Benin outlet report 2011

Of the 1,390 outlets that completed interviews (of 2,966 visited and 2,867 screened), 178 outlets reported having stocked antimalarials at any point in the three months prior to the interview and 1,212 outlet reported stocking antimalarials at the time of the interview.

Availability of any antiamalarial

Antimalarials were available in over 80% of screened outlets, with the exception of general retailers (shops and markets stalls, [31%]) and itinerant drug vendors (57%). On the day of the interview, at least one antimalarial was available in 87% of outlets in the public/not for-profit sector, including 94% of public health facilities. In the private sector, 100% of pharmacies and 82% of private for‐profit health facilities stocked antimalarials on the day of interview. Due to the large numbers of general retailers in the private sector, in total only one‐third (34%) of the private sector had any antimalarial available on the day of the interview. There is a clear difference in availability of antimalarials between these informal outlets (general retailers and itinerant drug vendors) and formal private sector outlets.

Outlet types stocking antimalarials 

The report shows the relative distribution of outlets that had at least one antimalarial in stock on the day of the interview. General retailers were the most common type of outlet stocking antimalarials, followed by community health workers (CHWs). In total, the public/not for-profit sector comprised one‐quarter of outlets stocking antimalarials.

Availability of different classes of antimalarials 

Among outlets stocking antimalarials on the day of interview, there was a large difference between the availability of first‐line quality assured ACT (FAACT) in the public/not for-profit sector and the private sector (86% and 23% respectively). All CHWs (n=42) with antimalarials in stock had FAACT, while 70% of public health facilities had FAACT in stock. Only 18% of general retailers stocked FAACT. More than 90% of all outlets stocked non‐artemisinin monotherapy, with the exception of CHWs who only had FAACT in stock. Outlets stocking oral artemisinin monotherapy were rare.

Availability of diagnostic blood testing 

Among outlets stocking antimalarials in the past three months, availability of diagnostic blood testing facilities was low. In the public/not for-profit sector, rapid diagnostic tests (RDTs) were more common than microscopy. However, only 36% of public health facilities had RDTs in stock and none of the 49 CHWs interviewed had RDTs available. Levels of any test availability were similar in private not for-profit and private for-profit health facilities (37% and 34%), but low in other private sector outlets (pharmacies 2% and general retailers 0%).

Price of antimalarials 

At the time of data collection no outlet type systematically provided FAACT free of charge; the median price of FAACT in public health facilities was USD 1.35 [n=311]. The median FAACT price in the private sector was USD 2.25 [n=563], and pharmacies were substantially more expensive than other private outlets (USD 9.18 [n=285], compared to USD 2.25 [n=183] in general retailers). By comparison, the median price of SP, a widely available non‐artemisinin therapy, was 5 times less expensive than the median FAACT cost in the private sector (USD 0.45 [n=562]).

Volumes of antimalarials sold/distributed 

The report presents the market share of different antimalarial classes sold/distributed in the 7 days before the survey, within each outlet type. Distribution of FAACT was more common in the public/not for-profit sector than in the private sector (48% compared to 17%). 64% of recent antimalarial sales in pharmacies were non‐quality assured ACTs, a category that includes non‐tablet formulations. Whilst 12% of adult equivalent treatment doses (AETDs) sold by general retailers were FAACTs, chloroquine comprised 45% of their market share and SP comprised 34%.

Provider knowledge 

Overall, 56% of providers interviewed were able to correctly state artemether lumefantrin (AL) as the recommended first‐line treatment for uncomplicated malaria in Benin. Knowledge was significantly higher in the public/not for-profit sector compared to the private sector (93% vs. 45%). Knowledge of the correct dosing regimen for adults was generally higher than that for children, although 90% of CHWs could state the correct regimen for a child while fewer (55%) could state this correctly for an adult.

The ACTwatch Outlet Survey, Benin, 2011 Survey Report presents the results of a cross‐sectional survey of outlets conducted in Benin from April 8-30, 2011.

The objective of the outlet survey 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. Price and availability data on diagnostic testing services is also collected.

A nationally representative sample of all outlets with the potential to sell or provide antimalarials to a consumer was taken through a census approach in 19 clusters across Benin; clusters were defined as arrondissements. Sampling was conducted using a one‐stage probability proportional to size (PPS) cluster design, with the measure of size being the relative cluster population. Oversampling of public health facilities and registered pharmacies was conducted to ensure adequate representation of these outlet types in the survey.

The inclusion criteria for this study were outlets that stocked an antimalarial at the time of survey or had stocked antimalarials 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 (national/referral/zone hospitals, health centres, village health units, dispensaries and maternities); 2) private not for‐profit health facilities (mission and non‐governmental organisation [NGO] health facilities); 3) private for‐profit health facilities (private clinics and hospitals); 4) registered pharmacies; 5) general retailers (stores, boutiques, and market stalls); 7) itinerant drug vendors (hawkers); and 8) community health workers. Refer to the appendices of the full report for definitions and numbers of each type of outlet included in the analysis.

Three questionnaire modules were administered to participating outlets: 1) a screening module, 2) an audit module (antimalarial audit sheets and rapid diagnostic test [RDT] audit sheets), and 3) a provider module. For all outlets, trained interviewers administered the screening module to collect information on the outlet type and 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 module 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 previous three months, the interviewer collected information on provider demographics, knowledge, perceptions, and medicine storage conditions using the provider module. Where these outlets had RDTs available, information on RDT brand, manufacturer, price and number of tests sold in the last week was collected using the rapid diagnostic test component of the audit module.

A total of 2,966 outlets were approached for inclusion in the study. Of the 99 outlets were not screened for various reasons, 53 refused to participate in screening; 30 outlets were closed down permanently; in 9 outlets an eligible respondent was not available; and 7 outlets were not open at the time of the survey visit. Overall, 2,867 outlets agreed to participate in the ACTwatch outlet survey and were screened. Of the 1,519 outlets that met the screening criteria and were eligible for interview, 104 refused to continue and in 25 outlets an eligible respondent wasn’t available or the time wasn’t convenient for the full interview. Of the 1,390 outlets that completed interviews, 178 outlets reported having stocked antimalarials at any point in the three months prior to the interview and 1,212 outlet reported stocking antimalarials at the time of the interview.