Abstract

BackgroundThe Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation’s capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector.MethodsA malaria medicine outlet survey was conducted in Kinshasa province in 2013. Stratified multi-staged sampling was used to select areas for the survey. Within sampled areas, all outlets with the potential to sell or distribute anti-malarials in the public and private sector were screened for eligibility. Among outlets with anti-malarials or malaria rapid diagnostic tests (RDT) in stock, a full audit of all available products was conducted. Information collected included product information (e.g. active ingredients, brand name), amount reportedly distributed to patients in the past week, and retail price.ResultsIn total, 3364 outlets were screened for inclusion across Kinshasa and 1118 outlets were eligible for the study. Among all screened outlets in the private sector only about one in ten (12.1%) were stocking quality-assured Artemisinin-based Combination Therapy (ACT) medicines. Among all screened public sector facilities, 24.5% had both confirmatory testing and quality-assured ACT available, and 20.2% had sulfadoxine-pyrimethamine (SP) available for intermittent preventive therapy during pregnancy (IPTp). The private sector distributed the majority of anti-malarials in Kinshasa (96.7%), typically through drug stores (89.1% of the total anti-malarial market). Non-artemisinin therapies were the most commonly distributed anti-malarial (50.1% of the total market), followed by non quality-assured ACT medicines (38.5%). The median price of an adult quality-assured ACT was $6.59, and more expensive than non quality-assured ACT ($3.71) and SP ($0.44). Confirmatory testing was largely not available in the private sector (1.1%).ConclusionsWhile the vast majority of anti-malarial medicines distributed to patients in Kinshasa province are sold within the private sector, availability of malaria testing and appropriate treatment for malaria is alarmingly low. There is a critical need to improve access to confirmatory testing and quality-assured ACT in the private sector. Widespread availability and distribution of non quality-assured ACT and non-artemisinin therapies must be addressed to ensure effective malaria case management.

Highlights

  • The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria

  • Positive cases of simple malaria should be treated with artesunate + amodiaquine (ASAQ) or artemether + lumefantrine (AL), ideally with a World Health Organization (WHO) pre-qualified product, referred to as a quality-assured artemisinin-based combination therapy (ACT)

  • A 2009 survey conducted by the ACTwatch project [6] revealed that there are several barriers to appropriate treatment in the DRC—namely that availability of quality-assured ACT medicines in the private sector, where most people seek treatment, is low (Table 1) [7]

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Summary

Introduction

The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation’s capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector. A 2009 survey conducted by the ACTwatch project [6] revealed that there are several barriers to appropriate treatment in the DRC—namely that availability of quality-assured ACT medicines in the private sector, where most people seek treatment, is low (Table 1) [7]. In 2009, only 14% of the anti-malarial stocking private sector had quality-assured ACT available. Oral artemisinin monotherapy was sold and distributed in the private sector, and contributed up to 10% of the total market share of all anti-malarials.

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