Private Retail Research Articles

P6147Access to essential cardiovascular medicines in Kerala, the state with the highest cardiovascular disease burden in India

Abstract Introduction The 2030 Agenda for Sustainable Development has prioritized the reduction of premature mortality due to NCDs – including cardiovascular diseases (CVD) - by a third. To achieve this goal, countries must achieve 80% availability of affordable essential medicines. Essential medicines as identified by the World Health Organization are those that meet the priority healthcare needs of majority population. Globally, India has the second highest CVD burden with over 1.7 million deaths annually, with the highest CVD morbidity and mortality rate in Kerala. Purpose To evaluate the availability, prices and affordability of essential CVD medicines in Kerala state to facilitate implementation of informed public health policy. Methods Using WHO/HAI methodology, we obtained data on availability and prices for 25 essential CVD medicines in a representative sample of 7 public-sector hospitals (survey anchors) and 37 private retail pharmacies located near the survey anchors in four districts. Additionally, we obtained the data from 10 government-subsidized discount pharmacies. We report availability as percentage of surveyed facilities where a given medicine was found. Median prices ratios (MPRs) were calculated by comparing consumer prices to the MSH International Reference Prices (IRPs). Medicines were considered affordable if the monthly supply costs less than one-day's wage of the lowest paid government worker. Results In the public-sector facilities (hospital and discount pharmacies combined), the mean (SD) availability of the surveyed CVD medicines was 52% (35.3%) for generic and 35.3% (20.7%) for originator brand (OB) version. 28% of surveyed medicines (including amlodipine, clopidogrel, losartan, metformin) were available in over 80% pharmacies. 12% (captopril, streptokinase and glyceryl trinitrate) were not available in any of the facilities. In the private sector, mean (SD) availability of generic and OB versions was 64.4% (37.2%) and 43.7% (34.6%), respectively. MPR was 1.28 [range: 0.02 (insulin NPH) – 16.7 (simvastatin)] for both lowest-priced generics (LPG) and most-sold generics (MSG). The lowest paid government worker in Kerala would spend 0.06 - 3.48 days' wages for the monthly supply of essential CVD medicines in the private sector. In government-subsidized discount pharmacies, mean availability was 49.3%. The generic medicine prices were 74% lower than in the private sector. Conclusions Availability of essential CVD medications in both public and private sector pharmacies fall short of the 80% target. In the private-sector, many essential CVD medications seem unaffordable especially considering the polypharmacy among CVD patients. Introducing policies to improve medicine availability in government-subsidized discount pharmacies is crucial in tackling Kerala's ever-increasing CVD burden.

Insulin price components: case studies in six low/middle-income countries

IntroductionUnderstanding price components for insulin products can help design interventions to improve insulin affordability in low/middle-income countries.MethodsAn adapted WHO/Health Action International standardised methodology was used in Brazil (Rio de Janeiro),...

Driving to a future without accidents? Connected automated vehicles’ impact on accident frequency and motor insurance risk

Road traffic accidents are largely driven by human error; therefore, the development of connected automated vehicles (CAV) is expected to significantly reduce accident risk. However, these changes are by no means proven and linear as different levels of automation show risk-related idiosyncrasies. A lack of empirical data aggravates the transparent evaluation of risk arising from CAVs with higher levels of automation capability. Nevertheless, it is likely that the risks associated with CAV will profoundly reshape the risk profile of the global motor insurance industry. This paper conducts a deep qualitative analysis of the impact of progressive vehicle automation and interconnectedness on the risks covered under motor third-party and comprehensive insurance policies. This analysis is enhanced by an assessment of potential emerging risks such as the risk of cyber-attacks. We find that, in particular, primary insurers focusing on private retail motor insurance face significant strategic risks to their business model. The results of this analysis are not only relevant for insurance but also from a regulatory perspective as we find a symbiotic relationship between an insurance-related assessment and a comprehensive evaluation of CAV’s inherent societal costs.

