ACTwatch Study Reference Document Uganda Outlet Survey 2015

www.ACTwatch.info Copyright © Population Services International (PSI). All rights reserved.

Evidence for Malaria Medicines Policy

ACTwatch Study Reference Document

Uganda Outlet Survey

2015

www.ACTwatch.info Page 1

Released 29 July 2016 Suggested citation ACTwatch Group and PACE. (2015). ACTwatch Study Reference Document: The Republic of Uganda Outlet Survey 2015. Washington DC: PSI. Contact Dr. Megan Littrell ACTwatch Principal Investigator PSI | 1120 19th St NW Suit 600 Washington DC 20036 [email protected]

Peter Buyungo Programme for Aaccessible Communication and Education (PACE) Uganda Plot # 2, Ibis Vale, Kololo – off Prince Charles Drive | Kampala, Uganda [email protected]

Acknowledgements ACTwatch is funded by the Bill and Melinda Gates Foundation, UNITAID, and the UK Department for International Development. This study was implemented by Population Services International (PSI).

PACE Uganda Peter Buyungo Henry Kaula Doreen Nakimuli

SEDC (cont.) Dr. Janestic Twikirize Hadijah Mwenyango Sharlotte Tusasirwe Aloysious Nyombi Jacob Mutazidwa

Field Supervisors Alex Nduhukire Anne Adikini Bruce Orech Denis Mitala Jennifer Agwang Lawrence Magara Mariam Magezi Monica Dhabangi Moses Okiror Olivia Nalwanga

Field Quality Controllers

Archileo Kiwanuka Bashir Kawalya Christine Isunu Jennifer Kobusingye Julia Vera Nashuha Lameck Kawooya Kalule Moureen Naamara Paul Tumuhairwe Phionah Kamara Sarah Akullo

Fieldwork Team Aaron Kiwanuka Aisha Nanteza Alice Nahabwe Anthony Katende Brian Gilbert Kyomuhendo

Fieldwork Team (cont.)

Christine Nagaba Denis Okello Dianah Komugisha Dorcas Acheng Edward Kalyesubula Emmanuel Kiwendo Godfrey Kusemererwa Ibrahim Mandali Jacqueline Namutaaya Joan Bakanansa Jobes Orombi John Robert Okello Juliet Murungi Keneth Nyombi Linda Tusiime Tracy Longok Maximilian Koibe Lydia Gift Namuswa Marble Katushabe Moreen Aliku Moses Aede Musa Kabunga Norah Nattimba Opio Kizito Phiona Tumusiime Richard Mugabi Rita Ochiba Samuel Kasoozi Scovia Alinda Seera Leah Dianah Buke Sira Egweu Stella Mudoola Stephen Adiga Suzan Basalirwa Vicent Otebata Wilberforce Ssebunya

Ministry of Health Dr. Peter Okui

ACTwatch Team Andrew Andrada Erick Auko Dr. Katie Bates Dr. Desmond Chavasse Kevin Duff Keith Esch Anna Fulton Tarryn Haslam Catharine Hurley Beth Kangwana Gloria Kigo Dr. Megan Littrell Julius Ngigi Dr. Kate O’Connell Ricki Orford Stephen Poyer Dr. Justin Rahariniaina Christina Riley Dr. Andria Rusk Julianna Smith Rachel Thompson Cynthia Whitman

Socio-Economic Data Center LTD (SEDC) Prof. Asingwire Narathius Joseph Kiwanuka Dr. Denis Muhangi

http://www.actwatch.info/

mailto:[email protected]

mailto:[email protected]


Table of Contents

List of Tables ...................................................................................................................................................... 3

List of Figures ..................................................................................................................................................... 5

Definitions .......................................................................................................................................................... 8

Introduction ..................................................................................................................................................... 10

Summary of Methods and Data Collection ...................................................................................................... 11

Summary of Key Findings ................................................................................................................................. 13

Results Section A: Core Indicators ................................................................................................................... 43

Results Section B: Core Indicators across Urban/Rural Location .................................................................... 61

Results Section C: Core Indicators across Survey Round: 2010, 2011, 2013, 2015 ......................................... 83

Annex 1: ACTwatch Background .................................................................................................................... 109

Annex 2: Country Background ....................................................................................................................... 112

Annex 3: Outlet Survey Methods ................................................................................................................... 118

Annex 4: Sampled Sub-Counties .................................................................................................................... 123

Annex 5: Detailed Sample Description .......................................................................................................... 125

Annex 6: Questionnaire ................................................................................................................................. 127

Annex 7: Antimalarial Reference ................................................................................................................... 149

Annex 8: RDT Reference ................................................................................................................................ 154

Annex 9. Sampling Weights ........................................................................................................................... 156

Annex 10: Indicator Definitions ..................................................................................................................... 158

Annex 11. Adult Equivalent Treatment Dose (AETD) .................................................................................... 166

Annex 12: Antimalarial Volumes.................................................................................................................... 168



List of Tables

Results Core Indicators

Table S1: Key results, by outlet type - 2015 .................................................................................................................... 13

Table A1: Availability of antimalarials, among all screened outlets, by outlet type ....................................................... 43

Table A2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type ..................... 45

Table A3: Types of quality-assured and Non-Quality Assured ACTs audited in the public and private sector .............. 47

Table A4: Antimalarial market composition ................................................................................................................... 48

Table A5a: Price of tablet formulation antimalarials, by outlet type ............................................................................. 49

Table A5b: Price of pre-packaged antimalarials, by outlet type ..................................................................................... 51

Table A6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type .......................... 52

Table A7: Malaria blood testing market composition .................................................................................................... 53

Table A8: Price of malaria blood testing for adults, by outlet type ................................................................................ 54

Table A9: Antimalarial market share .............................................................................................................................. 55

Table A10: Antimalarial market share across outlet type .............................................................................................. 56

Table A11: Malaria blood testing market share ............................................................................................................. 57

Table A12: Malaria blood testing market share, across outlet type ............................................................................... 58

Table A13: Provider case management knowledge and practices, by outlet type ......................................................... 59

Table A14: Provider antimalarial treatment knowledge and practices, by outlet type ................................................. 60

Results Across Urban/Rural Location

Table B1: Availability of antimalarials, among all screened outlets, by outlet type, across urban/rural sub-counties . 61

Table B2: Availability of antimalarials, among all outlets stocking at least one antimalarial, by outlet type, across urban/rural sub-counties ....................................................................................................................................... 65

Table B4: Antimalarial market composition, across urban/rural location ...................................................................... 69

Table B5a: Price of tablet formulation antimalarials, by outlet type, across urban/rural location ................................ 70

Table B5b: Price of pre-packaged antimalarials, by outlet type, across urban/rural location ....................................... 72

Table B6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across urban/rural location ............................................................................................................................................... 73

Table B8: Price of malaria blood testing, by outlet type, across urban/rural location ................................................... 74

Table B9.1: Antimalarial market share, urban ................................................................................................................ 75

Table B9.2: Antimalarial market share, rural .................................................................................................................. 76

Table B10.1: Antimalarial market share across outlets, urban ....................................................................................... 77

Table B10.2: Antimalarial market share across outlets, rural ......................................................................................... 78

Table B13: Provider case management knowledge and practices, by outlet type, across urban/rural location ........... 79

Table B14: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location .... 81

Results Across Survey Round

Table C1: Availability of antimalarials, among all screened outlets, by outlet type, across survey round .................... 83

Table C2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type, across survey round ...................................................................................................................................................................... 89



Table C4: Antimalarial market composition, across survey round ................................................................................. 94

Table C5: Price of tablet formulation antimalarials, by outlet type, across survey round ............................................. 95

Table C6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across survey round ...................................................................................................................................................................... 99

Table C8: Price of malaria blood testing for adults, by outlet type, across survey round ............................................ 101

Table C9: Antimalarial market share, across survey round .......................................................................................... 103

Table C10: Antimalarial market share, across outlet type, across survey round ......................................................... 105

Table C14: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round ............. 107

Annexes

Table X1. Sampled Sub-Counties .................................................................................................................................. 123

Table X2: Detailed sample description ......................................................................................................................... 125

Table X3: Number of antimalarials audited .................................................................................................................. 149

Table X4: Quality Assured (QA ACT) and Non-Quality Assured ACTs ........................................................................... 150

Table X5: Nationally Registered ACTs ........................................................................................................................... 152

Table X6: Severe Malaria Treatment ............................................................................................................................ 153

Table X7: Number of RDTs audited ............................................................................................................................... 154

Table X8: RDT Brand Names and Manufacturers* ....................................................................................................... 155

Table X9: Adult Equivalent Treatment Dose Definitions .............................................................................................. 167

Table X10: Antimalarial volumes, by outlet type .......................................................................................................... 168



List of Figures

Figure 1. Survey flow diagram, Uganda, 2015 ................................................................................................................ 12

Figure 2. Market composition: outlet type distribution, 2010-2015 ................................. Error! Bookmark not defined.

Figure 3. Market composition: outlet type distribution, 2015, urban/rural ..................... Error! Bookmark not defined.

Figure 4. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2010-2015 .............. 16

Figure 5. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2015, urban/rural... 16

Figure 6. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2010-2015 ............ 17

Figure 7. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2015, urban/rural 17

Figure 8. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey, 2010-2015 .............................................................................................................................................................. 18

Figure 9. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey, 2015, urban/rural ................................................................................................................................................... 18

Figure 10. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ logo in stock on the day of the survey, 2010-2015 ............................................................................................................ 19

Figure 11. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ logo in stock on the day of the survey, 2015, urban/rural................................................................................................. 19

Figure 12. Percentage of antimalarial-stocking outlets with non-quality assured ACT in stock on the day of the survey, 2010-2015 .............................................................................................................................................................. 20

Figure 13. Percentage of antimalarial-stocking outlets with non-quality assured ACT in stock on the day of the survey, 2015, urban/rural ................................................................................................................................................... 20

Figure 14. Types of quality-assured ACT and Non-Quality Assured ACT audited among public and private sector outlets, 2015 ........................................................................................................................................................... 21

Figure 15. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey, 2010-2015 .............................................................................................................................................................. 22

Figure 16. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey, 2015, urban/rural ................................................................................................................................................... 22

Figure 17. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2010-2015 ............ 23

Figure 18. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2015, urban/rural . 23

Figure 19. Percentage of antimalarial-stocking outlets with oral quinine in stock on the day of the survey, 2010-2015 ................................................................................................................................................................................ 24

Figure 20. Percentage of antimalarial-stocking outlets with oral quinine in stock on the day of the survey, 2015, urban/rural ............................................................................................................................................................. 24

Figure 21. Percentage of antimalarial-stocking outlets with injectable artesunate in stock on the day of the survey, 2010-2015 .............................................................................................................................................................. 25

Figure 22. Percentage of antimalarial-stocking outlets with injectable artesunate in stock on the day of the survey, 2015, urban/rural ................................................................................................................................................... 25

Figure 23. Percentage of antimalarial-stocking outlets with rectal artesunate in stock on the day of the survey, 2010-2015 ........................................................................................................................................................................ 26

Figure 24. Percentage of antimalarial-stocking outlets with rectal artesunate in stock on the day of the survey, 2015, urban/rural ............................................................................................................................................................. 26

Figure 25. Antimalarial market share, 2010-2015 .......................................................................................................... 27

Figure 26. Antimalarial market share within sector, 2010-2015 .................................................................................... 28

Figure 27. Antimalarial market share, 2015.................................................................................................................... 29



Figure 28. Antimalarial market share, 2015, urban/rural ............................................................................................... 29

Figure 29. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2010-2015 .................... 30

Figure 30. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2015, urban/rural ......... 30

Figure 31. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2010-2015 ....................... 31

Figure 32. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2015, urban/rural............ 31

Figure 33. Percentage of antimalarial-stocking outlets with malaria RDTs, 2010-2015 ................................................. 32

Figure 34. Percentage of antimalarial-stocking outlets with malaria RDTs, 2015, urban/rural ..................................... 32

Figure 35. Malaria blood testing market share, 2015 ..................................................................................................... 33

Figure 36. Malaria RDT market share by manufacturer, across sector, 2015 ................................................................ 33

Figure 37. Private sector median price of antimalarial adult equivalent treatment dosages (AETD), 2010-2015 ......... 34

Figure 38. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and pre-packaged pediatric quality-assured AL, 2015 .................................................................................................. 35

Figure 39. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and pre-packaged pediatric quality-assured AL, 2015, urban/rural ............................................................................. 36

Figure 40. Private sector median price of QA ACT adult equivalent treatment dosages (AETD) with and .................... 37

without the ‘green leaf’ logo, 2010-2015 ....................................................................................................................... 37

Figure 41. Median private sector consumer prices for malaria RDT testing for adults and children 2015 .................... 37

Figure 42. Median private sector prices for malaria RDT testing and QA ACT for adults and children 2015 ................. 38

Figure 43. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2010-2015 ................................................................................................................................................................................ 39

Figure 44. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2015, urban/rural ............................................................................................................................................................. 40

Figure 45. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a two-year old child, 2010-2015 ............................................................................................................................... 41

Figure 46. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a two-year old child, 2015, urban/rural .................................................................................................................... 42



Acronyms

ACT Artemisinin combination therapy

AETD Adult equivalent treatment dose

AL Artemether lumefantrine

AMFm Affordable Medicines Facility – malaria

ASAQ Artesunate amodiaquine

BMGF The Bill and Melinda Gates Foundation

CHW Community Health Worker

DHA PPQ Dihydroartemisinin piperaquine

DHS The Demographic and Health Survey

EMA European Medicines Agency

GFATM Global Fund to Fight AIDS, TB, and Malaria

IM

ICCM

Intramuscular injection

Integrated community case management

IV Intravenous injection

MOH Ministry of Health

NGO

NMCP

Non-governmental Organization

National Malaria Control Program

Oral AMT Oral artemisinin monotherapy

PMI

Pf

President’s Malaria Initiative

Plasmodium falciparum

QA ACT Quality-assured artemisinin combination therapy

QA RDT Quality-assured rapid diagnostic test

RDT

SP

Rapid diagnostic test

Sulfadoxine Pyrimethamine

UK

USAID

VHT

United Kingdom

United States Agency for International Development

Village Health Team



Definitions Survey Methods Definitions Outlet Any service delivery point or point of sale for commodities. Outlets are not restricted to

stationary points of sale and may include mobile units or individuals.

Outlets eligible for

inclusion in the

study

Outlets were administered a full questionnaire if they met at least one of three inclusion

criteria: (1) had one or more antimalarials in stock at the time of the survey visit; (2)

reportedly had one or more antimalarials in stock in the previous three months; or (3)

provide malaria blood testing (microscopy or rapid diagnostic tests) but do not provide

antimalarial treatment. Outlets not providing services to the general public (e.g. army and

military clinics) were excluded from the study.

Cluster The primary sampling unit, or cluster, for the outlet survey. It is an administrative unit

determined by the Ministry of Health (MOH) that hosts a population size of approximately

10,000 to 15,000 inhabitants. These units are defined by political boundaries. In Uganda,

they were defined as sub-counties.

Censused Cluster A sub-county where field teams conducted a full census of all outlets with the potential to

sell antimalarials.

Booster Sample A booster sample was collected by extending the primary sampling unit to a higher

administrative unit for sampling certain outlet types. This extension achieves a larger sample

size for specific outlets, allowing for estimates among key outlet types In this survey, a

booster sample was collected for public health facilities and pharmacies. The administrative

unit for sampling public health facilities was extended beyond sub-county to the county level

in urban clusters. The administrative unit for sampling pharmacies was extended beyond

sub-county to the county level in both urban and rural clusters. See Annex 9 for a detailed

description of the booster sampling methods.

Malaria Product Indicator Definitions Antimalarial Any medicine recognized by the WHO for the treatment of malaria. Medicines used solely for

the prevention of malaria were excluded from analysis of key indicators in this report.

Dosing/treatment

regimen

The posology or timing and number of doses of an antimalarial used to treat malaria. This

schedule often varies by patient weight.

Adult Equivalent

Treatment Dose

(AETD)

An AETD is the number of milligrams (mg) of an antimalarial drug required to treat a 60 kg

adult (see Annex 11).

Monotherapy An antimalarial medicine that has a single mode of action. This may be a medicine with a

single active compound or a synergistic combination of two compounds with related

mechanisms of action.

Artemisinin and its

derivatives

Artemisinin is a plant extract or synthetic plant extract used in the treatment of malaria. The

most common derivatives of artemisinin used to treat malaria are artemether, artesunate,

and dihydroartemisinin.

