The malaria testing and treatment market in Kinshasa, Democratic Republic of the Congo, 2013

Abstract

Background: 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.

Methods: A 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.

Results: In 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%).

Conclusions: While 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.

Keywords: ACT; Artemisinin-based combination therapy; Availability antimalarial; Democratic Republic of the Congo; Market share; Rapid diagnostic test.

Fig. 1

Anti-malarial market composition

Fig. 2

Anti-malarial availability among anti-malarial stocking outlets

Fig. 3

Anti-malarial market share

Fig. 4

Distribution of non quality-assured ACT available in the private sector, 2013. Notes Types of non quality-assured ACT audited in private sector outlets by generic type and dosage form, Kinshasa 2013 (n = 5,982, unweighted). Other generic tablets audited but comprising <1% total share were artesunate-mefloquine, dihydroartemisininpiperaquine-trimethoprim and artemisinin-piperaquine. AL artemether-lumefantrine; AS-SP artesunate-SP; DHA-PPQ dihydroartemisinin-piperaquine; ASAQ artesunate-amodiaquine. asterisk The unique brand counts does not differentiate tablet strengths or age/weight bands for the same branded product (e.g. Brand X of AL 20mg/120mg and Brand X of AL 40mg/240mg are counted as one unique brand, brand X).