Understanding the Brazilian expanded polystyrene supply chain and its reverse logistics towards circular economy

This paper aims to investigate the supply chain and reverse channels of expanded polystyrene packaging connection in Brazil and their roles to discuss the main challenges towards circular economy. In order to achieve this goal, we propose a four-step method, anchored in the literature, technical visits, and interviews with experts in the expanded polystyrene (EPS) industry. First, the EPS supply chain was characterised and mapped, and secondly, the stakeholders and logistics activities in reverse channels were analysed. Third, the Brazilian legislation and chain structure was reviewed to obtain an understanding of how this can influence the activities developed in reverse channels. Fourth, with an analysis of the data collected before, the barriers to implement EPS reverse chain were presented. The main results establish that the EPS can complete one cycle of the circular economy, which is recycling, but products need to be separated and washed. The most significant waste generators are public and private institutions, residences, and retailers. Notable barriers to its recycling are a lack of understanding of the nature of expanded polystyrene recycling by Brazilian people, high transport cost due to material density, and the dispersion of post-consumer expanded polystyrene in several regions of the country linked with the small number of recycling facilities. Finally, this issue could be explored in industries and companies that require their managers to adopt strategies to improve reverse logistics in order to promote the circular economy. The companies’ actions could facilitate a stronger circular supply chain since they could increase recycling efforts, reduce expanded polystyrene waste, and present new business models. The resulting generation of employment would contribute to the quality of life of contemporary society. The findings presented in the paper enable industries to identify and guide the most demanding significant steps and processes, and to shift the reverse chain and expanded polystyrene recycling to ensure that they operate more efficiently.

SWOC Analysis of Kirana Shops

The private village shops are the backbone of rural retail marketing. Private retail shops are ideal agencies for village distribution. There are around 2 million sales outlets at the retail level in rural India. One retail shop is serving around 600 families in the rural retail marketing. The retailer to consumer ratio has been very low with many such shops often located close to people residence, near to home and at the corner of the street, thus making location and convenience a major factor for their popularity. Kirana shop is one of the easiest ways to generate self- employment as it requires limited investment in land, capital and human resource. Kirana shops are unique business models in India especially in rural areas which are offering personal services and quality products as per demand of customers. A Kirana shop normally a range from 25 to 400 square feet with a various range of products which are daily requirement of customers. The total area of Sangli district is 8,572 sq. Mt. and there are 10 talukas and 734 towns in Sangli district and registered kirana shops are 5,741. The researcher has collected required information and data from Kirana shopkeepers in Sangli district. The primary data is collected through questionnaire. Discussion, interviews, observation and necessary field work. The sample selection of kirana shops have been selected on the basis of ‘Stratified Sampling Method’. While selecting villages, factors considered are the geographical location of taluka, such as East, West, North, South and Middle, and one village from each direction has selected Therefore, researcher has used ‘ Proportionate Sampling Method’ for selecting taluka- wise kirana shops. Researcher has found that the kirana shops are competing with local bazaars which are to be started by big traders and wholesalers in the sample study area. Competition is the major factor for existence of Kirana shops. Recovery of dues from customers is another challenging problem of the existence of Kirana shops, The consumer behavior is changing because of new technology. Fashions, life styles etc. However, changing consumer behavior is affecting rural based kirana shops. So, now a day, they are suffering for their existence.

Availability, pricing and affordability of selected medicines for noncommunicable diseases.