Artemisinin-based

Combination

Therapy (ACT)

An antimalarial that combines artemisinin or one of its derivatives with an antimalarial or

antimalarials of a different class.



Artemisinin

monotherapy

An antimalarial medicine that has a single active compound, where this active compound is

artemisinin or one of its derivatives.

Oral artemisinin

monotherapy

Artemisinin or one of its derivatives in a dosage form with an oral route of administration.

These include tablets, suspensions, and syrups and exclude suppositories and injections.

Non-artemisinin

therapy

An antimalarial medicine that does not contain artemisinin or any of its derivatives.

First-line

treatment

The government recommended treatment for uncomplicated malaria. Uganda’s first-line

treatment for uncomplicated malaria is artemether lumefantrine (20mg / 120mg). The first-

line treatment for uncomplicated malaria in pregnant women during the first trimester is

quinine.

Second-line

treatment

The government recommended second-line treatment for uncomplicated malaria. Uganda’s

second-line treatment for uncomplicated malaria is dihydroartemisinin-piperaquine

(40mg/320mg or 20mg/160mg pediatric).

Nationally

registered ACTs

ACTs registered with Uganda’s national drug authority and permitted for sale or distribution in

Uganda. Each country determines its own criteria for placing a drug on its nationally registered

listing.

Severe malaria

treatment

WHO recommends intravenous or intramuscular artesunate as first-line treatment in the

management of severe falciparum malaria. If artesunate is not available, artemether in

preference to quinine should be used for treating severe malaria cases. Rectal artesunate is

suitable for pre-referral treatment in children under 6 years of age.0F

1

Quality-assured

Artemisinin-Based

Combination

Therapies (QA

ACTs)

QA ACTs are ACTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s

Quality Assurance Policy. A QA ACT is any ACT that appeared on the Global Fund's indicative

list of antimalarials meeting the Global Fund's quality assurance policy prior to data collection

(see http://www.theglobalfund.org/en/healthproducts/qualityassurance/) or that previously

had C-status in an earlier Global Fund quality assurance policy. QA ACTs also include ACTs that

have been granted regulatory approval by the European Medicines Agency (EMA) – specifically

Eurartesim® and Pyramax®.

Quality-assured

ACT with the

“green leaf” logo,

or “co-paid ACTs”

The “green leaf” logo indicates that a quality-assured ACT was acquired through

a co-payment mechanism administered by the Global Fund (Affordable

Medicines Facility, malaria – or AMFm). These subsidized (co-paid) quality-

assured ACTs were available to first-line buyers in Uganda in the public sector

between 2010-2011 and private sector from 2010-2015.

Quality-assured

RDT

QA RDTs are RDTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s

Quality Assurance Policy. A QA RDT is any RDT that appeared on the Global Fund's indicative

list of RDTs meeting the Global Fund's quality assurance policy prior to data collection (see

http://www.theglobalfund.org/en/healthproducts/qualityassurance/).

1 World Health Organization. (2015). Guidelines for the treatment of malaria, 3rd edition. Geneva: WHO.


http://www.theglobalfund.org/en/healthproducts/qualityassurance/

http://www.theglobalfund.org/en/healthproducts/qualityassurance/


Introduction This country reference document is a detailed presentation of the 2015 national ACTwatch outlet survey (OS) conducted in Uganda. The 2015 OS follows previous survey rounds conducted by ACTwatch in Uganda in 2008, 2009, 2010, 2011, 2013 and 2015. ACTwatch is a multi-country research project implemented by PSI (www.psi.org). Standardized tools and approaches are employed to provide comparable data across countries and over time. ACTwatch is designed to provide timely, relevant, and high quality antimalarial market evidence. The goal of providing this market evidence is to inform and monitor national and global policy, strategy, and funding decisions for improving malaria case management. The project was launched in 2008 with funding from the Bill and Melinda Gates Foundation (BMGF), and is currently funded through mid-2016 by the BMGF, UNITAID, and DFID. See Annex 1 for more information about the ACTwatch project. ACTwatch antimalarial market monitoring in Uganda from 2008 to present has been implemented in the context of strategies designed and implemented to improve coverage of appropriate case management. This antimalarial market evidence monitored the health system readiness and performance for malaria case management in the context of recent strategies and investments to improve case management including:

End of the AMFm ACT subsidy mechanism implemented from 2011-2013 and continuation of a similar Global Fund co-payment subsidy mechanism with a lower co-payment/subsidy available to first-line buyers from 2014. ACT procurement was also supported by PMI.

Scale up of Village Health Team volunteers equipped to manage malaria at community level as part of community case management for childhood illnesses. VHT trainings began in 2010 and scale up was supported by the Global Fund and PMI.

National Malaria Control Policy adopted in 2012 recommending that all suspected malaria cases received confirmatory testing using microscopy or a malaria RDT prior to treatment. Scale up of blood testing using RDTs or microscopy was supported by funding from PMI and the Global Fund.

Transition in severe malaria case management to pre-referral treatment at community level with rectal artesunate and treatment of severe malaria with IV artesunate (phasing out IV quinine). Procurement of IV artesunate was supported by PMI.

Efforts to support and improve supply chain management and prevent ACT and RDT stock outs at public health facilities.

The 2015 OS was the sixth round of ACTwatch outlet surveys conducted in Uganda. This report presents trend lines with four data points: 1) the 2010 AMFm baseline survey; 2) the 2011 AMFm pilot endline survey; 3) the 2013 outlet survey; and 4) the most recent 2015 survey. These surveys are designed to monitor key antimalarial market indicators at national level and within urban and rural research domains. ACTwatch outlet survey findings can inform ongoing monitoring, evaluation, and adjustment to policy, strategy, and funding decisions to strengthen malaria case management.

Report notes

This document is a complete reference for the 2015 outlet survey. Please see annexes for information about the study context, design, implementation and data analysis.

Grey text for data appearing in report tables indicates that the estimate provided was derived from a small sample size. Specifically, grey text is used to indicate point estimates derived from an n of less than 50 and median prices derived from an n of less than 5.

Malaria testing and treatment prices are reported in US dollars. Price information is captured in local currency and converted to US dollars based on exchange rates available from www.oanda.com using the historical


http://www.psi.org/

http://www.oanda.com/


exchange rates tool. The average exchange rate over the entire data collection period is used for converting local currency captured during data collection to US dollars.

Summary of Methods and Data Collection A nationally-representative antimalarial outlet survey was conducted in Uganda between May 18, 2015 and July 2, 2015. A full description of research design and methods is provided in Annex 3. Briefly, a representative sample of sub-counties was selected from urban and rural domains (see sampled sub-counties in Annex 4). Within selected clusters, a census of all outlets with the potential to sell or distribute antimalarials and/or provide malaria blood testing was completed. Additional sub-counties were selected for oversampling of public health facilities and pharmacies. This booster sampling strategy was used to obtain a sufficient sample size for indicator estimates within these outlet types. Outlets were screened to determine eligibility. Outlets eligible for the survey met at least one of three criteria: 1) one or more antimalarials were in stock on the day of the survey; 2) one or more antimalarials were in stock in the three months preceding the survey; and/or 3) malaria blood testing (microscopy or RDT) was available. Outlets that do not serve the general public (e.g. military facilities) were excluded from the study. The results of the census are summarized in Figure 1. A detailed sample summary is provided in Annex 5.

A structured questionnaire programmed into mobile phones using DroidDB software was used to complete an audit of all antimalarials and malaria rapid diagnostic tests (RDTs) as well as a provider interview (see Annex 6). See Annex 7 and Annex 8 for detailed summaries of antimalarials and RDTs audited. Key informant interviews were conducted with specific stakeholders to supplement information for the Uganda background. All data cleaning and analysis was performed using Stata 13.1 (©StataCorp, College Station, TX). Data were weighted to account for variation in probability of outlet selection (see Annex 9), and standard error calculation reflected clustering of outlets at sub-county and county levels. Standard indicators were constructed according to definitions applied across ACTwatch project countries (see Annex 10).



Figure 1. Survey flow diagram, Uganda, 2015

A Outlets enumerated*

[9,919]

B Outlets screened**

[9,438]

D Outlets interviewed***

[4,724] 1 = [4,328] 2= [270] 3= [126]

Outlets not screened

[481]

Outlets that did not meet screening

criteria [4,658]

Outlets not interviewed

[56]

Interview interrupted [4] Respondent not available [218] Outlet closed at time of visit [122] Outlet closed permanently [84] Other [8] Refused [45]

Interview interrupted [2] Respondent not available [16] Outlet closed at time of visit [4] Other [4] Refused [30]

1: Antimalarials in stock on day of visit 2: Antimalarials reportedly in stock during the previous 3 months but not on the day of the visit 3: Malaria blood testing available but no antimalarials in stock * Identified as outlets with potential to sell or distribute antimalarials and/or provide malaria blood testing during

the census or booster sampling ** Administered questions to assess current or recent (previous 3 months) availability of antimalarials and malaria

blood testing (microscopy or rapid diagnostic test) *** A partial or complete interview was conducted with an outlet representative

C Outlets that met screening criteria

[4,780] 1 = [4,381] 2 = [273] 3 = [126]



Summary of Key Findings

Table S1: Key results, by outlet type - 2015

Public Health Facility

Community Health Worker

ALL Public / Not-

For-Profit1

Private For-Profit

Facility Pharmacy Drug Store

ALL Private

ALL Outlets2

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Readiness for malaria case management Proportion of all screened outlets outlets* with:

N=282 N=5,618 N=5,955 N=1,023 N=493 N=1,967 N=3,483 N=9,438

Availability of malaria blood testing

95.2 10.2 11.7 67.7 50.2 20.5 32.0 16.5

(89.4, 97.9) (5.2, 19.1) (6.5, 20.1) (61.5, 73.4) (43.1, 57.3) (17.4, 23.9) (28.7, 35.5) (11.6, 22.9)

Availability of QA ACT 93.8 11.1 12.5 69.5 94.8 72.3 72.0 26.6

(89.1, 96.5) (5.9, 20.0) (7.1, 21.0) (63.2, 75.1) (91.6, 96.8) (68.2, 76.0) (68.2, 75.4) (20.8, 33.4)

Availability of QA ACT and malaria blood testing

89.6 7.3 8.7 52.5 49.0 16.1 25.1 12.6

(83.8, 93.5) (3.2, 15.8) (4.3, 16.6) (46.2, 58.6) (41.9, 56.1) (13.6, 19.0) (22.1, 28.4) (8.5, 18.2)

Availability of QA ACT, blood testing not available

4.2 3.9 3.8 17.0 45.8 56.2 46.9 14.0

(1.6, 10.4) (2.0, 7.4) (2.0, 7.3) (13.3, 21.5) (38.8, 53.1) (52.6, 59.7) (43.8, 49.9) (11.4, 17.1)

Availability of national first-line severe malaria treatment (artesunate IV/IM)

53.1 0.0 0.8 20.0 63.8 2.3 7.3 2.4

(42.8, 63.1) - (0.6, 1.1) (16.1, 24.6) (53.5, 72.9) (1.0, 5.1) (5.5, 9.8) (1.8, 3.1)

Readiness for malaria case management Proportion of antimalarial-

stocking outlets with:

N=275 N=719 N=1,047 N=956 N=467 N=1,849 N=3,281 N=4,328

Availability of malaria blood testing

95.3 65.2 69.2 71.0 51.4 21.4 33.5 44.3

(89.3, 98.0) (42.0, 82.9) (49.1, 83.9) (64.2, 77.1) (44.1, 58.6) (18.3, 24.9) (30.1, 37.1) (36.1, 52.9)

Availability of QA ACT 96.1 99.7 99.2 74.7 96.5 77.4 77.1 83.8

(92.6, 98.0) (98.7, 99.9) (98.3, 99.6) (68.0, 80.3) (94.0, 97.9) (73.6, 80.9) (73.3, 80.4) (80.6, 86.6)

Availability of QA ACT and malaria blood testing

91.8 65.2 68.8 56.4 49.8 17.3 26.9 39.6

(86.3, 95.2) (42.0, 82.9) (48.7, 83.6) (49.5, 63.0) (42.6, 57.0) (14.7, 20.2) (23.9, 30.2) (31.3, 48.5)

Availability of QA ACT, blood testing not available

4.3 34.5 30.4 18.3 46.6 60.2 50.2 44.2

(1.7, 10.6) (16.9, 57.7) (15.8, 50.4) (14.4, 22.9) (39.5, 53.9) (56.3, 63.9) (46.8, 53.5) (37.2, 51.5)

Availability of national first-line severe malaria treatment (artesunate IV/IM)

54.4 0.0 6.5 21.5 64.9 2.4 7.8 7.4

(44.0, 64.5) -

(3.5, 11.7) (17.1, 26.6) (54.7, 73.8) (1.1, 5.5) (5.8, 10.4) (5.6, 9.7)



Table S1: Key results, by outlet type - 2015



ALL Public / Not-

For-Profit1

Private For-Profit


ALL Private

ALL Outlets2

Readiness for IPTp Proportion of outlets with:

Availability of SP, among all screened outlets*

81.4 0.0 1.3 48.5 82.5 45.9 47.1 12.1

(75.0, 86.5) (0.0, 0.1) (1.0, 1.7) (42.1, 54.8) (76.3, 87.3) (40.3, 51.7) (42.1, 52.1) (9.6, 15.3)

Availability of SP, among

antimalarial-stocking outlets

83.4 0.2 10.3 52.1 83.9 49.2 50.4 38.2

(77.4, 88.1) (0.0, 1.2) (6.0, 17.0) (45.7, 58.4) (77.6, 88.7) (43.5, 54.9) (45.4, 55.4) (31.9, 45.0)

Antimalarial market share within outlet/sector type

% % % % % % % %

% QA AL market share ^

72.4 99.8 59.5 73.1 41.5 38.0 52.9 47.5

Private sector price

Median

[IQR] (N)

Median

[IQR] (N)

Median

[IQR] (N)

Median

[IQR] (N)

Median

[IQR] (N)

Median price for one QA ACT AETD (tablets)

n/a n/a n/a $1.94 $1.29 $1.55 $1.62 n/a

[1.29-3.23]

(1,365) [0.97-1.94]

(1,467) [0.97-1.94] (2,446)

[1.13-1.94] (5,278)

Median price for one SP AETD (tablets)

n/a n/a n/a $0.65 $0.48 $0.48 $0.48 n/a

[0.48-0.81] (605) [[0.48-0.65]

(587) [0.48-0.65] (1,122)

[0.48-0.65] (2,314)

Median price for one pre-packaged pediatric QA AL #

n/a n/a n/a $0.65 $0.48 $0.32 $0.39 n/a

[0.32-0.97] (84) [0.32-0.97]

(134) [0.29-0.48] (173) [0.32-0.58] (391)

Median price for an RDT ## n/a n/a n/a $0.97 $0.97 $0.65 $0.81 n/a

[[0.65-0.97]

(514) [0.32-0.97]

(44) [0.65-0.97] (391) [0.65-0.97] (949)

1 Inclusive of N=55 screened/53 antimalarial-stocking private not-for-profit health facilities

2 Inclusive of community health workers, private not-for-profit health facilities, and drug vendors.

* The denominator includes 156 outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).

Outlets with at least one antimalarial in stock on the day of the survey or reportedly in stock within the past 3 months.

^ Percent market volume (adult equivalent treatment dosages sold/distributed in the previous week) accounted for by QA ACT sale/distribution within distribution by the outlet/sector.

# Pre-packaged QA AL for a 10kg child

## Price inclusive of consultation / service fees for a child under age 5.

Source: ACTwatch Outlet Survey, Uganda, 2015.



0

20

40

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80

100

PublicHealthFacility

CommunityHealthWorker

Private NotFor-Profit

HealthFacility

All Public Private For-ProfitHealthFacility

Pharmacy Drug Store GeneralRetailer

All Private

Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 4. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2010-2015 Among all screened outlets, across survey round

Antimalarial availability was high during each survey round and was greater than 90% in 2015 among all outlet types except CHWs (11%). *In 2010, 2011 and 2013, general retail outlets were screened for antimalarial availability. Thousands of retail outlets were included during each round, but very few were stocking antimalarials. As such in 2015, general retailers were not included in the study. For this reason, availability among all private outlets in 2015 is much higher than in previous years (due to exclusion of general retailers from the study).

Figure 5. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2015, urban/rural Among all screened outlets

Antimalarial availability was similar across urban and rural locations for all outlet types.

