraction of the antimalarial market composition in rural areas as compared with urban areas. For example, 40% of antimalarial-stocking outlets in rural Katanga are health facilities as compared with 25% in urban areas.
- ACT availability among antimalarial-stocking outlets was similar in 2009 and 2013 in Kinshasa with the exception of increased availability among private for-profit health facilities (33%, 63%) and drug shops (75%, 91%). In 2013, ACT availability among public facilities was 59% in Kinshasa compared with 83% in Katanga. Most antimalarial-stocking drug shops in Kinshasa (91%) were stocking ACT as compared with 71% in Katanga. Among the few antimalarial- stocking retailers in Katanga (N=15), 36% were stocking any ACT.
Availability of quality-assured ACT (QA ACT) among antimalarial-stocking outlets in Kinshasa was similar between 2009 and 2013. In 2013, QA ACT was available among more than half of antimalarial-stocking outlets in Kinshasa (59%) and Katanga (71%) as well as half of drug shops in Katanga but fewer than 10% of drug shops in Kinshasa.
Multiple types of non-quality-assured ACT (non-QA ACT) were available among public and private sector outlets in Kinshasa and Katanga including suspension and tablet formulations and various drug combinations. Most notably available across sectors and provinces were artemether lumefantrine (AL) tablets and suspensions. For example, most non-QA ACTs available in the private sector in Kinshasa were AL tablets (31%) or suspensions (36%). Similarly in the private sector in Katanga, most non-QA ACTs available were AL tablets (33%) or suspensions (33%).
Oral artemisinin monotherapy (oral AMT) was available among the majority of antimalarial-stocking pharmacies (76%) and drug stores (83%) as well as nearly one-third of public health facilities (30%) and private for-profit facilities (33%) and in Kinshasa in 2009. In 2013, oral AMT was largely no longer available in Kinshasa and Katanga. Among the N=18,790 antimalarial medicines audited in 2013, four products were oral AMT (two in Kinshasa, two in Katanga).
The private sector distributed the majority of antimalarials in Kinshasha (2009, 96%; 2013, 97%) and Katanga provinces (2013, 86%). The most commonly distributed antimalarials are non-artemisinin therapies including SP and quinine. In 2013, non-artemisinin therapy accounted for 50% market share in Kinshasa and 59% in Katanga. While oral artemisinin monotherapy (oral AMT) accounted for 11% of the antimalarial market share in Kinshasa in 2009, oral AMT market share in 2013 was nearly 0%. Non-quality-assured ACT market share in Kinshasa was 18% in 2009 and increased to 39% in 2013.
The percentage of antimalarial-stocking outlets with malaria blood testing available (RDT or microscopy) remained high over time among public and private health facilities in Kinshasa. In 2013, approximately 90% of these facilities had malaria blood testing available in Kinshasa, as compared with approximately 75% among facilities in Katanga. Blood testing was generally not available among drug stores.
This country reference document is a detailed presentation of the 2013 ACTwatch outlet survey (OS) conducted in Kinshasa and Katanga Provinces. The 2013 OS follows a previous survey round conducted by ACTwatch in the DRC in 2009.
ACTwatch antimalarial market monitoring in the DRC from 2009 to present has been implemented in the context of investments and strategies to improve coverage of appropriate case management (see Annex 2). According to national policy in the DRC, appropriate case management entails confirmatory testing using microscopy or rapid diagnostic tests (RDTs) for all suspected cases, and treatment of confirmed cases with the first-line artemisinin combination therapy (ACT). Since 2005, the first-line ACT has been artesunate amodiaquine (ASAQ). In 2012 artemether lumefantrine (AL) was identified as a suitable alternative first-line therapy. Oral artemisinin monotherapy was officially banned in the DRC in 2007.
The ACTwatch outlet survey conducted in 2009 provided national-level estimates and was stratified to estimate indicators within four geographic areas, one of which was Kinshasa. The 2013 survey focused on Kinshasa and Katanga provinces. Trends between 2009 and 2013 are therefore available for Kinshasa province. Another outlet survey round is planned for 2015. These surveys are designed to monitor key antimalarial market indicators. ACTwatch outlet survey findings can inform ongoing monitoring, evaluation, and adjustment to policy, strategy, and funding decisions to strengthen malaria case management.