The global and national burden of noncommunicable diseases continues to rise, thus making access to medicines increasingly important. The objective of this study was to evaluate the availability, pricing, and affordability of selected medicines for noncommunicable diseases in the Islamic Republic of Iran used in 2014 based on the World Health Organization (WHO)/Health Action International (HAI) methodology. The price and availability data for 54 selected medicines were collected from public and private retail pharmacies as well as private pharmacies located in public hospitals in six cities of the Islamic Republic of Iran on the basis of the standardized methodology developed by WHO and HAI. The outcome measures were percentage availability of medicines, ratios of medicine prices to the international reference prices, and the affordability. Affordability was defined as the number of days' wages needed by the lowest-paid unskilled government worker to afford one month of chronic treatment. The procurement price of the surveyed Lowest Priced Generic and Most Sold Generic medicines was 1.19 times the international reference price. The patient price was not significantly different among different pharmacy retail settings compared with the international reference prices. Moreover, the overall mean availability of the surveyed Lowest Priced Generic medicines in public, private, and other settings was 75.5%, 83.3% and 80.3%, respectively. All the treatment costs for the high burden noncommunicable diseases were less than one day's wages of the lowest-paid government worker. This study indicated that procurement prices of the surveyed medicines were reasonable in comparison with the international reference price. Moreover, the availability of generic forms of the surveyed medicines was good but originator brand medicines were significantly low in all the three settings.

How to Understand ʿal yede? Title Pages of Hebrew Private Library Catalogues Printed in the Dutch Republic during the Long 18th Century

Abstract As a first step towards more research in the field of Jewish private libraries and Hebrew auction catalogues, this zuta focuses on the understudied corpus of 18th-century Hebrew book sales catalogues printed in the Dutch Republic. It is not always clear if these 18th-century catalogues contain collections from private libraries or retail stocks of publishers, printers, or booksellers. In this article I will analyse and compare the title pages of several catalogues, in order to understand the meaning of the phrase ʿal yede in relation to ownership of the catalogued collections.

Evaluating medicine prices, availability and affordability in Bangladesh using World Health Organisation and Health Action International methodology

BackgroundPrevious studies have shown limited availability of medicines in health facilities in Bangladesh. While medicines are dispensed for free in public facilities, they are paid out-of-pocket in private pharmacies. Availability, price and affordability are key concerns for access to medicines in Bangladesh.MethodsThe World Health Organization/Health Action International survey methodology was used to determine price, availability and affordability of 61 lowest price generic (LPG) and originator branded medicines in public facilities, private retail pharmacies and private clinics across 6 regions of Bangladesh. Medicines for non-communicable and infectious diseases, and both on and off the national Essential Medicines List were included. Prices were compared internationally using Median Price Ratio (MPR).ResultsMean LPG (originator brand) availability in the public sector, private retail pharmacies, and private clinics was 37%, 63 (4) percent, and 54 (2) percent, respectively. Medicines for Non-Communicable Diseases (NCD) and essential medicines were significantly less available than infectious disease medicines and non-essential medicines, respectively.Mean LPG (originator brand) MPR was 0.977 in the public sector, 1.700 (3.698) in private retail pharmacies and 1.740 (3.758) in private clinics. Six medicines were expensive by international standards across all sectors.The least affordable treatments in both private sectors were bisoprolol (hypertension), metformin (diabetes) and atorvastatin (hypercholesterolemia).ConclusionAvailability and affordability of NCD medicines are key concerns where the burden of NCD is rising. These findings show improvement from earlier studies, but room for further advances in availability and affordability of NCD medicines in Bangladesh. A small number of medicines are consistently expensive across sectors in Bangladesh, suggesting the need for strategies to address prices for certain medicines.

Descriptive Study of Foodborne Disease Using Case Monitoring Data in Shandong Province, China, 2016-2017

In order to generate data on the burden of foodborne diseases in Shandong Province, we aimed to use the case monitoring data of foodborne diseases from 2016 to 2017 to estimate. Data were obtained from the foodborne disease surveillance reporting system with dates of onset from Jan 1, 2016, to Dec 31, 2017, in Shandong, China. The places of food exposure were categorized by settings as follows: private home, catering facility, collective canteens, retail markets, rural banquets and other. Exposed food is divided into 23 categories. Overall incidence rate and proportions by exposure categories, age, and sex-specific incidence rates were calculated and sex proportions compared. Approximately 75.00% of cases who had at least one exposure settings were in private homes. The most frequently reported exposed food was a variety of food (meaning more than two kinds of food). The two-year average incidence rate was 75.78/100,000, sex-specific incidence rate was much higher for females compared to males (78.23 vs. 74.69 cases per 100,000 population). An age-specific trend was observed in the cases reported (Chi-Square for linear trend, χ2=4.39, P=0.036<0.05). A preliminary estimate of 14 million cases of foodborne diseases in Shandong province each year. Future studies should focus on cross-sectional and cohort studies to facilitate the assessment of the distribution and burden of foodborne disease of the population in Shandong. Considering strengthening the burden of foodborne diseases in foodborne disease surveillance is also a feasible way.

Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India

IntroductionIndia has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients....

Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa.

BackgroundCostly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.AimThis study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments.SettingThe study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa.MethodsAn exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators – one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes.ResultsCo-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes’ function.ConclusionUnavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments.Keywordsco-payments; high socio-economic; low socio-economic; medical scheme; medicines pricing policy; National Health Insurance; pharmacist; prescribed minimum benefit; retail pharmacy; regulator.

Malaria testing and treatment knowledge among selected rural patent and proprietary medicine vendors (PPMV) in Nigeria

BackgroundMalaria is a leading cause of illness and death in Nigeria, but access of poor people to quality anti-malarial services remains low especially in the rural areas. Patent and proprietary medicine vendors (PPMVs) provide the majority of malaria treatment in rural areas, but little is known about their knowledge of malaria testing and treatment of uncomplicated malaria as recommended in the 2011 National Malaria Control Programme policy.MethodsA cross-sectional survey was conducted in two purposively selected states (Oyo and Bayelsa) in Nigeria with each state representing a different geographic and linguistic–ethnic region in the southern part of the country. Two rural LGAs were randomly selected from each state and data were collected from 160 randomly selected PPMVS (40 per LGA) using a structured questionnaire. Data were analysed using descriptive statistics.ResultsThe 2011 National Policy on Malaria Diagnosis and Treatment is mostly unknown to PPMVs. Although most PPMVs (89%) knew that artemisinin-based combination therapy (ACT) is recommended in the national policy, 91% also thought non-ACT were endorsed. The proportion of PPMVs who stated they would treat a malaria case with an artemisinin-based combination at the correct dose was 33% for a child under five, 47% for an adult male and 14% for a pregnant woman in her second trimester. The proportion of PPMVs who reported they would diagnose a case of malaria prior to treatment using a malaria rapid diagnostic test (RDT) kit was 1.9% for children under five, 7.5% for adult males and 3.1% for pregnant women in their first trimester due to lack of knowledge. Almost two-thirds (65.6%) would correctly refer children with severe malaria to health facility.ConclusionsSubstantial knowledge gaps on the use of RDTs and treatment with artemisinin-based combinations exist among rural PPMVs. Given existing evidence regarding the effectiveness of private retail outlets in malaria case management, PPMVs should be provided with competency-based training and supervision to improve the quality of care they provide.

Knowledge, attitudes, and practices of community pharmacists in relation to generic medicines in Palestine: a cross-sectional study