*



0

20

40

60

80

100

Public HealthFacility

CommunityHealth Worker

Private not-for-Profit Health

Facility

All Public Private for-Profit Health

Facility

Pharmacy Drug Store All Private

Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 6. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

ACTs were available among nearly all antimalarial-stocking public health facilities (96%), CHWs (100%) and pharmacies (100%) in 2015. Availability was also high and had increased significantly in recent years among drug stores, from 50% in 2010 to 86% in 2015. Nearly 90% of antimalarial-stocking private sector outlets were stocking ACTs in 2015 (89%).

Figure 7. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Availability of ACTs was similar across urban and rural locations for the public sector. In the private sector, ACT availability was higher in urban (93%) versus rural (83%) areas, including among private for-profit facilities (urban, 94%; rural, 79%) and drug stores (urban 92%; rural, 84%).



0

20

40

60

80

100

Public Health Facility Private not-for-ProfitHealth Facility

Private for-Profit HealthFacility

Drug Store All Private

Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 8. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

Quality-assured ACTs were available among nearly all antimalarial-stocking public health facilities (96%), CHWs (100%) and pharmacies (97%) in 2015. Availability was also high and had increased significantly in recent years among drug stores, from 10% in 2010 to 77% in 2015. Three in four (77%) antimalarial-stocking private sector outlets were stocking QA ACTs in 2015, an increase from 11% in 2010.

Figure 9. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Aavailability of QA ACTs was similar across urban and rural locations for the public sector. In the private sector, ACT availability was higher in urban (84%) versus rural (74%) areas, including among private for-profit facilities (urban, 80%; rural, 70%) and drug stores (urban 86%; rural, 75%).



0

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Per

cen

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s

2010 2011 2013 2015

Figure 10. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ logo in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

Following the implementation of the AMFm program in late 2010, ‘green leaf’ logo QA ACT availability among public health facilities hit its peak in 2011 at 83% of facilities, but decreased to 41% in 2013 and 11% in 2015. ‘Green leaf’ logo QA ACT availability has remained high among antimalarial-stocking private sector outlets since the end of the AMFm pilot period in 2011 (61%) and in 2015, more than 70% of private sector outlets were stocking these ACTs (73%). This includes 72% of private for-profit health facilities, 94% of pharmacies, and 73% of drug stores.

Figure 11. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ logo in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

‘Green leaf’ logo QA ACTs were more commonly available among private sector urban (80%) versus rural outlets (70%). This includes higher availability among drug stores in urban (81%) versus rural areas (70%).



0

20

40

60

80

100




Per

cen

tage

of

ou

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s

2010 2011 2013 2015

Figure 12. Percentage of antimalarial-stocking outlets with non-quality assured ACT in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

Availability of non-QA ACTs remained below 10% among public health facilities across all survey rounds. In the private sector, non-QA ACT availability decreased from 52% in 2010 to 34% in 2011 and was 38% in 2015. Private sector availability was particularly high among pharmacies; nearly all pharmacies were stocking non-QA ACT across survey rounds. Half of private for-profit health facilities and one-third of drug stores were stocking non-QA ACT in 2015.

Figure 13. Percentage of antimalarial-stocking outlets with non-quality assured ACT in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Availability of non-QA ACTs was higher in urban versus rural areas. Within the private sector, more than half (56%) of antimalarial-stocking outlets in urban areas had non-QA ACTs in stock as compared with 29% in rural areas.



Non-quality assured Public Sector

N=59

Figure 14. Types of quality-assured ACT and Non-Quality Assured ACT audited among public and private sector outlets, 2015 Among all ACT medicines audited, across sector, 2015

The majority of QA ACTs audited in both the public (100%) and private sector (76%) were Al tablets. Nearly one-quarter of QA ACTs audited in the private sector were ASAQ tablets. Non-quality assured ACTs audited in the private sector included AL tablets (35%) and DHA-PPQ tablets (31%) as well as AL non-tablets (17%) such as suspensions and DHQ-PPQ non-tablets (8%).

Qual ity-assured Public Sector

N=2,011

Qual ity-assured Private Sector

N=5,369AL tablet

A NAP tablet

A PPQ tablet

DHA PPQ tablet

DHA SP tablet

AL non-tablet

DHA PPQ non-tablet

Non-quality assured Private Sector

N=7,179



0

20

40

60

80

100




Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 15. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

The majority of antimalarial-stocking outlets in Uganda were stocking non-artemisinin therapy during each survey round, with the exception of CHWs. These include SP and quinine.

Figure 16. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Non-artemisinin therapy availability was higher among public health facilities in urban (97%) versus rural areas (87%).



0

20

40

60

80

100




Per

cen

tage

of

ou

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s

2010 2011 2013 2015

Figure 17. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey round

Although SP is no longer indicated for malaria case management, it is used for intermittent preventive therapy during pregnancy (IPTp). Readiness for IPTp remains high among public health facilities, with more than 80% stocking SP in 2015 (83%). SP has also been commonly found in the private sector, where about half of all antimalarial-stocking outlets have SP in stock.

Figure 18. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

SP availability was higher among public health facilities in urban (90%) versus rural areas (75%). SP availability was also higher in in the private sector in urban (58%) versus rural areas (46%).



0

20

40

60

80

100




Per

cen

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of

ou

tlet

s

2010 2011 2013 2015

Figure 19. Percentage of antimalarial-stocking outlets with oral quinine in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey rounds

Oral quinine is one of two second-line treatments for malaria in Uganda. Availability of oral quinine among antimalarial-stocking public health facilities was 61% in 2015. Oral quinine availability remained high in the private sector over time, although availability has decreased from 90% in 2010 to 78% in 2015.

Figure 20. Percentage of antimalarial-stocking outlets with oral quinine in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Availability of oral quinine was higher among public health facilities in urban (74%) versus rural areas (45%). Private sector availability was similar in urban versus rural areas.



0

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40

60

80

100




Per

cen

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s

2010 2011 2013 2015

Figure 21. Percentage of antimalarial-stocking outlets with injectable artesunate in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey rounds

Availability of injectable artesunate, the first line recommended treatment for severe malaria since 2014, increased considerably in 2015 compared to prior years. Over 50% of antimalarial-stocking public health facilities had injectable artesunate available in the last survey round. Availability has also increased in 2015 among pharmacies to 64%, and among private for-profit health facilities to 20%.

Figure 22. Percentage of antimalarial-stocking outlets with injectable artesunate in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Availability of injectable artesunate was higher among public health facilities in urban (64%) versus rural areas (39%). Data trends suggest higher availability in urban versus rural private for-profit health facilities (urban, 27%; rural, 13%) and pharmacies (urban, 65%; rural, 57%).



0

20

40

60

80

100


CommunityHealthWorker


HealthFacility

All Public Private For-Profit Health

Facility

Pharmacy Drug Store GeneralRetailer

All Private

Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 23. Percentage of antimalarial-stocking outlets with rectal artesunate in stock on the day of the survey, 2010-2015 Among all outlets with at least one antimalarial in stock, across survey rounds

Rectal artesunate is recommended for pre-referral treatment of severe malaria. Availability in public health facilities increased from 1% in 2013 to 31% in 2015, but remained low in all other outlet types.

Figure 24. Percentage of antimalarial-stocking outlets with rectal artesunate in stock on the day of the survey, 2015, urban/rural Among all outlets with at least one antimalarial in stock

Availability of rectal artesunate was higher among public health facilities in rural (43%) versus urban areas (21%).



Figure 25. Antimalarial market share, 2010-2015 Relative market volume (sale/distribution) of antimalarial AETDs, by sector and antimalarial class, across survey round

The private sector has accounted for more than half of the antimalarial market share at national level in 2011 (53%), 2013 (56%) and 2015 (54%). Market share for QA ACT increased from 40% in 2010 to 57% in 2011 during the AMFm pilot period and remained high in 2013 (55%) and 2015 (59%). The market share for QA ACT with the ‘green leaf’ logo was 43% in 2011 and decreased with continuation of the mechanism in the private sector only, to 26% in 2013 and 34% in 2015. Market share for non-QA ACT has remained around 10% over time. Market share for non-artemisinin therapies including SP has declined over time to 29% in 2015 and SP accounted for 20% of the antimalarial market share.

010

20

30

40

506070

80

90

100

Public Private Public Private Public Private Public Private

2010 2011 2013 2015

Pe

rce

nta

ge o

f to

tal m

arke

t vo

lum

e

QA ACT green leaf QA ACT without green leaf

Non QA ACT SP

Other non-artemisinin therapy Non-oral artemisinin monotherapy



Figure 26. Antimalarial market share within sector, 2010-2015 Relative market volume (sale/distribution) of antimalarial AETDs, within sector, by antimalarial class, across survey round

Within the public sector, QA ACTs have accounted for the majority of antimalarials distributed during each survey round. QA ACT market share increased from 68% in 2010 to 78% in 2011, and declined to 72% in 2013 and 73% in 2015. A decline in QA ACT market share relative to SP, which may be used for IPTp, may be due to increased rational ACT use with scale-up of confirmatory testing prior to treatment. However, it is noted that market share for other non-artemisinin therapy, namely oral quinine, has increased in 2015 to 8% from 2% in 2013. Within the private sector, QA ACT market share increased during the AMFm pilot period from 5% in 2010 to 39% in 2011, and continued to increase in 2013 (44%) and 2015 (48%). Nearly all of these QA ACTs distributed in the private sector have the ‘green leaf’ logo indicating subsidized product from the Global Fund. Within the private sector, market share for non-QA ACT was 19% in 2015 and SP accounted for 20% of the antimalarial market share.

0

10

20

30

40

50

60

70

80

90

100

Public Private Public Private Public Private Public Private

2010 2011 2013 2015

Pe

rce

nta

ge o

f se

cto

r m

arke

t vo

lum

e


Non QA ACT SP




Figure 27. Antimalarial market share, 2015 Relative market volume (sale/distribution) of antimalarial AETDs, by outlet type and antimalarial class

Private sector market share in 2015 (54%) is comprised of relative market share for drug stores (31%), private for‐profit health facilities (14%), and pharmacies (9%).

Figure 28. Antimalarial market share, 2015, urban/rural Relative market volume (sale/distribution) of antimalarial AETDs, by sector and antimalarial class

The private sector distributed 72% of the antimalarials in urban areas, and 43% of the antimalarials in rural areas. QA ACT market share was higher in rural (63%) versus urban areas (54%) and non-QA ACT market share was higher in urban (17%) versus rural areas (6%). SP market share was about nearly 20% in both urban and rural areas, with more of the SP distribution occurring in the public sector in rural areas (10%) as compared to urban areas (5%).

0

20

40

60

80

100

Public Private Public Private

Urban Rural

Pe

rce

nta

ge o

f se

cto

r m

arke

t vo

lum

e


Non QA ACT SP


0

20

40

60

80

100

Public Private Private For-Profit

Facility

Pharmacy Drug Store

Pe

rce

ntag

e o

f to

tal m

arke

t vo

lum

e


Non QA ACT SP




0

20

40

60

80

100




Health Facility


Facility


Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 29. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2010-2015 Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across survey round

Availability of malaria blood testing increased in all outlet types in 2015, compared to baseline. Availability was highest among private not for-profit facilities (96%) and public health facilities (95%). Availability was above 50% in all other outlet types in 2015 except drug stores, where availability of blood testing was 21%.

Figure 30. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2015, urban/rural Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months

Data trends suggest higher availability of malaria blood testing among antimalarial stocking outlets in urban versus rural areas. Among private sector outlets, availability was 44% in urban areas as compared with 27% in rural areas.



0

20

40

60

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100




Health Facility


Facility


Per

cen

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of

ou

tlet

s

2010 2011 2013 2015

Figure 31. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2010-2015 Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across survey round

Availability of malaria microscopy increased in public health facilities, from 32% in 2010 to 54% in 2015. Microscopy testing was available in roughly 40% of private for-profit health facilities across all survey rounds.

Figure 32. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2015, urban/rural Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months

Availability of malaria microscopy was higher among public health facilities in urban (72%) versus rural locations (35%). Data trends also suggest higher availability among private for-profit facilities in urban (51%) versus rural areas (31%).



0

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100




Health Facility


Facility


Per

cen

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ou

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s

2010 2011 2013 2015

Figure 33. Percentage of antimalarial-stocking outlets with malaria RDTs, 2010-2015 Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across survey round

Availability of malaria RDTs increased considerably from 2010 to 2015 in all outlet types. Availability in public health facilities increased from 4% in 2010 to 82% in 2015, in community health workers from 12% in 2010 to 58% in 2015, and in private not-for-profit facilities from 9% in 2010 to 87% in 2015. Although availability remained lower in the private sector compared to the public sector, increases were also seen: from 10% to 48% in private for-profit facilities, from 22% to 51% in pharmacies, and from 2% to 20% in drug stores.

Figure 34. Percentage of antimalarial-stocking outlets with malaria RDTs, 2015, urban/rural Among all outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across urban and rural zones

Availability of malaria RDTs was similar across urban and rural areas in 2015.



Figure 35. Malaria blood testing market share, 2015 Relative market volume (sale/distribution) of malaria blood testing using RDTs and microscopy, by outlet type and type of test

Nearly three quarters of all malaria blood tests were performed by public sector outlets (71%) and the majority of these were performed using RDTs (70%). Private for-profit facilities accounted for the majority of malaria blood testing performed by the private sector (22% of all tests performed, 76% of all tests performed in the private sector).

Figure 36. Malaria RDT market share by manufacturer, across sector, 2015 Relative market volume (sale/distribution) of malaria RDTs by manufacturer, within the public sector, private sector, and total market

Among RDTs performed within the public sector, the majority (82%) were manufactured by Access Bio Inc, followed by Astel Diagnostics (9%) and Standard Diagnostics, Inc (8%). In the private sector, Access Bio Inc accounted for 74% of the RDT market share, followed by Standard Diagnostics at 6%.

0

10

20

30

40

50

60

70

80

90

100

Public Private Private For-Profit

FacilityPharmacy Drug Store

Pe

rce

nta

ge o

f to

tal m

arke

t vo

lum

e

Microscopy RDT

0

10

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70

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90

100

Public Private

Pe

rce

nta

ge o

f w

ith

in o

utl

et

mar

ket

volu

me

ACCESS BIO STANDARD DIAGNOSTICS INC

ASTEL DIAGNOSTICS Other RDT manufacturer

Manufacturer not specified



Figure 37. Private sector median price of antimalarial adult equivalent treatment dosages (AETD), 2010-2015 Among all SP and quality-assured ACT (tablet formulation only) available in the private sector, in 2010 US dollars to account for inflation, across survey round

The median private sector price for one adult equivalent treatment dose (AETD) of QA ACT has decreased steadily over time. However, even the lowest price of QA ACT, at $1.48 in 2015 was still more than three times as expensive as a full course of SP at $0.44. The price of SP also decreased over time, from $0.70 in 2010 to $0.44 in 2015.



Figure 38. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and pre-packaged pediatric quality-assured AL, 2015 Among all SP, QA ACT, and pre-packaged pediatric (treatment for a 2 year old child) QA AL (tablet formulation only) available in the private sector, in 2015 US Dollars

The price of one QA ACT AETD in the private sector in 2015 USD was $1.62 compared with $0.48 for one SP AETD. Pre-packaged AL for a 10kg child (6-tablets) was $0.39 in the private sector. Private for-profit facilities had the highest prices for all drug types compared to other private outlets. The cost of one SP AETD was $0.65 in these outlets in 2015, compared to $0.48 in all other outlet types. One QA ACT AETD was $1.94 in 2015 in private for-profit facilities, $1.55 in drug stores, and $1.29 in pharmacies.

$0.65

$1.62

$0.65

$0.48

$1.29

$0.48$0.48

$1.62

$0.32$0.48

$1.62

$0.39

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

SP AETD QA ACT AETD Pre-packaged pediatric QA AL

20

15

USD

Private For-Profit Facility Pharmacy Drug Store All Private



Figure 39. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and pre-packaged pediatric quality-assured AL, 2015, urban/rural Among all SP, QA ACT, and pre-packaged pediatric (treatment for a 2 year old child) QA AL (tablet formulation only) available in the private sector, in 2015 US Dollars, across survey round

The private sector price of QA ACT and SP was similar in urban and rural areas. Pre-packaged AL for a 10kg child was $0.48 in urban areas as compared with $0.39 in rural areas.

$0.48 $0.48

$1.62 $1.62

$0.48$0.39

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

Urban Rural Urban Rural Urban Rural

SP AETD QA ACT AETD Pre-packaged pediatric QA AL

20

15

USD

All Private



Figure 40. Private sector median price of QA ACT adult equivalent treatment dosages (AETD) with and without the ‘green leaf’ logo, 2010-2015 Among all quality-assured ACT (tablet formulation only) available in the private sector, in 2010 US dollars to account for inflation, across survey rounds

The private sector median price for QA ACT with the ‘green leaf’ logo has matched that of QA ACT without the ‘green leaf’ logo at each survey round until 2015, when the price of QA ACT without the logo was $0.15 cheaper than QA ACT with the logo.

