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Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar.
Malar J. 2016 06 22; 15:334.MJ

Abstract

BACKGROUND

Artemisinin-based combination therapy (ACT) is a key strategy for global malaria elimination efforts. However, the development of artemisinin-resistant malaria parasites threatens progress and continued usage of oral artemisinin monotherapies (AMT) predisposes the selection of drug resistant strains. This is particularly a problem along the Myanmar/Thailand border. The artemisinin monotherapy replacement programme (AMTR) was established in 2012 to remove oral AMT from stocks in Myanmar, specifically by replacing oral AMT with quality-assured ACT and conducting behavioural change communication activities to the outlets dispensing anti-malarial medications. This study attempts to quantify the characteristics of outlet providers who continue to stock oral AMT despite these concerted efforts.

METHODS

A cross-sectional survey of all types of private sector outlets that were stocking anti-malarial drugs in 13 townships of Eastern Myanmar was implemented from July to August 2014. A total of 573 outlets were included. Bivariate and multivariable logistic regressions were conducted to assess outlet and provider-level characteristics associated with stocking oral AMT.

RESULTS

In total, 2939 outlets in Eastern Myanmar were screened for presence of any anti-malarial drugs in August 2014. The study found that 573 (19.5 %) had some kind of oral anti-malarial drug in stock at the time of survey and among them, 96 (16.8 %) stocked oral AMT. In bivariate analyses, compared to health care facilities, itinerant drug vendors, retailers and health workers were less likely to stock oral AMT (33.3 vs 12.9, 10.0, 8.1 %, OR = 0.30, 0.22, 0.18, respectively). Providers who cut blister pack or sell partial courses (40.6 vs 11.7 %, OR 5.18, CI 3.18-8.44) and those who based their stock decision on consumer demand (32.8 vs 12.1 %, OR 3.54, CI 2.21-5.63) were more likely to stock oAMT. Multivariate logistic regressions produced similar significant associations.

CONCLUSION

Private healthcare facilities and drug shops and providers who prioritize consumers' demand instead of recommended practices were more likely to stock oral AMT. Malaria elimination strategies should include targeted interventions to effectively reach those outlets.

Authors+Show Affiliations

Population Services International Myanmar, 16 West Shwe Gone Dine Fourth Street, Yangon, Myanmar.Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94116, USA. May.Sudhinaraset@ucsf.edu.Population Services International Myanmar, 16 West Shwe Gone Dine Fourth Street, Yangon, Myanmar.Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94116, USA.Population Services International Myanmar, 16 West Shwe Gone Dine Fourth Street, Yangon, Myanmar.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27333781

Citation

Thein, Si Thu, et al. "Who Continues to Stock Oral Artemisinin Monotherapy? Results of a Provider Survey in Myanmar." Malaria Journal, vol. 15, 2016, p. 334.
Thein ST, Sudhinaraset M, Khin HS, et al. Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar. Malar J. 2016;15:334.
Thein, S. T., Sudhinaraset, M., Khin, H. S., McFarland, W., & Aung, T. (2016). Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar. Malaria Journal, 15, 334. https://doi.org/10.1186/s12936-016-1392-5
Thein ST, et al. Who Continues to Stock Oral Artemisinin Monotherapy? Results of a Provider Survey in Myanmar. Malar J. 2016 06 22;15:334. PubMed PMID: 27333781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar. AU - Thein,Si Thu, AU - Sudhinaraset,May, AU - Khin,Hnin Su Su, AU - McFarland,Willi, AU - Aung,Tin, Y1 - 2016/06/22/ PY - 2016/02/23/received PY - 2016/06/15/accepted PY - 2016/6/24/entrez PY - 2016/6/24/pubmed PY - 2017/6/27/medline KW - AMTR KW - Malaria elimination KW - Oral artemisinin monotherapy KW - Outlet survey KW - Private health care providers SP - 334 EP - 334 JF - Malaria journal JO - Malar J VL - 15 N2 - BACKGROUND: Artemisinin-based combination therapy (ACT) is a key strategy for global malaria elimination efforts. However, the development of artemisinin-resistant malaria parasites threatens progress and continued usage of oral artemisinin monotherapies (AMT) predisposes the selection of drug resistant strains. This is particularly a problem along the Myanmar/Thailand border. The artemisinin monotherapy replacement programme (AMTR) was established in 2012 to remove oral AMT from stocks in Myanmar, specifically by replacing oral AMT with quality-assured ACT and conducting behavioural change communication activities to the outlets dispensing anti-malarial medications. This study attempts to quantify the characteristics of outlet providers who continue to stock oral AMT despite these concerted efforts. METHODS: A cross-sectional survey of all types of private sector outlets that were stocking anti-malarial drugs in 13 townships of Eastern Myanmar was implemented from July to August 2014. A total of 573 outlets were included. Bivariate and multivariable logistic regressions were conducted to assess outlet and provider-level characteristics associated with stocking oral AMT. RESULTS: In total, 2939 outlets in Eastern Myanmar were screened for presence of any anti-malarial drugs in August 2014. The study found that 573 (19.5 %) had some kind of oral anti-malarial drug in stock at the time of survey and among them, 96 (16.8 %) stocked oral AMT. In bivariate analyses, compared to health care facilities, itinerant drug vendors, retailers and health workers were less likely to stock oral AMT (33.3 vs 12.9, 10.0, 8.1 %, OR = 0.30, 0.22, 0.18, respectively). Providers who cut blister pack or sell partial courses (40.6 vs 11.7 %, OR 5.18, CI 3.18-8.44) and those who based their stock decision on consumer demand (32.8 vs 12.1 %, OR 3.54, CI 2.21-5.63) were more likely to stock oAMT. Multivariate logistic regressions produced similar significant associations. CONCLUSION: Private healthcare facilities and drug shops and providers who prioritize consumers' demand instead of recommended practices were more likely to stock oral AMT. Malaria elimination strategies should include targeted interventions to effectively reach those outlets. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/27333781/Who_continues_to_stock_oral_artemisinin_monotherapy_Results_of_a_provider_survey_in_Myanmar_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1392-5 DB - PRIME DP - Unbound Medicine ER -