BackgroundGeneric substitution of medicines has become common practice in many countries and is considered to be a key method to contain pharmaceutical expenditure without compromising health-care quality. However, the safety and quality of generic products are of concern to health professionals. This study aimed to investigate community pharmacists' knowledge, attitudes, and practices in relation to generic medicines in Palestine. MethodsA cross-sectional observational study was carried out using a convenience sampling technique to distribute a data collection form to practicing pharmacists in the West Bank. In Palestine, the majority of pharmacists work in private retail pharmacies called community pharmacies. Other forms of professional pharmacy in Palestine include pharmacists in industry, in the regulatory governmental sector, and in hospitals and other clinical settings. Here, a sample of licensed community pharmacists completed the questionnaire, which consisted of four main sections: demographic and practice details of the participants, and their knowledge of, attitudes towards, and factors influencing their selection and dispensing of generic medicines. The Mann–Whitney U test or Kruskal–Wallis test were used, as appropriate. A p value of less than 0·05 was considered significant. FindingsA total of 302 community pharmacists were interviewed, of whom 52% (157 out of 302) were male. The participants' mean knowledge score in relation to generic medicines was 5·91 (SD 1·27), and the highest score was 8 out of 10 (the maximum possible score was 10). Knowledge score was not significantly associated with any of the sociodemographic characteristics. Most pharmacists in the study (87%; 264 out of 302) agreed that they should be given the right to substitute with generic medicines, and the majority (62%; 188 out of 302) supported generic substitution for brand name drugs in all situations in which a generic medicine is available. The main two factors affecting pharmacists' selection and dispensing of generic medicines were personal faith in the product (86%; 260 of 302) and cost effectiveness of generic medicines (84%; 269 of 302). InterpretationParticipant community pharmacists in Palestine had basic knowledge with regard to generic medicines. In particular, their knowledge score pertaining to the technical and regulatory aspects of bioequivalence and pharmacokinetic parameters was insufficient. These data suggest a demand for interventions to develop pharmacists' awareness of these important matters underlying the safety, quality, and efficacy of generic medicines. FundingNone.

Disparities in Access to Supplemental Nutrition Assistance Program Retailers Over Time and Space

The largest public assistance program in the United States, the Supplemental Nutrition Assistance Program (SNAP), relies on private retailers for program access. We analyze geo-coded SNAP-authorized convenience and grocery stores in 2000 and 2010 to determine factors associated with their accessibility. Results demonstrate that accessibility was higher in areas with high rates of SNAP income-eligible individuals, but that some spatial disparity persists, particularly in areas with lower initial access and rural areas. Findings highlight the importance of SNAP-authorized convenience stores if markets continue to determine the location of SNAP access points.

The impact assessment of Scheduel H1 on the sales of over-the-counter antibiotics in India: Evidence from quasi-experimental research design

Purpose: The Schedule H1 of Drugs and Cosmetics Act of Government of India sought to regulate over the counter antibiotic sales in the private market. The objective of this research is to conduct impact evaluation of this policy intervention. Methods & Materials: The intervention is a policy for redcuing over-the-counter sales of antibiotics named Schedule H1 of Drugs and Cosmetics Act of Government of India implemented through/on retail pharmacies on selected antibiotic notified under the new Schedule H1. Monthly data on the antibiotics sold in the private retail market were studied. An ITS model controlling for seasonality and autocorrelation was used to examine the dataset for significant level and trend shifts. Results: Our preliminary analysis suggest a post intervention decrease in the average monthly market share of antibiotics under Schedule H1 by 1.56 percent which was significant (p < 0.05) and a decrease in the trend by 0.041 percent which was not significant (p > 0.05). The ITS model adjusted for seasonality and autocorrelation suggets slight reduction effect size i.e. −1.53% from −1.56% in level change but no change in the trend estimate. Conclusion: The segmented regression analysis of pharmaceutical sales is a robust method for measuring the impact of interventions directed towards medicines utilization. The Schedule H1 intervention was associated with significant decrease in over-the-counter sales of the notified antibiotics intially but the reduction in sales or the impact of the intervention could not be sustained over long term.

Microbiological Evaluation of Chicken Carcasses Retailed in Al-Boheira Province with Detection of Some Enteropathogens