Figure 41. Median private sector consumer prices for malaria RDT testing for adults and children 2015 Among all RDTs available within private for-profit health facilities, pharmacies and drug stores, in 2015 US dollars

The median private sector price for adult RDTs was equal to the price for child RDTs in each outlet type. Prices for RDTs in private for-profit facilities and pharmacies were the same: $0.97. RDTs in drug stores were cheaper by one-third at $0.65.



Figure 42. Median private sector prices for malaria RDT testing and QA ACT for adults and children 2015 Among antimalarial-stocking outlets, in 2015 US dollars

The median private sector price for malaria RDT testing for a child was two times more expensive than the cost of pre-packaged QA AL treatment (RDT, $0.65; QA AL, $0.32). However, for adults, the median price for malaria RDT testing was considerable cheaper ($0.65) as compared with the price of pre-packaged QA AL treatment ($1.62).



0

20

40

60

80

100




Health Facility


Facility


Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 43. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2010-2015 Among providers in outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across survey round

Across survey rounds, more than 90% of providers among antimalarial‐stocking public health facilities correctly stated the first‐line treatment for uncomplicated malaria (AL). Knowledge of first-line treatment increased over time among providers at private for-profit health facilities (85% in 2015) and drug stores (84% in 2015). Slight decreases were seen in antimalarial drug knowledge among community health workers (from 97% in 2010 to 82% in 2015), and private not for-profit facilities (from 93% in 2010 to 89% in 2015).



Figure 44. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2015, urban/rural Among providers in outlets with at least one antimalarial in stock on the day of the survey or within the past three months

First-line treatment knowledge was similar among providers in urban versus rural areas across outlet type.



0

20

40

60

80

100




Health Facility


Facility


Per

cen

tage

of

ou

tlet

s

2010 2011 2013 2015

Figure 45. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a two-year old child, 2010-2015 Among providers in outlets with at least one antimalarial in stock on the day of the survey or within the past three months, across survey round

The percentage of providers who correctly stated the first-line dosing regimen for uncomplicated malaria in a two-year old child increased among private sector outlet types compared to baseline, and decreased among public sector outlet types compared to baseline. Proportion of retailers in private for-profit health facilities who correctly stated the treatment rose from 59% in 2010 to 76% in 2015, in pharmacies from 72% to 84%, and in drug stores from 65% to 75%. The proportion of community health workers who correctly stated the dosing regimen declined from 91% in 2010 to 66% in 2015, in private not for-profit facilities from 78% to 76%, and data trends showed only a slight decline in public health facilities from 92% to 91%.



Figure 46. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a two-year old child, 2015, urban/rural Among providers in outlets with at least one antimalarial in stock on the day of the survey or within the past three months

Knowledge of the dosing regimen for a two-year old child using the first-line treatment for uncomplicated malaria was similar among providers in urban versus rural areas across outlet type, apart from pharmacies which showed higher percentages of respondents reporting accurate dosing knowledge in urban areas (86%) compared to rural areas (68%).



Results Section A: Core Indicators

Table A1: Availability of antimalarials, among all screened outlets, by outlet type



Private Not For-Profit Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets* stocking:

N=282 N=5618 N=55 N=5955 N=1023 N=493 N=1967 N=3483 N=9438

Any antimalarial at the time of survey visit

97.6 11.2 97.8 12.6 93.1 98.3 93.4 93.4 31.7

(93.0, 99.2) (5.9, 20.1) (87.6, 99.6) (7.2, 21.1) (90.4, 95.1) (96.4, 99.2) (91.3, 95.0) (91.8, 94.7) (25.1, 39.2)

Any ACT 93.8 11.1 96.7 12.5 80.3 97.9 80.4 80.7 28.7

(89.1, 96.5) (5.9, 20.0) (88.0, 99.1) (7.1, 21.1) (74.2, 85.3) (96.1, 98.9) (76.9, 83.5) (77.3, 83.6) (22.4, 35.9)

AL 93.8 11.1 96.7 12.5 75.1 97.8 79.1 78.4 28.2

(89.1, 96.5) (5.9, 20.0) (88.0, 99.1) (7.1, 21.1) (68.5, 80.7) (96.0, 98.8) (75.5, 82.3) (75.0, 81.6) (22.0, 35.3)

ASAQ 1.4 0.0 8.3 0.1 26.4 59.1 15.2 18.5 4.4

(0.5, 3.6) - (3.2, 19.7) (0.0, 0.2) (21.6, 32.0) (47.9, 69.5) (12.5, 18.3) (15.7, 21.6) (3.5, 5.6)

DHA-PPQ 1.5 0.0 10.9 0.1 30.6 96.9 13.7 18.9 4.5

(0.7, 3.3) - (4.6, 23.5) (0.0, 0.2) (25.2, 36.5) (94.4, 98.3) (10.6, 17.6) (15.3, 23.0) (3.3, 6.2)

Quality Assured ACT (QA ACT)

93.8 11.1 93.6 12.5 69.5 94.8 72.3 72.0 26.6

(89.1, 96.5) (5.9, 20.0) (84.2, 97.5) (7.1, 21.0) (63.2, 75.1) (91.6, 96.8) (68.2, 76.0) (68.2, 75.4) (20.8, 33.4)

QA ACT with the “green leaf” logo

10.8 2.4 40.1 2.7 67.3 92.3 68.2 68.3 18.3

(6.5, 17.3) (1.1, 5.2) (25.5, 56.5) (1.4, 5.3) (61.2, 72.9) (87.3, 95.5) (63.6, 72.5) (64.1, 72.3) (15.0, 22.1)

QA ACT without the “green leaf” logo

92.8 8.8 64.5 10.0 6.9 20.6 5.8 6.3 9.1

(88.0, 95.8) (4.1, 18.1) (46.8, 78.9) (5.1, 18.7) (5.0, 9.5) (12.8, 31.5) (4.6, 7.3) (5.1, 7.7) (5.2, 15.6)

QA AL 93.8 11.1 92.2 12.5 63.8 93.1 70.1 69.0 25.9

(89.1, 96.5) (5.9, 20.0) (82.7, 96.7) (7.1, 21.0) (57.2, 70.0) (88.8, 95.9) (66.0, 74.0) (65.1, 72.6) (20.2, 32.5)

Non-Quality Assured ACT (non-QA ACT)

6.0 0.0 17.3 0.2 46.0 97.7 30.8 35.3 8.5

(2.5, 13.6) (0.0, 0.1) (9.3, 30.1) (0.1, 0.3) (39.8, 52.3) (95.6, 98.8) (26.4, 35.6) (30.7, 40.2) (6.5, 11.1)

Nationally Registered ACT 93.8 4.1 95.6 5.6 75.3 97.9 69.7 71.4 21.2

(89.1, 96.5) (1.8, 9.3) (84.9, 98.8) (3.1, 10.2) (69.0, 80.6) (96.0, 98.9) (65.7, 73.5) (67.6, 75.0) (17.0, 26.2)

Any non-artemisinin therapy 90.0 0.0 91.0 1.5 87.1 97.2 82.7 83.9 21.1

(84.8, 93.6) (0.0, 0.1) (80.1, 96.2) (1.2, 1.9) (83.0, 90.4) (94.7, 98.5) (78.7, 86.0) (80.7, 86.7) (17.4, 25.3)

Sulfadoxine-Pyrimethamine 81.4 0.0 67.6 1.3 48.5 82.5 45.9 47.1 12.1

(75.0, 86.5) (0.0, 0.1) (53.1, 79.3) (1.0, 1.7) (42.1, 54.8) (76.3, 87.3) (40.3, 51.7) (42.0, 52.1) (9.6, 15.3)

Oral Quinine 59.9 0.0 85.2 1.2 65.9 94.1 75.0 73.2 18.2

(50.1, 69.1) - (73.1, 92.4) (0.9, 1.5) (60.7, 70.8) (89.1, 96.8) (70.8, 78.9) (69.5, 76.6) (15.0, 22.0)

Other non-artemisinin therapy ^

0.6 0.0 1.3 0.0 9.1 53.5 10.5 10.8 2.6

(0.2, 1.9) - (0.2, 8.6) - (6.2, 13.2) (43.1, 63.6) (8.4, 13.1) (9.1, 12.8) (2.0, 3.4)



Table A1: Availability of antimalarials, among all screened outlets, by outlet type




ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


N=282 N=5618 N=55 N=5955 N=1023 N=493 N=1967 N=3483 N=9438

Oral artemisinin monotherapy

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -

Non-oral artemisinin monotherapy

71.4 0.3 61.4 1.4 47.7 84.0 10.9 20.6 5.9

(62.7, 78.7) (0.1, 0.6) (44.0, 76.3) (1.0, 1.9) (42.2, 53.3) (77.0, 89.2) (8.2, 14.4) (17.5, 24.1) (4.7, 7.5)

Any treatment for severe malaria

74.5 0.3 79.9 1.5 78.6 89.6 24.8 38.4 10.3

(66.0, 81.5) (0.1, 0.6) (64.0, 89.9) (1.1, 2.1) (74.2, 82.5) (84.0, 93.4) (21.0, 29.1) (34.7, 42.2) (8.3, 12.6)

Artesunate IV/IM # 53.1 0.0 42.3 0.8 20.0 63.8 2.3 7.3 2.3

(42.8, 63.1) - (26.4, 59.9) (0.6, 1.1) (16.1, 24.6) (53.65 72.9) (1.0, 5.1) (5.5, 9.8) (1.8, 3.1)

Artesunate Rectal 30.6 0.3 8.5 0.6 1.6 5.1 0.4 0.7 0.7

(22.7, 39.9) (0.1, 0.6) (3.3, 20.2) (0.4, 1.0) (0.9, 2.6) (3.1, 8.4) (0.2, 1.0) (0.5, 1.2) (0.5, 0.9)

Artemether IV/IM 3.1 0.0 25.5 0.2 38.4 72.9 10.0 17.6 4.3

(1.0, 9.2) - (14.6, 40.6) (0.1, 0.3) (33.1, 44.1) (63.3, 80.7) (7.6, 13.1) (14.8, 20.8) (3.3, 5.6)

Quinine IV/IM 24.3 0.0 71.1 0.7 67.1 79.5 20.0 31.9 8.1

(14.7, 37.4) - (55.6, 82.8) (0.5, 1.0) (60.2, 73.4) (70.1, 86.5) (16.5, 24.0) (28.4, 35.6) (6.5, 10.1)


At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria.

^ Other types of non-artemisinin therapy – other than SP: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine.

# At the time of the 2015 Uganda ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria.




Table A2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type



Private Not For-Profit

Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets* stocking: N=275 N=719 N=53 N=1047 N=956 N=476 N=1849 N=3281 N=4328

Any ACT 96.1 99.7 98.9 99.4 86.3 99.7 86.1 86.4 90.3

(92.6, 98.0) (98.7, 99.9) (92.6, 99.8) (98.6, 99.7) (79.6, 91.0) (98.3, 99.9) (83.2, 88.6) (83.3, 89.0) (87.8, 92.3)

AL 96.1 99.7 98.9 99.4 80.7 99.5 84.7 84.0 88.7

(92.6, 98.0) (98.7, 99.9) (92.6, 99.8) (98.6, 99.7) (73.9, 86.0) (98.3, 99.9) (81.8, 87.3) (80.8, 86.7) (85.9, 90.9)

ASAQ 1.4 0.0 8.5 0.5 28.4 60.2 16.2 19.8 13.9

(0.6, 3.7) - (3.3, 20.0) (0.2, 1.4) (23.0, 34.5) (48.8, 70.5) (13.4, 19.5) (16.8, 23.1) (11.1, 17.3)

DHA PPQ 1.5 0.0 11.1 0.7 32.8 98.6 14.7 20.2 14.3

(0.7, 3.4) (0.0, 0.2) (4.7, 24.0) (0.3, 1.6) (27.0, 39.2) (97.0, 99.3) (11.4, 18.7) (16.4, 24.6) (10.9, 18.6)


96.1 99.7 95.7 99.2 74.7 96.5 77.4 77.1 83.8

(92.6, 98.0) (98.7, 99.9) (87.2, 98.7) (98.3, 99.6) (68.0, 80.3) (94.0, 97.9) (73.6, 80.9) (73.3, 80.4) (80.6, 86.6)


11.0 21.4 41.0 21.6 72.3 93.9 73.0 73.2 57.6

(6.7, 17.7) (8.4, 44.6) (25.9, 57.9) (9.6, 41.4) (65.8, 78.0) (89.7, 96.5) (68.6, 77.0) (69.0, 77.0) (47.2, 67.3)


95.1 78.8 65.9 79.5 7.4 21.0 6.2 6.7 28.8

(91.5, 97.2) (55.6, 91.7) (48.4, 79.9) (59.6, 91.0) (5.4, 10.2) (12.9, 32.2) (4.9, 7.9) (5.5, 8.2) (18.9, 41.1)

QA AL 96.1 99.7 94.3 99.1 68.6 94.8 75.1 73.9 81.5

(92.5, 98.0) (98.7, 99.9) (85.5, 97.9) (98.2, 99.6) (61.8, 74.6) (91.2, 96.9) (71.2, 78.6) (70.0, 77.4) (78.1, 84.5)


6.1 0.1 17.7 1.5 49.4 99.4 33.0 37.8 26.8

(2.6, 13.9) (0.0, 0.6) (9.5, 30.7) (0.8, 2.8) (42.8, 56.1) (98.2, 99.8) (28.4, 37.9) (33.0, 42.9) (21.6, 32.8)


(92.6, 98.0) (19.3, 58.9) (85.8, 99.7) (27.7, 63.0) (73.8, 86.4) (98.3, 99.9) (70.9, 78.0) (72.6, 79.9) (58.4, 74.4)

Any non-artemisinin therapy 92.3 0.2 93.0 12.2 93.6 98.9 88.5 89.9 66.3

(88.4, 94.9) (0.0, 1.2) (82.3, 97.5) (7.0, 20.0) (90.7, 95.6) (97.5, 99.5) (85.0, 91.3) (87.2, 92.1) (55.4, 75.8)


(77.4, 88.1) (0.0, 1.2) (54.2, 80.9) (6.0, 17.0) (45.7, 58.4) (77.6, 88.7) (43.5, 54.9) (45.4, 55.4) (31.9, 45.0)

Oral Quinine 61.4 0.0 87.1 9.3 70.8 95.7 80.4 78.4 57.4

(51.4, 70.5) (0.0, 0.2) (74.8, 93.9) (5.3, 15.8) (65.9, 75.3) (91.8, 97.8) (76.3, 83.8) (74.9, 81.5) (48.4, 66.0)

Other non-artemisinin therapy ^ 0.6 0.0 1.3 0.1 9.8 54.4 11.3 11.5 8.1

(0.2, 1.9) - (0.2, 8.8) (0.0, 0.4) (6.6, 14.1) (43.8, 64.7) (9.0, 14.0) (9.7, 13.7) (6.4, 10.2)

Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -

Non-oral artemisinin monotherapy 73.2 2.3 62.8 11.0 51.3 85.5 11.7 22.1 18.7

(64.7, 80.2) (1.0, 5.6) (44.7, 77.9) (6.4, 18.3) (45.1, 57.4) (78.9, 90.3) (8.9, 15.3) (18.8, 25.7) (15.3, 22.8)

Any treatment for severe malaria 76.3 2.3 81.7 12.2 84.5 91.1 26.6 41.1 32.4

(68.0, 83.0) (1.0, 5.6) (65.1, 91.5) (7.1, 20.2) (79.9, 88.2) (86.0, 94.5) (22.5, 31.1) (37.3, 45.0) (27.1, 38.1)



Artesunate IV/IM # 54.4 0.0 43.3 6.5 21.5 64.9 2.4 7.8 7.4

(44.0, 64.5) - (26.8, 61.3) (3.5, 11.7) (17.1, 26.6) (54.7, 73.8) (1.1, 5.5) (5.8, 10.4) (5.6, 9.7)

Rectal Artesunate 31.4 2.3 8.6 5.0 1.7 5.2 0.4 0.8 2.1

(23.3, 40.8) (1.0, 5.6) (3.3, 20.6) (2.8, 8.7) (1.0, 2.8) (3.1, 8.6) (0.2, 1.1) (0.5, 1.3) (1.5, 2.9)

Artemether IV/IM 3.1 0.0 26.1 1.6 41.3 74.1 10.7 18.8 13.6

(1.0, 9.4) - (15.0, 41.3) (0.8, 3.2) (35.6, 47.2) (64.8, 81.7) (8.1, 14.0) (15.9, 22.2) (10.7, 17.1)

Quinine IV/IM 24.9 0.0 72.7 5.6 72.1 80.9 21.4 34.2 25.5

(15.1, 38.2) - (56.7, 84.4) (3.0, 10.3) (64.9, 78.3) (71.6, 87.6) (17.7, 25.7) (30.6, 38.0) (21.0, 30.6)

*Antimalarial-stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet. The denominator includes 68 outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).







