Zambia outlet report 2009
Data were collected between 14th April 2009 and 3rd July 2009. A total of 3,840 outlets were sampled (by strata: urban, N=2,915; rural, N=925). Overall, 3,840 providers agreed to participate in the ACTwatch outlet survey. Of these, 469 outlets stocked antimalarials at any point in the three months prior to the interview, and 442 outlets stocked antimalarials at the time of the interview.
Availability of antimalarials
Most public health facilities stocked antimalarials as well as non-artemisinin montherapies (AMTs). Availability of oral AMT was less than 2%. In the private sector, few differences were observed over time. Highest stockage rates were found for n-AMTs. First line treatment was found in one out of every three outlets in the private sector.
Availability of diagnostic blood testing
In the follow up survey, 44% of public health facilities stocked microscopic blood testing, and 89% stocked rapid diagnostic tests. Private sector availability of testing was generally low (<15%). There were few changes observed over time in public health facilities, though a slight decrease in microscopy was observed, and an increase in RDTs. Socking rates in the private sector remained similar.
Price of antimalarials
In public health facilities, the price of first line treatment was free of charge. Few differences were observed over time in the private sector, the most popular treatment, SP, remained 18 times less expensive than the first line treatment. Volumes of antimalarials sold/distributed
Most first line treatment in Zambia, is distributed in the public sector (~16%). N-AMTs distributed in this sector is largely SP, presumable for intermittent preventive treatment in pregnant women. Less than 10% of ACTs were distributed in the private sector. Slight decreases were observed in the follow up survey of this antimalarial class.
Provider knowledge in the public sector was generally high and higher at follow up with 94% of providers knowing the first line treatment. Among providers that knew the first line treatment, knowledge of the dosing regimen was quite high. Slight increases were observed in the private sector, though knowledge of the first line treatment was lower (60%). Improvements were found over time in the proportion of providers that knew the correct child dosing regimen (88%).
The outlet survey is one of the ACTwatch research components. The objective is to monitor levels and trends in the availability, price and volumes of antimalarials, and providers’ perceptions and knowledge of antimalarial medicines at different outlets. This report presents indicators on availability, price, volumes, affordability in outlets and provider knowledge of antimalarials. National trends over time are presented first, followed by outlet survey round 2 indicators presented across outlet categories and urbanisation.
A nationally representative sample of all outlets that could sell or provide antimalarials to a consumer was taken through a census approach in 38 sub-districts/wards across two strata, urban and rural areas, in Zambia. Sampling was conducted using a one-stage probability proportional to size (PPS) cluster design, with the measure of size being the relative sub-district/ward population. Outlet inclusion criteria for this study included outlets which stocked an antimalarial at the time of survey or in the previous three months. An outlet is defined as any point of sale or provision of commodities for individuals. Outlets included in the survey are as follows: 1) public health facilities (government health facilities, hospitals, health posts); 2) Part One pharmacies (pharmacies licensed by the Pharmaceutical Regulatory Authority); 3) drug stores; 4) private health facilities (private hospitals, clinics, and surgeries); 5) grocery stores; and 6) other outlets (kiosks, containers, kantembas, and super/mini markets and petrol stations) [see Appendix A for definitions and numbers of each type of outlet]. Oversampling of public health facilities and Part One pharmacies was conducted in districts surrounding the selected sub-districts/wards.
Among outlets, three questionnaires were administered: 1) Screening Questionnaire 2) Audit sheet and 3) Provider Questionnaire. For all outlets, trained interviewers administered the screening questionnaire to collect information on the outlet type; location, including the outlet’s longitude and latitude; and information on availability of antimalarials. Among those outlets that stocked antimalarials at the time of survey, the audit sheet was administered. For each antimalarial, information was recorded on the brand and generic names, strength, expiry, amount sold in the last week and price to the consumer. Among outlets that stocked antimalarials at the time of interview, or in the past three months, the interviewer collected information on provider demographics, knowledge, and perceptions. Interviewers observed outlet licensing and storage conditions of medicines using the provider questionnaire.
Several validation and data checking steps occurred during and after data collection. Double data entry was conducted using Microsoft Access (Microsoft Cooperation, Seattle, WA, USA). Data was analysed using SPSS 17.0 (SPSS Inc., Chigaco, IL, USA).