A total of 100 freshly slaughtered chicken carcasses samples were randomly collected from different private retail outlets in Al-Boheira Province during the period extended from March to September 2018 including; thigh and breast (50 samples of each). Samples were subjected to microbiological evaluation via making of aerobic plate count (APC), Enterobacteriaceae count (EC), Coliforms count (CC) as well as molds and yeasts counts. In addition, isolation of some enteropathogens including; Escherichia coli, Salmonella and Shigella was attempted. It was recorded that APC ranged from 5×103 to 6.8×105, with a mean value 2.3×105±2.8×105cfu/g in samples collected from breast, while in samples of the thigh it ranged from 4.9×104 to 1.8×106, with a mean value 6.9×105±7.1×105 cfu/g. Concerning EC, it was found that EC ranged from 6×102to 1.8×103, with a mean value 1.3×103±3.8×102 cfu/g in samples of breast, while in the thigh samples, it ranged from 1.8×103 to 2.5×103, with a mean value 2×103±1.7×103cfu/g. Also, it was recorded that CC of the examined samples ranged from 6×102to 1.6×103, with a mean value 1.1×103±3.4×102cfu/g in breast samples, while in thigh samples, it ranged from 1.6×103to 2.3×103, with a mean value1.8×103±1.8×102cfu/g. The trail of isolation of some enteropathogens revealed the isolation of Salmonellae from thigh and breast samples at the rate of 22 and 18%, respectively. E. coli isolated from both types of samples breast and thigh were at percentage of 40%and48% in breast and thigh, respectively. Furthermore, Shigella spp. was isolated from chicken carcasses breast and thigh samples at percentage of 30% and 42%, respectively. Also, it was found that yeast count ranged from 3.1×102 to 5.4×103, with a mean value 2.2×103±2.1×103cfu/g in breast samples of fresh chicken carcasses, while in samples from thigh ranged from 3.8×102 to 5.7×103, with a mean value 2.3×103 ± 2.2×103 cfu/g. Also, it was found that mould count ranged from 1.1×102 to 1.3×102, with a mean value 7.3×102±9.5×102cfu/g in breast samples of fresh chicken carcasses, while in samples from thigh ranged from 1.3×102 to 2.4×103, with a mean value 1×103±9.6×102cfu/g According to the recorded results in the current study, it was clear that increased bacterial counts with occurrence of pathogenic bacteria in the examined samples that exceed the Egyptian standards especially thigh samples reflected the poor hygienic conditions that accompanied the traditional slaughtering process reducing the quality of chicken meat sold under such conditions that should alarm the danger bells to prevent selling of freshly slaughtered chicken carcasses and give the chance for chilled and frozen chicken carcasse.

A17062 Evaluating Hypertension prevalence, treatment and management in Nepal

Objectives: The objective of Nepal May Measurement Month (MMM) 2017 Study was to raise awareness about hypertension while evaluating hypertension status and medicines access situation during healthcare-facility exit interviews. Methods: Total 6,127 patients (mean age 38.7 ± 21.0 years) participated in facility based blood pressure screening – conducted at mean temperature of 28.3 ± 3.9 °C) – at nine districts in Nepal. Results: According to the WHO 1999 guidelines, 16.7% (n = 1021) were found hypertensive; however, this proportion would be 47.3% as per AHA, 2017 guidelines.55.7% of hypertensive were being treated and of them 94.4% were under control. In terms of access to medicines, hypertensive participants under treatment reported to obtain their antihypertensive medications predominantly from three sources: private hospitals or clinics (52.9%), followed by government health facilities (18.5%) and private retail pharmacies (17.6 %). Majority of hypertensive participants had to spend > = 30 minutes to reach nearest health facility (52.9%) for medicine refills, mostly so by walking (53.7%) and fewer by motor vehicles (42.3%) and bicycle (4%). Upon asked about medication adherence, 11.5% participants under treatment reported that they are forgetful to take medicines regularly, while 94.9% reported themselves being careless to take medicines regularly and 5.4% had missed a planned health care visit in last one month. Conclusion: Given the suboptimal treatment and adherence status, our study population is at higher risk of future cardiovascular events. Similar screening activities should be continued in future, by involving provincial and local governments and doing more or so by the participation of volunteers and students network.