Table A3: Types of quality-assured and Non-Quality Assured ACTs audited in the public and private sector

ACT generic name and formulation Quality-assured ACT Non-Quality Assured ACT

Public sector Private sector Public Sector Private Sector

% (95% CI) % (95% CI) % (95% CI) % (95% CI)

Proportion of all audited antimalarials: N audited=2,011 N audited=5,369 N audited=59 N audited=7,179

Tablet formulation:

Artemether lumefantrine 99.66 75.64 25.19 35.24

99.16-99.87 72.24-78.75 11.59-46.37 30.47-40.32

Artesunate mefloquine 0 0 0 1.02

- - - 0.68-1.51

Artesunate amodiaquine 0.34 24.36 0 0.27

0.13-0.84 21.25-27.76 - 0.08-0.98

Dihydroartemisinin piperaquine 0 0 42.63 31.18

- - 25.85-61.3 28.71-33.75

Arterolene piperaquine 0 0 0.49 0.28

- - 0.06-2.63 1.15-0.54

Artemisinin napthoquine 0 0 19.04 6.74

- - 7.74-39.72 5.44-8.32

Non-tablet formulation*:

Artemether lumefantrine 0 0 12.42 17.26

- - 5.67-25.07 15.08-19.68

Dihydroartemisinin piperaquine 0 0 0.32 7.89

- - 0.05-2.31 6.54-9.49

Artesunate mefloquine 0 0 0 0.12

- - - 0.06-0.27

* Non-tablet ACTs were most commonly suspensions but also included granules and suppositories.




Outlet type, among outlets with at least 1 antimalarial in stock on the day of the survey:*




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

% % % % % % % %

N=3,907 outlets

6.3 25.0 1.4 32.8 15.5 2.0 49.7 67.2

(5.1, 7.8) (15.6, 37.6) (1.0, 2.0) (23.5, 43.7) (12.4, 19.2) (1.3, 3.1) (41.7, 57.7) (56.3, 76.5)

Table A4: Antimalarial market composition

sition

* Excluding booster sample outlets. Outlets with at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet.




Table A5a: Price of tablet formulation antimalarials, by outlet type

Private

For-Profit Facility

Pharmacy Drug Store ALL

Private

Median price of a tablet AETD*: Median [IQR]

(N of Antimalarials)

Median [IQR]


Median [IQR]


Median [IQR]


Any ACT $2.59 $2.91 $1.62 $1.94

[1.62-4.20] (2,352) [1.62-4.85] (4,158) [1.29-2.59] (3,714) [1.29-3.23] (10,224)

AL $1.94 $1.62 $1.55 $1.62

[1.45-3.10] (1,392) [1.29-2.59] (1,828) [1.13-1.94] ((2,623) [1.29-1.94] (5,843)

ASAQ $2.15 $1.29 $1.94 $1.94

[1.29-4.85] (437) [0.81-2.59] (415) [0.97-3.56] (504) [0.97-3.88] (1,356)

DHA PPQ $4.85 $3.88 $4.85 $4.85

[3.88-5.17] (458) [3.23-4.85] (1,190) [3.23-4.85] (478) [3.23-4.85] (2,126)

Quality Assured ACT (QA ACT) $1.94 $1.29 $1.55 $1.62

[1.29-3.23] (1,365) [0.97-1.94] (1,467) [0.97-1.94] (2,446) [1.13-1.94] (5,278)

QA ACT with the “green leaf” logo $1.94 $1.29 $1.55 $1.62

[1.29-3.23] (1,280) [0.97-1.94] (1,229) [0.97-1.94] (2,302) [1.13-1.94] (4,811)

QA ACT without the “green leaf” logo $1.62 $6.46 $1.29 $1.45

[1.29-3.23] (84) [2.59-8.08] (237) [0.97-1.62] (133) [1.08-1.94] (454)

QA AL $1.62 $1.29 $1.55 $1.55

[1.29-2.59] (931) [0.97-1.94] (1,053) [0.97-1.94] (1,942) [1.13-1.94] (3,926)

Non-Quality Assured ACT (Non-QA ACT) $3.88 $3.88 $3.23 $3.23

[2.59-4.85] (987) [2.91-6.46-] (2,691) [1.62-4.85] (1,268) [1.94-4.85] (4,946)

SP $0.65 $0.48 $0.48 $0.48

[0.48-0.81] (605) [[0.48-0.65] (587) [0.48-0.65] (1,122) [0.48-0.65] (2,314)

Oral Quinine $3.39 $2.72 $3.39 $3.39

[2.72-4.07] (454) [2.72-4.07] (384) [2.72-4.07] (1,116) [2.72-4.07] (1,954)



Table A5a: Price of tablet formulation antimalarials, by outlet type

Private

For-Profit Facility


Private



Median [IQR]


Median [IQR]


Median [IQR]


* AETD - adult equivalent treatment dose - is or the number of milligrams required to treat a 60kg adult (see Annex 11). Information provided by the respondent about price for a specific amount of antimalarial drug (e.g. price per tablet or price per specific package size) was converted to the price per AETD.

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. Figures in this table are derived using audited products with price information. The numbers of antimalarials captured in audit sheets with missing price and/ or product information are as follows: 219 any ACT tablet, 102 artemether lumefantrine tablet, 96 QA ACT tablet, 84 QA ACT with the 'green leaf' logo tablet, 11 QA ACT without the 'green leaf' logo tablet, 123 non-Quality Assured ACT tablet, 40 SP tablet.




Table A5b: Price of pre-packaged antimalarials, by outlet type

Private

For-Profit Facility


Private

Median price of one pre-packaged therapy:

Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Adult QA AL $1.62 $1.29 $1.62 $1.62

[1.29-2.26] (664) [0.97-1.62] (670) [1.29-1.62] (1,269) [1.29-1.94] (2,603)

Pediatric QA AL * $0.65 $0.48 $0.32 $0.39

[0.32-0.97] (84) [0.32-0.97] (134) [0.29-0.48] (173) [0.32-0.58] (391)

* Pediatric AL is the pre-packaged regimen appropriate for a 2 year old child. Figures in this table are derived using audited products with price information. The numbers of antimalarials captured in audit sheets with missing price information are as follows: 45 adult AL, 8 child AL







Facility

ALL Public / Not- For-

Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets** stocking

N=280 N=900 N=53 N=1233 N=966 N=467 N=1914 N=3347 N=4580

Any malaria blood testing

95.4 58.2 96.1 62.3 70.1 51.4 20.9 32.6 42.6

(89.5, 98.1) (35.5, 77.9) (87.6, 98.9) (41.8, 79.1) (63.1, 76.3) (44.1, 58.6) (17.8, 24.4) (29.2, 36.3) (34.2, 51.4)

N=279 N=900 N=53 N=1232 N=966 N=467 N=1914 N=3347 N=4579

Microscopic blood tests 55.7 0.0 64.4 6.4 41.1 0.6 1.2 10.3 9.0

(47.6, 63.5) - (47.0, 78.7) (3.8, 10.5) (34.3, 48.1) (0.2, 1.4) (0.6, 2.3) (8.2, 12.8) (7.1, 11.3)

N=280 N=900 N=53 N=1233 N=965 N=467 N=1914 N=3346 N=4579

Rapid diagnostic tests (RDTs)

81.7 58.2 86.5 61.0 47.7 51.4 20.1 26.8 38.3

(71.2, 89.0) (35.5, 77.9) (69.5, 94.7) (40.6, 78.1) (41.7, 53.8) (44.1, 58.6) (17.1, 23.4) (23.9, 30.0) (29.7, 47.7)

Table A6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type

* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked antimalarials in the previous 3 months. ** Results in this table are derived using responses captured among outlets with blood testing information. 19 antimalarial-stocking outlet was missing information about both availability of

microscopy and availability of RDTs. 20 antimalarial-stocking outlet had partial information about blood testing availability and are included in the denominator of the indicator “any blood testing available.”




Outlet type, among outlets with malaria blood testing available on the day of the survey:*




ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

% % % % % % % %

N=2,082 outlets 11.3 43.0 2.6 56.9 21.1 1.7 20.4 43.1

(8.3, 15.2) (28.9, 58.3) (1.7, 4.0) (44.9, 68.1) (15.2, 28.4) (1.0, 2.8) (15.1, 26.9) (31.9, 55.1)

Table A7: Malaria blood testing market composition

* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked antimalarials in the previous 3 months. ** Results in this table are derived using responses captured among outlets with blood testing information. 19 antimalarial-stocking outlet was missing information about both availability of microscopy and

availability of RDTs. 20 antimalarial-stocking outlet had partial information about blood testing availability and are included in the denominator of the indicator “any blood testing available.”




Table A8: Price of malaria blood testing for adults, by outlet type

Private For-Profit


ALL Private

Total median price to consumers:*

Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Microscopic blood tests

Adult $0.97 $1.62 $0.65 $0.97

[0.65-0.97] (409) [0.97-1.62] (8) [0.48-0.97] (19) [0.65-0.97] (436)

Child under age five $0.97 $1.62 $0.65 $0.81

[0.65-0.97] (410) [0.97-1.62] (8) [0.48-0.97] (18) [0.65-0.97] (436)


Adult $0.97 $0.97 $0.65 $0.81

[[0.65-0.97] (513) [0.32-0.97] (44) [0.65-0.97] (390) [0.65-0.97] (947)

Child under five $0.97 $0.97 $0.65 $0.81

[[0.65-0.97] (514) [0.32-0.97] (44) [0.65-0.97] (391) [0.65-0.97] (949)

* Total price to the consumer including consultation and/or service fees. Microscopic blood testing price information was not available (missing or “don’t know” response) for: 257 adult RDTs, 7 child RDTs, 5 adult microscopy tests, 5 child microscopy tests




Table A9: Antimalarial market share

AETDs sold or distributed in the previous week by outlet type and antimalarial type as a percentage of all AETDs sold / distributed:*




Facility

TOTAL Public / Not-

For-Profit

Private For-Profit


TOTAL Private

ANTI-MALARIAL TOTAL**

% % % % % % % % %

1. Any ACT 29.1 2.5 2.1 33.6 9.0 6.0 20.9 35.9 69.6

AL 29.0 2.5 1.9 33.4 6.5 3.5 17.9 27.9 61.3

ASAQ 0.0 0.0 0.0 0.0 1.1 0.7 1.7 3.5 3.6

DHA PPQ 0.0 0.0 0.1 0.2 1.3 1.6 1.2 4.1 4.3

Quality Assured ACT (QA ACT) 29.0 2.5 1.9 33.4 5.9 3.3 16.6 25.8 59.2

QA ACT with the “green leaf” logo 0.9 0.5 0.5 2.0 5.2 3.3 15.2 23.7 25.7

QA ACT without the “green leaf” logo 28.1 2.0 1.3 31.4 0.6 0.1 1.4 2.1 33.5

Non-Quality Assured ACT 0.1 0.0 0.2 0.3 3.2 2.7 4.3 10.1 10.4


2. Any non-artemisinin therapy 10.5 0.0 1.0 11.5 4.7 2.5 10.3 17.5 29.0


Oral Quinine 3.4 0.0 0.2 3.5 0.9 0.3 2.3 3.5 7.1


3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy 0.5 0.0 0.1 0.5 0.4 0.3 0.2 0.9 1.4

Artesunate IV/IM # 0.3 0.0 0.0 0.3 0.1 0.1 0.0 0.2 0.6

OUTLET TYPE TOTAL*** 40.0 2.5 3.1 45.7 14.1 8.8 31.4 54.3 100.0

* A total of 74749.61 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.

** Row sum – market share for the specified antimalarial medicine. *** Column sum – market share for the specified outlet type.

At the time of the 2015 Country ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. ^ Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine # At the time of the 2015 Country ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria. Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column. A total of 20,137 antimalarials (in the census sample) were audited. Of these, 565 audited antimalarials were not included in market share calculations due to incomplete or inconsistent

information.




AETDs sold or distributed in the previous week by antimalarial type as a percentage of all AETDs sold / distributed within each outlet

type:*




Facility

TOTAL Public / Not-

For-Profit

Private For-Profit


TOTAL Private

% % % % % % % %

1. Any ACT 72.7 99.8 65.3 73.6 63.9 68.2 66.6 66.1

AL 72.6 99.8 59.6 73.2 45.8 40.2 57.0 51.4

ASAQ 0.0 0.0 1.1 0.1 8.1 7.9 5.4 6.5

DHA PPQ 0.1 0.0 4.3 0.3 9.5 17.9 3.8 7.6

Quality Assured ACT (QA ACT) 72.4 99.8 59.5 73.1 41.5 38.0 52.9 47.5

QA ACT with the “green leaf” logo 2.3 21.1 16.8 4.3 36.9 37.1 48.4 43.6

QA ACT without the “green leaf” logo 70.2 78.7 42.7 68.8 4.6 0.8 4.3 3.8

Non-Quality Assured ACT 0.2 0.0 5.8 0.6 22.4 30.3 13.7 18.6

Nationally Registered ACT 72.4 39.6 63.2 70.0 54.8 58.4 52.9 54.3

2. Any non-artemisinin therapy 26.2 0.2 33.0 25.2 33.3 28.4 32.8 32.2

Sulfadoxine-Pyrimethamine 17.6 0.2 26.4 17.3 22.3 18.1 21.8 21.3

Oral Quinine 8.4 0.0 5.5 7.8 6.1 3.8 7.4 6.5

Other non-artemisinin therapy ^ 0.0 0.0 0.0 0.0 2.2 5.0 2.2 2.6

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy 1.2 0.0 1.6 1.1 2.9 3.4 0.7 1.7

Artesunate IV/IM # 0.8 0.0 0.6 0.7 0.8 0.8 0.1 0.4

Table A10: Antimalarial market share across outlet type

* AETDs reportedly sold or distributed in the previous seven days: 21739.042 public health facilities; 1553.3854 community health workers; 2198.3319 private not for-profit health facilities; 16760.319 private for-profit health facilities; 10032.617 pharmacies; 22465.919 drug stores. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. ^ Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine # At the time of the 2015 Uganda ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria. Categories 1 through 4 sum to 100% within each column. A total of 20,137 antimalarials were audited. Of these, 565 audited antimalarials were not included in market share calculations due to due to incomplete or inconsistent information, including the following number of antimalarials by outlet type: 42 public health facilities; 2 community health workers; 34 private not for-profit health facilities; 164 private for-profit health facilities; 191 pharmacies; 132 drug stores.




Table A11: Malaria blood testing market share

Number of malaria blood tests provided in the previous week by outlet type and blood test type as a percentage of all blood tests provided:*




Facility

TOTAL Public / Not

For-Profit

Private For-Profit


TOTAL Private

BLOOD TEST TOTAL**

% % % % % % % % %

1. Malaria microscopy 14.0 0.0 1.9 15.9 13.4 0.0 0.8 14.2 30.1

2. RDT 45.2 4.9 4.8 55.0 8.7 0.4 5.7 14.9 69.9


* A total of 52356 malaria blood tests were reportedly administered in the previous seven days. ** Row sum – market share for the specified type of blood testing medicine. *** Column sum – market share for the specified outlet type. Categories 1 and 2 sum to 100% in the far-right column – malaria blood testing total column. A total of 2,588 malaria blood tests were audited. Of these, 108 audited tests were not included in market share calculations due to incomplete or inconsistent information.




