Pharmacoeconomics of Antimalarials in Private-for-Profit (PFP) Drug-Outlets in Gulu and Kitgum Towns, Northern Uganda

Abstract

Background: Clinically-diagnosed malaria is the leading cause of morbidity and mortality in Uganda accounting for 25 to 40% of outpatients, 15 to 20% of all hospital admissions, and 9 to 14% of all hospital deaths. This situation was exacerbated by The Lord's Resistance Army (LRA) rebellion in northern Uganda which completely ran down the health care system. While malaria remains the number one killer disease in northern Uganda, antimalarials are lacking in the public health facilities. Consequently, Private-for-profit drug-outlets have come up to help bridge the gap. However, the cost-effectiveness and treatment outcome ratings of antimalarials are not clear. Objective: To assess the pharmacoeconomics of malaria treatment in Private-for-profit (PFP) drug-outlets in Gulu Municipality and Kitgum Town Council.

Methodology: This was a descriptive cross-sectional study sites were registered drug outlets. Study participants were drug-outlet owners, their employees, and malaria patients. We employed both purposive and random sampling methods to select the study participants. Data were collected using questionnaires and analysed using the SPSS computer package.

Results: Up to 91.1% of the respondents indicated that antimalarials are expensive. The prices varied from less than 5,000 to over 20,000 Ugandan shillings per dose (Exchange rate: 1$ = Ush 2,650). Fansidar and chloroquine were rated as being relatively cheap and ACTs expensive (Ush 11,000 to 15,000). Duration of treatment, frequency of administration, needles and syringes, raised the cost of some medicines. Most patients preferred cheap medicines (76.2%); those with low administration frequencies (77.5%); and those with short treatment duration (95%). Most patients (80.9%) buy antimalarials without testing, while 66.6% do not buy full doses.

Conclusion: The cost benefit analysis of the use of antimalarials is unfavourable. The unit price of the medicines, their irrational use and the lack of professionals in the outlets together add up to high overall costs and poor treatment outcomes.

Keywords: ACTs; malaria; northern Uganda; pharmacoeconomics; private-for-profit drug outlets.

Figure 1

Professions of PFP Drug-outlet Respondents

Figure 2

a. Poor Rating, b. Excellent Rating