Private retail drug shops: what they are, how they operate, and implications for health care delivery in rural Uganda

BackgroundRetail drug shops play a significant role in managing pediatric fevers in rural areas in Uganda. Targeted interventions to improve drug seller practices require understanding of the retail drug shop market and motivations that influence practices. This study aimed at describing the operational environment in relation to the Uganda National Drug Authority guidelines for setup of drug shops; characteristics, and dispensing practices of private retail drug shops in managing febrile conditions among under-five children in rural western Uganda.MethodsCross sectional survey of 74 registered drug shops, observation checklist, and 428 exit interviews using a semi-structured questionnaire with care-seekers of children under five years of age, who sought care at drug shops during the survey period. The survey was conducted in Mbarara and Bushenyi districts, South Western Uganda, in May 2013.ResultsUp to 90 and 79% of surveyed drug shops in Mbarara and Bushenyi, largely operate in premises that meet National Drug Authority requirements for operational suitability and ensuring medicines safety and quality. Drug shop attendants had some health or medical related training with 60% in Mbarara and 59% in Bushenyi being nurses or midwives. The rest were clinical officers, pharmacists. The most commonly stocked medicines at drug shops were Paracetamol, Quinine, Cough syrup, ORS/Zinc, Amoxicillin syrup, Septrin® syrup, Artemisinin-based combination therapies, and multivitamins, among others. Decisions on what medicines to stock were influenced by among others: recommended medicines from Ministry of Health, consumer demand, most profitable medicines, and seasonal disease patterns. Dispensing decisions were influenced by: prescriptions presented by client, patients’ finances, and patient preferences, among others. Most drug shops surveyed had clinical guidelines, iCCM guidelines, malaria and diarrhea treatment algorithms and charts as recommended by the Ministry of Health. Some drug shops offered additional services such as immunization and sold non-medical goods, as a mechanism for diversification.ConclusionMost drug shops premises adhered to the recommended guidelines. Market factors, including client demand and preferences, pricing and profitability, and seasonality largely influenced dispensing and stocking practices. Improving retail drug shop practices and quality of services, requires designing and implementing both supply-side and demand side strategies.

Availability of brands of six essential medicines in 124 pharmacies in Maharashtra

BackgroundThe aim of this study is to assess the availability and rational use of six essential medicines in private retail outlets in Maharashtra state. The study focuses on the range of brands for each medicine, and the availability of these brands in the pharmacies. The medicines were chosen because they are included in the World Health Organization’s (WHO) essential medicines list (EML), the Indian national and Maharashtra state medicines list, and are all included in existing Indian public health initiatives and national disease control programmes.MethodsData was gathered on the availability of the medicines and the range and frequency of brands in 124 private retail pharmacies between January and May 2012. As there is currently no centralised database in India of available pharmaceutical brands, we collected data on the range of products of the 6 essential medicines available in the Indian market by consulting three open access Indian pharmaceutical databases, CIMS India, Medindia, and Medguide, and the commercial database, Pharmatrac; we compared this data with the results of the survey. The six essential medicines used in this study are: artemisinin (malaria), lamivudine (HIV/AIDS), rifampicin (tuberculosis control), oxytocin (reproductive health), fluoxetine (mental health) and metformin (diabetes).ResultsThe study found that for each of the selected medicines there were multiple approved products listed in Indian databases, 2186 in total. The Pharmatrac database lists only 1359 brands of the selected medicines; 978 (72%) of these had zero sales in 2011-2012. Our survey found very low availability of the brands: 17% Pharmatrac marketed brands (163/978) and 12% of all Pharmatrac brands (163/1359) were available. Metformin was the only medicine with high availability in the study pharmacies at 91%, Rifampacin was the second highest at 64.5%; the other four medicines were available in less than half the pharmacies. A small number of brands were dominating the market.Conclusionthe survey shows that market competition has generated a large number of brands of the six study medicines but this has not translated into sufficient availability of these medicines in the study pharmacies. The data calls for a review of available brands, taking into consideration levels of sale and grounds for approval, and the setting up of a centralised database of registered pharmaceutical products.

A Comparative Analysis of Patients’ Medicine Price in a Public Tertiary Hospital and Private Retail Community Pharmacy in a Rural Nigerian Community

A Comparative Analysis of Patients’ Medicine Price in a Public Tertiary Hospital and Private Retail Community Pharmacy in a Rural Nigerian Community