Table A12: Malaria blood testing market share, across outlet type

Number of malaria blood tests provided in the previous week by blood test type as a percentage of all blood tests provided within each outlet type:*




Facility

TOTAL Public / Not-For-

Profit

Private For-Profit


TOTAL Private

BLOOD TEST TOTAL**

% % % % % % % % %

Total blood testing market

1. Malaria microscopy 23.6 0.0 28.4 22.4 60.7 3.1 11.7 48.9 30.1

2. RDT 76.4 100.0 71.6 77.6 39.3 96.9 88.3 51.1 69.9

Malaria RDT market

Manufacturer

Access Bio Inc. 88.5 12.7 95.9 82.4 77.0 37.4 72.7 74.2 80.6

Standard Diagnostics Inc. 0.5 87.1 0.0 8.2 5.1 2.5 8.5 6.3 7.8

Astel Diagnostics 11.0 0.0 1.3 9.1 0.7 0.7 1.0 0.8 7.4

Other 0.0 0.1 2.4 0.2 15.5 33.6 15.9 16.2 3.6

Unknown 0.0 0.1 0.4 0.0 1.7 25.8 1.9 2.5 0.6

* Malaria blood tests reportedly administered in the previous seven days: 268 public health facilities; 679 community health workers; 83 private not for-profit health facilities; 929 private for-profit health facilities; 84 pharmacies; 437 drug stores

Categories 1 through 2 sum to 100% in within each column. A total of 2,588 malaria blood tests were audited. Of these, 108 audited tests were not included in market share calculations due to incomplete or inconsistent information.

Manufacturer was not captured for 45 RDTs audited.




Table A13: Provider case management knowledge and practices, by outlet type




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

Proportion of providers who: %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Would refer a 2 year old child with symptoms of severe malaria to a health facility

- N=899 - N=899 - N=463 N=1904 N=2367 N=3266

Yes, would refer to health facility

n/a 97.0 n/a 97.0 n/a 91.7 77.5 77.8 84.9

(93.0, 98.7) (93.0, 98.7) (84.2, 95.8) (73.6, 81.0) (73.9, 81.2) (80.5, 88.4)

Would recommend that a client with a negative malaria blood test take an antimalarial

N=280 N=852 N=52 N=1184 N=948 N=445 N=1809 N=3202 N=4386

Yes – sometimes 58.9 8.8 55.8 14.4 54.0 65.7 38.0 42.2 32.9

(48.5, 68.6) (4.9, 15.4) (39.6, 70.9) (9.3, 21.6) (48.5, 59.5) (53.3, 76.4) (34.2, 42.0) (38.6, 46.0) (28.0, 38.2)

Yes – always 4.5 0.5 5.1 1.0 6.6 3.2 4.2 4.7 3.5

(1.6, 11.8) (0.2, 1.7) (1.3, 18.4) (0.5, 2.2) (4.4, 9.7) (1.6, 6.4) (3.1, 5.7) (3.6, 6.1) (2.6, 4.6)

Circumstances cited for recommending antimalarial treatment to a client who tested negative for malaria:*

N=164 N=81 N=31 N=276 N=602 N=265 N=788 N=1655 N=1931

Patient has signs and symptoms of malaria.

93.9 98.6 100.0 97.5 95.9 94.7 93.6 94.3 94.8

(80.7, 98.3) (91.8, 99.8) - (93.0, 99.1) (93.5, 97.5) (88.3, 97.7) (90.4, 95.8) (92.1, 96.0) (92.8, 96.2)

When the patient asks for antimalarial treatment.

23.7 4.6 24.4 13.5 25.5 26.8 16.4 19.4 18.6

(14.9, 35.5) (1.3, 15.2) (10.2, 48.1) (7.8, 22.4) (18.5, 34.0) (14.4, 44.4) (13.1, 20.5) (15.8, 23.7) (15.2, 22.5)

Provider doesn't trust the test results.

3.3 9.3 0.0 5.9 4.9 8.8 6.5 6.1 6.1

(0.9, 10.9) (4.5, 17.9) - (3.1, 11.0) (2.8, 8.5) (3.4, 20.6) (4.7, 9.0) (4.5, 8.2) (4.6, 8.1)

Other (all other reasons) 13.9 35.4 25.3 27.4 17.7 13.8 19.5 18.8 20.0

(7.2, 25.3) (20.3, 54.1) (9.3, 52.7) (17.9, 39.5) (13.4, 23.0) (8.1, 22.3) (15.1, 24.8) (15.2, 23.1) (16.6, 24.0)

Provider questions were administered to one staff member working in each outlet eligible for a full interview (current/recent antimalarial-stocking outlets or outlets providing malaria blood testing). * No providers were missing information on circumstances for recommending antimalarials to clients who tested negative for malaria.




Table A14: Provider antimalarial treatment knowledge and practices, by outlet type




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of providers who: N=280 N=899 N=53 N=1232 N=962 N=463 N=1904 N=3329 N=4561 Correctly state the national first-line treatment for uncomplicated

malaria

94.3 82.3 88.7 83.3 84.5 90.7 84.1 84.3 84.0

(88.3, 97.3) (69.8, 90.3) (74.9, 95.3) (72.1, 90.7) (78.4, 89.1) (85.6, 94.1) (80.1, 87.5) (80.5, 87.5) (78.9, 88.0)

Correctly state the first-line dosing regimen for:

An adult 93.4 59.2 84.9 62.6 82.3 87.5 82.1 82.2 75.6

(87.5, 96.7) (47.1, 70.3) (70.9, 92.9) (50.8, 73.0) (75.9, 87.2) (80.7, 92.1) (78.0, 85.6) (78.3, 85.6) (69.0, 81.2)

A two-year old child 91.2 65.7 76.2 67.8 75.8 83.8 75.1 75.4 72.9

(85.1, 94.9) (51.9, 77.3) (60.9, 86.8) (55.1, 78.4) (70.0, 80.8) (76.2, 89.3) (71.1, 78.7) (71.7, 78.8) (66.9, 78.1)

Report an ACT as the most effective antimalarial medicine for:

Adults 96.7 78.7 90.3 80.4 85.2 94.4 84.9 85.1 83.5

(94.0, 98.3) (72.5, 83.8) (79.0, 95.8) (74.6, 85.1) (80.6, 88.9) (89.2, 97.2) (81.6, 87.6) (82.1, 87.7) (80.1, 86.4)

Children 97.0 97.7 94.5 97.5 81.7 87.4 82.0 82.0 87.2

(93.3, 98.7) (96.0, 98.6) (83.8, 98.3) (95.8, 98.5) (75.1, 86.8) (80.0, 92.3) (77.7, 85.6) (77.7, 85.6) (83.7, 90.0)

Report an ACT as the antimalarial he/she most commonly recommends for:

Adults 98.5 60.6 93.4 64.5 87.5 97.2 87.2 87.4 79.7

(96.5, 99.4) (49.0, 71.1) (83.8, 97.5) (53.0, 74.5) (83.5, 90.7) (91.0, 99.2) (83.9, 89.9) (84.4, 89.9) (72.6, 85.4)

Children 96.9 97.9 88.5 97.5 81.8 92.7 82.0 82.1 87.3

(92.7, 98.7) (96.1, 98.9) (75.7, 95.0) (95.7, 98.5) (75.2, 86.9) (86.5, 96.2) (77.1, 86.0) (77.5, 85.9) (83.6, 90.2)

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was Uganda’s first line treatment for uncomplicated malaria. Numbers of providers (N) in this table are the total number of providers eligible for table indicators. The number of providers with missing information include: 37 providers were missing information on the national first-line treatment, the first-line dosing regimen for adults and children, 34 providers and 35 providers were missing information on the most effective antimalarial medicine for adults and children and on the most often recommended antimalarial for adults and children, respectively.




Results Section B: Core Indicators across Urban/Rural Location

Table B1: Availability of antimalarials, among all screened outlets, by outlet type, across urban/rural sub-counties




Facility

ALL Public /

Not- For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


Urban N=137 Rural N=145










Urban 97.4 7.5 99.4 12.3 91.9 98.4 95.3 94.2 49.5

(87.5, 99.5) (2.3, 21.8) (95.7, 99.9) (6.2, 25.3) (87.5, 94.8) (96.2, 99.4) (93.5, 96.6) (92.6, 95.4) (37.3, 61.7)

Rural 97.8 11.7 97.2 12.6 94.3 97.1 92.7 93.0 28.1

(92.8, 99.3) (5.8, 22.0) (82.4, 99.6) (6.6, 22.6) (90.5, 96.7) (95.2, 98.2) (89.9, 94.8) (90.6, 94.8) (20.7, 36.8)

Any ACT

Urban 95.1 7.4 99.4 12.7 86.3 98.1 87.3 87.4 46.3

(86.6, 98.3) (2.2, 21.8) (95.7, 99.9) (6.0, 25.1) (80.9, 90.4) (95.9, 99.1) (82.9, 90.7) (84.1, 90.0) (34.4, 58.6)

Rural 92.0 11.6 95.7 12.5 74.2 97.1 78.0 77.4 25.0

(84.9, 95.9) (5.8, 22.0) (83.6, 99.0) (6.6, 22.5) (63.7, 82.4) (95.2, 98.2) (73.5, 82.0) (72.7, 81.5) (18.2, 33.4)

AL

Urban 95.1 7.4 99.4 12.7 78.5 97.9 85.2 83.2 44.4

(86.6, 98.3) (2.2, 21.8) (95.7, 99.9) (6.0, 25.1) (69.4, 85.4) (95.7, 99.0) (80.4, 89.0) (78.8, 86.8) (32.8, 56.7)

Rural 92.0 11.6 95.7 12.5 71.6 97.1 77.0 76.1 24.8

(84.9, 95.9) (5.8, 22.0) (83.6, 99.0) (6.6, 22.5) (61.7, 79.8) (95.2, 98.2) (72.3, 81.1) (71.3, 80.3) (17.9, 33.1)

ASAQ

Urban 1.3 0.0 3.2 0.1 31.0 60.6 22.9 27.4 12.4

(0.4, 4.7) - (0.5, 17.1) (0.0, 0.4) (24.4, 38.6) (48.1, 72.0) (17.8, 29.0) (22.9, 32.2) (8.7, 17.2)

Rural 1.6 0.0 10.1 0.1 21.7 47.2 12.5 14.1 2.8

(0.4, 6.3) - (3.5, 26.0) (0.0, 0.2) (14.8, 30.7) (29.2, 66.1) (9.8, 15.8) (11.2, 17.7) (2.1, 3.7)

DHA PPQ

Urban 2.2 0.0 22.1 0.4 40.0 97.1 30.1 36.4 16.6

(0.9, 5.5) - (7.0, 51.7) (0.2, 1.0) (33.2, 47.1) (94.2, 98.5) (23.3, 38.0) (30.8, 42.3) (12.1, 22.3)

Rural 0.5 0.0 6.7 0.0 20.9 95.6 7.9 10.4 2.0

(0.1, 3.5) - (1.8, 22.5) (0.0, 0.1) (13.3, 31.2) (90.6, 98.0) (5.6, 11.2) (7.0, 15.1) (1.2, 3.3)


Urban 95.1 7.4 95.9 12.7 73.3 95.1 81.7 79.2 42.6

(86.6, 98.3) (2.2, 21.8) (82.3, 99.2) (6.0, 25.0) (65.0, 80.3) (91.4, 97.2) (77.8, 85.1) (74.9, 82.0) (32.0, 53.9)







Facility

ALL Public /

Not- For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)











Rural 92.0 11.6 92.7 12.5 65.5 92.6 69.0 68.5 23.3

(84.9, 95.9) (5.8, 22.0) (79.7, 97.6) (6.5, 22.5) (56.1, 73.9) (86.3, 96.2) (63.8, 73.8) (63.4, 73.2) (16.9, 31.2)


Urban 11.1 2.8 37.1 3.7 70.4 92.5 77.5 75.5 36.0

(5.5, 21.3) (0.5, 13.3) (14.5, 67.1) (1.1, 11.5) (63.0, 76.9) (86.7, 95.9) (73.3, 81.3) (71.3, 79.3) (27.3, 45.7)

Rural 10.3 2.3 41.1 2.6 64.1 91.1 64.9 64.9 14.6

(5.0, 20.0) (1.0, 5.5) (23.8, 61.0) (1.2, 5.7) (54.3, 72.8) (81.5, 96.0) (59.0, 70.5) (59.0, 70.3) (11.5, 18.4)


Urban 94.5 4.8 65.0 9.8 8.7 20.1 6.9 8.1 9.1

(86.1, 97.9) (1.1, 19.0) (36.8, 85.6) (4.3, 20.8) (6.1, 12.3) (11.6, 32.6) (4.5, 10.5) (6.0, 10.7) (5.4, 14.9)

Rural 90.6 9.3 64.2 10.0 5.1 24.6 5.4 5.4 9.1

(83.1, 94.9) (4.0, 20.1) (42.0, 81.7) (4.6, 20.4) (2.7, 9.4) (14.4, 38.7) (4.1, 7.2) (4.1, 7.1) (4.6, 17.3)

QA AL

Urban 95.1 7.4 95.9 12.7 66.1 93.4 78.6 74.7 40.5

(86.6, 98.3) (2.2, 21.8) (82.3, 99.2) (6.0, 25.0) (56.1, 74.9) (88.5, 96.3) (74.2, 82.5) (69.5, 79.2) (30.6, 51.3)

Rural 92.0 11.6 90.9 12.5 61.5 91.1 67.1 66.2 22.8

(84.9, 95.9) (5.8, 22.0) (77.8, 96.6) (6.5, 22.5) (52.6, 69.7) (81.5, 96.0) (61.8, 72.1) (61.0, 71.1) (16.5, 30.7)


Urban 10.2 0.0 27.9 0.9 56.8 97.7 47.0 52.6 24.1

(4.1, 23.3) - (10.5, 56.0) (0.4, 1.9) (49.9, 63.5) (95.3, 98.9) (39.2, 55.0) (46.3, 58.9) (17.1, 32.9)

Rural 0.5 0.0 13.4 0.1 34.8 97.1 25.1 26.9 5.3

(0.1, 3.5) (0.0, 0.1) (5.7, 28.7) (0.0, 0.2) (25.5, 45.4) (95.2, 98.2) (20.5, 30.3) (21.7, 32.9) (3.7, 7.5)

Nationally Registered ACT

Urban 95.1 3.7 99.4 9.3 82.1 98.0 78.0 80.2 41.2

(86.6, 98.3) (0.9, 14.2) (95.7, 99.9) (4.8, 17.2) (76.5, 86.6) (95.8, 99.0) (70.7, 83.8) (74.4, 85.0) (30.3, 53.0)

Rural 92.0 4.2 94.2 5.1 68.2 97.1 66.8 67.1 17.1

(84.9, 95.9) (1.6, 10.3) (79.5, 98.5) (2.4, 10.6) (57.6, 77.2) (95.2, 98.2) (61.9, 71.4) (62.0, 71.8) (12.7, 22.5)

Any non-artemisinin therapy

Urban 94.1 0.2 82.8 5.7 84.6 97.2 89.4 88.0 42.7

(86.9, 97.5) (0.0, 1.0) (59.5, 94.0) (3.4, 9.3) (77.4, 89.8) (94.3, 98.6) (85.7, 92.2) (85.1, 90.4) (32.8, 53.1)







Facility

ALL Public /

Not- For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)











Rural 84.7 0.0 94.0 0.9 89.7 97.1 80.3 82.0 16.6

(74.8, 91.2) - (81.1, 98.3) (0.7, 1.3) (84.7, 93.2) (95.2, 98.2) (75.1, 84.7) (77.3, 85.9) (13.0, 20.8)

Sulfadoxine-Pyrimethamine

Urban 87.6 0.2 62.3 5.1 47.3 83.0 58.0 55.1 27.6

(77.8, 93.4) (0.0, 1.0) (39.0, 81.0) (2.9, 8.8) (36.9, 58.0) (76.0, 88.2) (51.6, 64.1) (48.8, 61.2) (20.1, 36.6)

Rural 73.4 0.0 69.6 0.8 49.6 78.4 41.7 43.2 8.9

(64.6, 80.6) - (51.3, 83.2) (0.5, 1.1) (42.4, 56.8) (58.6, 90.4) (34.4, 49.4) (36.2, 50.3) (6.5, 12.1)

Oral Quinine

Urban 72.4 0.0 82.2 4.5 60.5 94.6 82.3 74.9 36.1

(60.2, 81.9) - (59.4, 93.6) (2.7, 7.4) (54.4, 66.3) (88.7, 97.5) (77.3, 86.5) (70.4, 78.9) (28.2, 44.9)

Rural 43.9 0.0 86.3 0.7 71.5 89.9 72.5 72.3 14.5

(26.9, 62.4) - (70.7, 94.2) (0.5, 1.0) (62.9, 78.7) (83.7, 93.9) (67.0, 77.4) (67.2, 77.0) (11.3, 18.4)


Urban 1.1 0.0 0.0 0.0 7.6 53.8 16.7 14.9 6.7

(0.3, 3.3) - - (0.0, 0.2) (4.4, 13.1) (42.3, 64.9) (11.6, 23.3) (11.3, 19.3) (5.0, 8.9)

Rural 0.0 0.0 1.7 0.0 10.6 50.9 8.4 8.8 1.7

- - (0.2, 12.0) (0.0, 0.1) (6.3, 17.3) (27.8, 73.6) (6.4, 10.8) (7.1, 11.0) (1.2, 2.4)


Urban 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -

Rural 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -


Urban 75.6 0.7 65.2 5.0 53.2 84.9 14.9 31.6 17.0

(63.5, 84.6) (0.2, 2.2) (36.9, 85.7) (2.9, 8.7) (45.9, 60.4) (76.9, 90.5) (8.5, 24.7) (26.0, 37.9) (12.4, 22.8)

Rural 65.9 0.2 60.0 0.9 42.1 77.0 9.5 15.3 3.6

(51.6, 77.9) (0.1, 0.7) (38.6, 78.2) (0.6, 1.3) (33.7, 51.0) (68.0, 84.0) (7.1, 12.8) (12.3, 18.9) (2.7, 4.9)








Facility

ALL Public /

Not- For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)











Urban 77.8 0.7 83.3 5.4 78.8 89.7 22.8 45.9 23.6

(65.9, 86.4) (0.2, 2.2) (54.3, 95.4) (3.1, 9.2) (72.3, 84.1) (83.3, 93.9) (14.4, 34.2) (38.7, 53.0) (17.4, 31.1)

Rural 70.1 0.2 78.7 1.0 78.5 88.3 25.5 34.8 7.5

(55.8, 81.3) (0.1, 0.7) (58.3, 90.7) (0.6, 1.5) (72.1, 83.8) (81.0, 93.1) (21.4, 30.2) (30.7, 39.1) (5.8, 9.6)

Artesunate IV/IM #

Urban 64.4 0.0 55.9 3.8 26.5 64.7 6.7 16.2 9.4

(50.2, 76.4) - (27.9, 80.5) (2.1, 6.8) (20.3, 33.6) (53.1, 74.7) (2.6, 16.4) (12.3, 21.0) (7.0, 12.4)

Rural 38.5 0.0 37.3 0.4 13.3 56.6 0.7 3.0 0.9

(21.8, 58.4) - (19.6, 59.2) (0.2, 0.8) (8.7, 19.9) (46.4, 66.3) (0.3, 1.5) (1.9, 4.8) (0.6, 1.4)

Artemether IV/IM

Urban 4.6 0.0 26.2 0.6 42.2 74.1 13.1 26.1 12.1

(1.2, 15.8) - (9.9, 53.4) (0.3, 1.2) (34.1, 50.9) (63.2, 82.6) (7.8, 21.0) (20.3, 32.5) (8.5, 16.8)

Rural 1.1 0.0 25.2 0.1 34.5 63.4 8.9 13.4 2.7

(0.3, 3.6) - (12.5, 44.3) (0.1, 0.3) (27.6, 42.2) (54.0, 71.9) (6.5, 12.2) (10.6, 16.9) (1.9, 3.8)

Quinine IV/IM

Urban 21.8 0.0 69.8 2.0 64.3 79.7 18.0 37.3 17.9

(12.9, 34.4) - (44.9, 86.8) (1.2, 3.4) (52.3, 74.8) (68.9, 87.4) (10.1, 30.0) (30.0, 45.3) (12.7, 24.6)

Rural 27.6 0.0 71.5 0.5 70.0 77.7 20.7 29.3 6.1

(11.3, 53.4) - (51.7, 85.5) (0.3, 0.9) (62.7, 76.4) (68.1, 85.1) (17.1, 24.8) (25.8, 33.0) (4.7, 7.8)

Rectal Artesunate

Urban 20.9 0.7 9.6 1.7 2.2 4.7 0.8 1.4 1.6

(12.1, 33.7) (0.2, 2.2) (2.3, 32.3) (0.8, 3.5) (1.1, 4.1) (2.6, 8.3) (0.2, 2.9) (0.8, 2.5) (0.9, 2.7)

Rural 43.2 0.2 8.0 0.5 0.9 8.8 0.3 0.4 0.5

(32.2, 54.9) (0.1, 0.7) (2.3, 24.4) (0.3, 0.8) (0.4, 2.4) (5.2, 14.3) (0.1, 1.0) (0.2, 0.9) (0.3, 0.8)








Table B2: Availability of antimalarials, among all outlets stocking at least one antimalarial, by outlet type, across urban/rural sub-counties




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets* stocking: Urban N=134 Rural N=141









Any ACT

Urban 97.7 97.7 100.0 98.0 94.0 99.6 91.6 92.8 93.5

(91.9, 99.4) (83.3, 99.7) - (92.3, 99.5) (90.4, 96.3) (98.0, 99.9) (86.9, 94.7) (89.3, 95.2) (90.6, 95.6)

Rural 94.1 99.9 98.5 99.6 78.6 100.0 84.2 83.2 89.1

(87.5, 97.3) (98.9, 100.0) (89.7, 99.8) (98.9, 99.8) (67.0, 86.9) - (80.5, 87.2) (79.0, 86.8) (85.6, 91.8)

AL

Urban 97.7 97.7 100.0 98.0 85.4 99.5 89.4 88.4 89.8

(91.9, 99.4) (83.3, 99.7) - (92.5, 99.5) (77.7, 90.8) (98.1, 99.8) (84.4, 92.9) (84.0, 91.7) (86.1, 92.6)

Rural 94.1 99.9 98.5 99.6 75.9 100.0 83.0 81.8 88.2

(87.5, 97.3) (98.9, 100.0) (89.7, 99.8) (98.9, 99.8) (65.0, 84.3) - (79.3, 86.2) (77.5, 85.5) (84.5, 91.2)

ASAQ

Urban 1.3 0.0 3.3 0.8 33.8 61.6 24.0 29.1 25.0

(0.4, 4.8) - (0.5, 17.2) (0.3, 2.4) (26.0, 42.6) (48.9, 72.9) (18.5, 30.5) (24.2, 34.5) (20.0, 30.7)

Rural 1.6 0.0 10.4 0.5 23.0 48.7 13.4 15.2 9.9

(0.4, 6.4) - (3.6, 26.7) (0.2, 1.6) (15.6, 32.6) (29.9, 67.8) (10.6, 16.9) (12.1, 19.0) (7.4, 13.1)

DHA PPQ

Urban 2.3 0.0 22.2 3.2 43.5 98.6 31.6 38.6 33.5

(0.9, 5.6) - (7.0, 52.0) (1.1, 8.7) (36.0, 51.3) (96.8, 99.4) (24.4, 39.9) (32.5, 44.9) (26.6, 41.1)

Rural 0.5 0.0 6.9 0.3 22.1 98.4 8.6 11.1 7.2

(0.1, 3.6) (0.0, 0.2) (1.8, 23.0) (0.1, 1.1) (14.1, 33.0) (92.7, 99.7) (6.1, 11.9) (7.5, 16.2) (4.7, 11.1)


Urban 97.7 97.7 96.4 97.6 79.8 96.6 85.8 84.1 86.1

(91.9, 99.4) (83.3, 99.7) (82.4, 99.4) (92.2, 99.3) (72.3, 85.7) (93.8, 98.2) (81.8, 89.0) (79.8, 87.6) (82.0, 89.3)

Rural 94.1 99.9 95.4 99.4 69.5 95.4 74.4 73.6 82.9

(87.5, 97.3) (98.9, 100.0) (82.8, 98.9) (98.6, 99.8) (58.9, 78.3) (90.2, 97.9) (69.5, 78.8) (68.5, 78.2) (78.5, 86.6)


Urban 11.4 37.2 37.3 28.7 76.7 93.9 81.3 80.2 72.7

(5.6, 21.8) (6.6, 83.2) (14.6, 67.5) (9.2, 60.6) (70.0, 82.2) (89.1, 96.7) (77.3, 84.8) (76.2, 83.7) (65.6, 78.8)

Rural 10.6 20.0 42.3 20.6 67.9 93.9 70.0 69.7 52.0

(5.2, 20.5) (7.0, 45.3) (24.2, 62.8) (8.0, 43.5) (56.9, 77.2) (84.5, 97.7) (64.3, 75.2) (63.8, 75.1) (39.5, 64.3)








Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)










Urban 97.0 64.2 65.4 75.7 9.5 20.4 7.3 8.6 18.3

(91.6, 99.0) (20.5, 92.6) (37.0, 85.9) (44.6, 92.4) (6.7, 13.4) (11.7, 33.3) (4.7, 11.0) (6.4, 11.5) (12.3, 26.4)

Rural 92.6 80.1 66.1 80.0 5.4 25.3 5.8 5.8 32.6

(85.7, 96.4) (54.6, 93.1) (44.0, 82.9) (56.8, 92.4) (2.8, 9.9) (14.6, 40.2) (4.4, 7.8) (4.4, 7.6) (20.0, 48.3)

QA AL

Urban 97.7 97.7 96.4 97.6 72.0 94.9 82.5 79.3 81.9

(91.9, 99.4) (83.3, 99.7) (82.4, 99.4) (92.2, 99.3) (63.1, 79.4) (90.8, 97.2) (78.1, 86.2) (74.4, 83.4) (77.4, 85.7)

Rural 94.1 99.9 93.5 99.4 65.2 93.9 72.4 71.2 81.4

(87.5, 97.3) (98.9, 100.0) (81.1, 98.0) (98.4, 99.7) (55.2, 74.0) (84.5, 97.7) (67.4, 77.0) (66.0, 75.9) (76.8, 85.2)


Urban 10.5 0.0 28.1 6.7 61.9 99.3 49.3 55.9 48.7

(4.2, 23.9) - (10.6, 56.4) (2.7, 15.4) (54.3, 69.0) (98.0, 99.8) (40.8, 57.9) (49.0, 62.5) (39.7, 57.9)

Rural 0.5 0.1 13.8 0.7 36.9 100.0 27.1 29.0 18.8

(0.1, 3.6) (0.0, 0.7) (5.8, 29.4) (0.3, 1.7) (27.1, 47.8) - (22.3, 32.4) (23.5, 35.1) (14.0, 24.7)

Nationally Registered ACT

Urban 97.7 48.6 100.0 71.2 89.4 99.5 81.8 85.2 83.2

(91.9, 99.4) (10.1, 88.9) - (2.1, 92.8) (83.6, 93.3) (98.0, 99.9) (74.2, 87.6) (78.8, 89.9) (73.4, 89.9)

Rural 94.1 35.9 96.9 40.8 72.3 100.0 72.1 72.1 60.9

(87.5, 97.3) (17.4, 59.9) (80.7, 99.6) (22.7, 61.8) (60.5, 81.6) - (67.6, 76.1) (67.3, 76.6) (50.5, 70.3)


Urban 96.7 2.1 83.2 43.7 92.1 98.7 93.8 93.4 86.2

(92.8, 98.5) (0.2, 17.2) (59.3, 94.4) (20.7, 69.8) (86.8, 95.4) (97.2, 99.4) (90.3, 96.1) (91.1, 95.1) (76.9, 92.1)

Rural 86.6 0.0 96.7 7.5 95.0 100.0 86.6 88.1 59.0

(78.1, 92.2) (0.0, 0.2) (85.3, 99.3) (3.9, 14.0) (91.5, 97.2) - (81.9, 90.2) (84.0, 91.2) (46.2, 70.7)


Urban 89.9 2.1 62.7 39.1 51.5 84.3 60.8 58.5 55.7

(80.8, 95.0) (0.2, 17.2) (39.1, 81.4) (19.0, 63.9) (40.8, 62.0) (77.4, 89.4) (54.3, 67.0) (52.0, 64.7) (49.5, 61.8)

Rural 75.0 0.0 71.6 6.0 52.6 80.8 45.0 46.4 31.8

(66.7, 81.8) (0.0, 0.2) (52.6, 85.1) (3.1, 11.2) (45.4, 59.7) (58.0, 92.8) (37.5, 52.7) (39.4, 53.6) (24.6, 40.0)

Oral Quinine

Urban 74.3 0.0 82.7 34.7 65.9 96.1 86.4 79.5 73.0

(62.3, 83.5) - (59.3, 94.0) (17.1, 57.8) (60.6, 70.8) (91.5, 98.2) (80.9, 90.5) (74.7, 83.6) (64.7, 79.9)







Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)










Rural 44.8 0.0 88.8 5.5 75.7 92.6 78.2 77.8 51.7

(27.6, 63.4) (0.0, 0.2) (72.7, 95.9) (2.7, 10.9) (67.4, 82.5) (87.6, 95.6) (73.0, 82.6) (73.0, 82.0) (41.0, 62.2)


Urban 1.1 0.0 0.0 0.4 8.3 54.7 17.5 15.8 13.6

(0.3, 3.4) - - (0.1, 1.3) (4.7, 14.3) (43.0, 65.9) (12.2, 24.5) (12.0, 20.5) (10.3, 17.7)

Rural 0.0 0.0 1.8 0.1 11.2 52.4 9.0 9.5 6.1

- - (0.2, 12.3) (0.0, 0.6) (6.7, 18.3) (27.8, 75.9) (7.0, 11.5) (7.6, 11.8) (4.5, 8.2)


Urban 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -

Rural 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -


Urban 77.6 8.7 65.6 38.7 57.9 86.3 15.6 33.6 34.3

(65.6, 86.3) (5.6, 13.4) (37.0, 86.0) (22.4, 58.1) (49.3, 66.1) (78.8, 91.4) (8.9, 25.9) (27.7, 40.1) (28.0, 40.8)

Rural 67.4 1.8 61.8 6.9 44.6 79.3 10.3 16.4 13.0

(53.2, 79.0) (0.6, 5.5) (39.2, 80.2) (3.5, 13.1) (35.6, 54.0) (69.8, 86.4) (7.7, 13.7) (13.3, 20.2) (9.9, 16.8)


Urban 79.9 8.7 83.7 41.5 85.8 91.2 23.9 48.7 47.7

(68.1, 88.1) (5.6, 13.4) (54.1, 95.7) (23.7, 61.9) (79.4, 90.4) (85.3, 94.8) (15.1, 35.7) (41.5, 55.9) (40.6, 54.8)

Rural 71.7 1.8 81.0 7.9 83.2 91.0 27.6 37.4 26.7

(57.6, 82.5) (0.6, 5.5) (59.3, 92.6) (4.0, 14.8) (76.0, 88.6) (85.1, 94.7) (23.1, 32.5) (33.2, 41.8) (21.3, 33.0)

Rectal Artesunate

Urban

21.5 8.7 9.6 13.2 2.3 4.8 0.8 1.5 3.2

(12.4, 34.5) (5.6, 13.4) (2.3, 32.5) (8.6, 19.8) (1.2, 4.4) (2.6, 8.4) (0.2, 3.0) (0.9, 2.7) (2.2, 4.6)

Rural 44.1 1.8 8.3 3.7 1.0 9.0 0.3 0.4 1.6

(33.2, 55.7) (0.6, 5.5) (2.4, 25.0) (1.8, 7.6) (0.4, 2.6) (5.3, 14.9) (0.1, 1.1) (0.2, 1.0) (1.0, 2.7)

Artesunate IV/IM #

Urban 66.1 0.0 56.2 29.0 28.8 65.7 7.0 17.2 18.9

(51.6, 78.1) - (28.1, 80.9) (14.7, 49.1) (21.9, 36.9) (54.2, 75.6) (2.7, 17.2) (13.1, 22.3) (14.7, 23.9)

Rural 39.3 0.0 38.4 3.2 14.1 58.3 0.8 3.2 3.2

(22.4, 59.3) - (19.9, 61.0) (1.3, 7.7) (9.1, 21.3) (47.7, 68.3) (0.4, 1.6) (2.0, 5.1) (2.1, 4.8)







Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)










Artemether IV/IM

Urban 4.7 0.0 26.3 4.5 46.0 75.2 13.7 27.7 24.4

(1.3, 16.2) - (9.9, 53.7) (1.8, 10.8) (37.2, 55.1) (64.6, 83.5) (8.2, 22.0) (21.9, 34.5) (18.6, 31.3)

Rural 1.1 0.0 26.0 1.1 36.6 65.3 9.6 14.5 9.6

(0.3, 3.7) - (12.9, 45.3) (0.5, 2.8) (29.2, 44.7) (55.8, 73.7) (7.0, 13.1) (11.5, 18.0) (7.1, 12.9)

Quinine IV/IM

Urban 22.4 0.0 70.2 15.3 70.1 81.0 18.9 39.7 36.1

(13.3, 35.2) - (44.9, 87.3) (8.0, 27.3) (57.5, 80.2) (70.3, 88.4) (10.6, 31.4) (32.0, 47.8) (28.8, 44.2)

Rural 28.3 0.0 73.6 4.2 74.2 80.1 22.3 31.5 21.6

(11.6, 54.2) - (52.8, 87.5) (1.9, 9.1) (66.1, 80.9) (70.5, 87.1) (18.5, 26.7) (27.9, 35.4) (17.0, 27.1)

* Antimalarial-stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet. The denominator includes 68 outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).







Table B4: Antimalarial market composition, across urban/rural location





Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

% % % % % % % %

Urban, N= 1,406 outlets 3.8 7.7 1.5 13.0 29.6 7.1 50.3 87.0

(2.5, 5.7) (2.5, 21.1) (0.9, 2.6) (6.6, 24.0) (22.0, 38.6) (4.7, 10.5) (41.6, 58.9) (76.0, 93.4)

Rural, N= 2,501 outlets 7.2 31.2 1.4 39.8 10.5 0.2 49.5 60.2

(5.5, 9.3) (19.3, 46.2) (0.9, 2.2) (28.3, 52.6) (7.6, 14.3) (0.1, 0.8) (39.2, 59.9) (47.4, 71.7)





Table B5a: Price of tablet formulation antimalarials, by outlet type, across urban/rural location

Private

For-Profit Facility


Private



Median [IQR]


Median [IQR]


Median [IQR]


Any ACT

Urban $3.20 $2.91 $1.94 $2.15

[1.62-4.85] (1,388) [1.29-4.85] (3,645) [1.29-3.23] (1,487) [1.29-3.88] (6,520)

Rural $1.94 $3.88 $1.62 $1.62

[1.29-3.23] (964) [2.26-6.46] (513) [1.29-2.26] (2,227) [1.29-2.59] (3,704)

AL

Urban $2.15 $1.62 $1.45 $1.62

[1.62-3.23] (820) [0.97-2.59] (1,592) [0.97-1.94] (976) [1.29-2.59] (3,388)

Rural $1.62 $2.59 $1.62 $1.62

[1.29-2.26] (572) [1.62-3.23] (236) [1.16-1.94] (1,647) [1.29-1.94] (2,455)

ASAQ

Urban $2.59 $1.29 $1.94 $1.94

[1.62-5.17] (266) [0.81-2.59] (368) [0.97-3.23] (212) [0.97-3.88] (846)

Rural $1.94 $1.62 $1.94 $1.94

[1.29-3.88] (171) [0.97-3.88] (47) [0.97-3.88] (292) [1.13-3.88] (510)

DHA-PPQ

Urban $4.85 $3.88 $4.85 $4.85

[3.88-5.82] (258) [3.23-4.85] (1,047) [3.23-4.85] (234) [3.23-4.85] (1,539)

Rural $4.85 $4.85 $4.36 $4.85

[3.23-4.85] (200) [3.88-6.14] (143) [3.23-4.85] (244) [3.23-4.85] (587)


Urban $1.94 $1.29 $1.45 $1.62

[1.55-3.23] (802) [0.97-1.94] (1,276) [0.97-1.94] (919) [1.08-2.33] (2,997)

Rural $1.62 $1.94 $1.55 $1.62

[1.29-2.59] (563) [1.29-3.23] (191) [1.13-1.94] (1,527) [1.16-1.94] (2,281)




Table B5a: Price of tablet formulation antimalarials, by outlet type, across urban/rural location

Private

For-Profit Facility


Private



Median [IQR]


Median [IQR]


Median [IQR]


Urban $1.94 $1.29 $1.45 $1.62

[1.62-3.23] (741) [0.97-1.62] (1,067) [0.97-1.94] (879) [1.08-2.33] (2,687)

Rural $1.62 $1.62 $1.55 $1.62

[1.29-2.59] (539) [1.29-2.59] (162) [1.13-1.94] (1,423) [1.16-1.94] (2,124)


Urban $1.94 $5.82 $1.29 $1.29

[0.86-3.23] (60) [1.94-8.08] (208) [1.13-1.62] (39) [1.13-2.59] (307)

Rural $1.55 $8.08 $1.45 $1.55

[1.29-1.94] (24) [4.85-8.08] (29) [0.97-1.62] (94) [0.97-1.62] (147)


Urban $4.85 $3.88 $3.56 $3.88

[3.23-5.17] (586) [2.91-6.21] (2,369) [2.26-4.85] (568) [2.59-4.85] (3,523)

Rural $3.23 $4.85 $2.33 $2.59

[1.94-4.85] (401) [3.23-9.31] (322) [1.62-3.88] (700) [1.62-4.20] (1,423)


Urban $0.65 $0.48 $0.48 $0.48

[0.48-0.97] (335) [0.32-0.65] (518) [0.48-0.65] (415) [0.48-0.65] (1,268)

Rural $0.65 $0.65 $0.48 $0.48

[0.48-0.65] (270) [0.48-0.65] (69) [0.48-0.65] (707) [0.48-0.65] (1,046)

Oral Quinine

Urban $4.07 $2.72 $2.72 $2.72

[2.72-4.07] (231) [2.72-3.39] (338) [2.72-4.07] (350) [2.72-4.07] (919)

Rural $3.39 $3.39 $3.39 $3.39

[2.72-4.07] (223) [2.72-4.07] (46) [2.72-4.07] (766) [2.72-4.07] (1,035)


At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. Figures in this table are derived using audited products with price information. The numbers of antimalarials captured in audit sheets with missing price and/ or product information are as follows: 219 any ACT tablet, 63 AL tablet, 96 QA ACT tablet, 84 QA ACT with the 'green leaf' logo tablet, 11 QA ACT without the 'green leaf' logo tablet, 123 non-Quality Assured ACT tablet, 40 SP tablet. Source: ACTwatch Outlet Survey, Uganda, 2015.



Table B5b: Price of pre-packaged antimalarials, by outlet type, across urban/rural location

Private

For-Profit Facility


Private

Median price of one pre-packaged therapy:

Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Adult QA AL

Urban $1.62 $1.29 $1.45 $1.62

[1.55-2.59] (386) [0.97-1.62] (586) [0.97-1.62] (476) [1.29-1.94] (1,448)

Rural $1.62 $1.62 $1.62 $1.62

[1.29-1.94] (278) [1.55-2.59] (84) [1.29-1.94] (793) [1.29-1.94] (1,155)

Pediatric QA AL *

Urban $0.81 $0.32 $0.32 $0.48

[[0.48-1.29] (50) [0.32-0.81] (111) [0.32-0.48] (58) [0.32-0.65] (219)

Rural $0.48 $0.65 $0.32 $0.39

[0.32-0.81] (34) [0.48-1.13] (23) [0.19-0.48] (115) [0.19-0.48] (172)

* Pediatric QA AL is the pre-packaged regimen appropriate for a 2 year old child. Figures in this table are derived using audited products with price information. The numbers of antimalarials captured in audit sheets with missing price information are as follows:

45 adult AL, 8 child QA AL




Table B6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across urban/rural location




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets** stocking Urban N=136 Rural N=144










Urban 98.2 66.9 100.0 79.8 78.8 51.0 24.3 44.4 50.0

(95.3, 99.3) (49.8, 80.5) - (69.8, 86.1) (71.1, 84.8) (42.8, 59.1) (20.2, 28.9) (39.6, 49.2) (45.2, 54.6)

Rural 91.8 57.4 94.7 59.9 61.6 55.0 19.8 27.0 40.0

(79.5, 97.0) (32.7, 78.9) (83.2, 98.5) (36.5, 79.4) (50.3, 71.7) (44.0, 65.5) (15.9, 24.3) (22.8, 31.6) (28.7, 52.5)


Urban 71.8 0.0 78.6 29.8 51.2 0.6 1.5 18.8 20.6

(58.3, 82.3) - (42.5, 94.8) (12.0, 55.5) (39.7, 62.6) (0.2, 1.6) (0.3, 7.6) (14.8, 23.6) (15.9, 26.1)

Rural 34.8 0.0 59.1 3.2 31.0 0.0 1.0 6.1 5.0

(25.0, 46.2) - (39.0, 76.5) (1.7, 5.9) (23.7, 39.4) - (0.6, 1.8) (4.5, 8.4) (3.7, 6.6)


Urban 80.6 66.9 89.5 73.3 48.3 51.0 23.0 33.0 39.4

(67.5, 89.2) (49.8, 80.5) (65.5, 97.5) (63.3, 81.4) (41.7, 54.9) (42.8, 59.1) (19.3, 27.3) (28.3, 38.0) (33.5, 45.5)

Rural 83.3 57.4 85.4 59.3 47.1 55.0 19.0 23.9 37.9

(62.4, 93.7) (32.7, 78.9) (62.1, 95.4) (36.1, 78.9) (37.1, 57.4) (44.0, 65.5) (15.3, 23.4) (20.1, 28.1) (26.7, 50.7)

* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked antimalarials in the previous 3 months. ** Results in this table are derived using responses captured among outlets with blood testing information. 19 antimalarial-stocking outlet was missing information about both availability of microscopy

and availability of RDTs. 20 antimalarial-stocking outlet had partial information about blood testing availability and are included in the denominator of the indicator “any blood testing available.”




Table B8: Price of malaria blood testing, by outlet type, across urban/rural location

Private

For-Profit Facility


Private

Total median price to consumers:* Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]



Adult

Urban $0.97 $1.62 $0.65 $0.97

[0.65-0.97] (257) [0.97-1.62] (8) [0.65-0.65] (6) [0.65-0.97] (271)

Rural $0.65 - $0.65 $0.65

[0.65-0.97] (152) - [0.32-0.97] (13) [0.65-0.97] (165)

Child under age five

Urban $0.97 $1.62 $0.65 $0.97

[0.65-0.97] (257) [0.97-1.62] (8) [0.65-0.65] (6) [0.65-0.97] (271)

Rural $0.65 - $0.97 $0.65

[0.65-0.97] (153) - [0.32-1.62] (12) [0.65-0.97] (165)


Adult

Urban $0.97 $0.97 $0.81 $0.97

[0.81-0.97] (281) [0.32-0.97] (39) [0.65-0.97] (133) [0.65-0.97] (453)

Rural $0.81 $0.97 $0.65 $0.81

[0.65-0.97] (232) [0.97-0.97] (5) [0.65-0.97] (257) [0.65-0.97] (494)

Child under five

Urban $0.97 $0.97 $0.65 $0.97

[0.81-0.97] (281) [0.32-0.97] (39) [0.65-0.97] (133) [0.65-0.97] (453)

Rural $0.65 $0.97 $0.65 $0.65

[0.48-0.97] (233) [0.97-0.97] (5) [0.65-0.97] (258) [0.65-0.97] (496)

* Total price to the consumer including consultation and/or service fees. Microscopic blood testing price information was not available (missing or “don’t know” response) for: 257 adult RDTs, 7 child RDTs, 5 adult microscopy tests, 5 child microscopy tests




Table B9.1: Antimalarial market share, urban

AETDs sold or distributed in the previous week by outlet type and antimalarial type as a percentage of all AETDs sold/ distributed:*




Facility

TOTAL Public / Not

For-Profit

Private For-Profit


TOTAL Private


% % % % % % % % %

1. Any ACT 20.3 1.1 1.4 22.8 13.2 14.3 21.3 48.8 71.6

AL 20.3 1.1 1.1 22.5 8.7 8.4 16.4 33.5 56.0

ASAQ 0.0 0.0 0.0 0.0 1.9 1.7 2.2 5.9 5.9

DHA PPQ 0.0 0.0 0.3 0.3 2.4 3.7 2.4 8.6 8.9








Oral Quinine 0.1 0.0 0.1 0.2 1.0 0.8 1.5 3.3 3.5




Artesunate IV/IM # 0.3 0.0 0.0 0.3 0.2 0.2 0.1 0.5 0.8


* A total of 32472.389 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.


At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. ^ Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine # At the time of the 2015 Uganda ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria. Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column. A total of 9,717 antimalarials were audited. Of these, 380 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information.




Table B9.2: Antimalarial market share, rural





Facility

TOTAL Public / Not

For-Profit

Private For-Profit


TOTAL Private


% % % % % % % % %

1. Any ACT 34.9 3.4 2.5 40.8 6.2 0.5 20.7 27.4 68.2

AL 34.9 3.4 2.4 40.7 5.0 0.3 19.0 24.2 64.9

ASAQ 0.0 0.0 0.1 0.1 0.6 0.0 1.3 2.0 2.0

DHA PPQ 0.0 0.0 0.0 0.1 0.6 0.1 0.4 1.1 1.2








Oral Quinine 5.6 0.0 0.3 5.8 0.8 0.0 2.9 3.6 9.5




Artesunate IV/IM # 0.3 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.4


* A total of 42,277.225 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.


At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. ^ Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine # At the time of the 2015 Uganda ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria. Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column. A total of 10,414 antimalarials were audited. Of these, 179 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information.




Table B10.1: Antimalarial market share across outlets, urban





Facility

TOTAL Public / Not-

For-Profit

Private For-Profit


TOTAL Private

% % % % % % % %

1. Any ACT 79.7 99.1 82.9 80.7 65.6 67.8 69.7 68.0

AL 79.6 99.1 67.0 79.6 43.4 39.8 53.6 46.7

ASAQ 0.1 0.0 0.1 0.1 9.6 8.1 7.3 8.2

DHA PPQ 0.0 0.0 15.8 0.9 12.1 17.7 8.0 12.0








Oral Quinine 0.4 0.0 3.1 0.6 5.0 3.9 5.0 4.6




Artesunate IV/IM # 1.1 0.0 1.5 1.1 1.2 0.9 0.3 0.7

* AETDs reportedly sold or distributed in the previous seven days: 4696.003 public health facilities; 391.41667 community health workers; 715.85464 private not for-profit health facilities; 9411.2769 private for-profit health facilities; 8864.4269 pharmacies; 8393.4114 drug stores. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. ^ Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine # At the time of the 2015 Uganda ACTwatch outlet survey, artesunate IV/IM was the first-line treatment for severe malaria. Categories 1 through 4 sum to 100% within each column. A total of 9,717 antimalarials were audited. Of these, 380 audited antimalarials were not included in market share calculations due to due to incomplete or inconsistent information, including the following number of antimalarials by outlet type: 12 public health facilities; 0 community health workers; 20 private not for-profit health facilities; 121 private for profit health facilities; 175 pharmacies; 52 drug stores.




Table B10.2: Antimalarial market share across outlets, rural





Facility

TOTAL Public / Not-

For-Profit

Private For-Profit


TOTAL Private

% % % % % % % %

1. Any ACT 70.2 99.9 60.5 71.3 61.5 79.1 64.5 64.0

AL 70.2 99.9 57.6 71.0 49.0 50.3 59.2 56.7

ASAQ 0.0 0.0 1.4 0.1 6.2 3.6 4.2 4.7

DHA PPQ 0.1 0.0 1.1 0.1 6.1 21.4 1.1 2.6








Oral Quinine 11.2 0.0 6.1 10.2 7.7 1.3 8.9 8.5




Artesunate IV/IM # 0.6 0.0 0.3 0.6 0.3 0.3 0.0 0.1

* AETDs reportedly sold or distributed in the previous seven days: 17043.039 public health facilities; 1161.9688 community health workers; 1482.4772 private not for-profit health facilities; 7349.042 private for-profit health facilities; 1168.1897 pharmacies; 14,070.008 drug stores. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria. # Other non-artemisinin therapies include: Amodiaquine, Atovaquone-proguanil, Chloroquine, Hydroxychloroquine sulphate, Mefloquine, Primaquine Categories 1 through 4 sum to 100% within each column. A total of 10,414 antimalarials were audited. Of these, 179 audited antimalarials were not included in market share calculations due to due to incomplete or inconsistent information, including the following number of antimalarials by outlet type: 24 public health facilities; 2 community health workers; 14 private not for-profit health facilities; 43 private for-profit health facilities; 16 pharmacies; 80 drug stores




Table B13: Provider case management knowledge and practices, by outlet type, across urban/rural location




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets


(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Would refer a 2 year old child with symptoms of severe malaria to a health facility

- Urban N=120 Rural N=779

- Urban N=120 Rural N=779

- Urban N=409

Rural N=54 Urban N=607 Rural N=1297



Yes, would refer to health facility

Urban n/a 91.9 n/a 91.9 n/a 91.0 86.1 86.4 87.2

(70.9, 98.1) (69.9, 98.2) (82.6, 95.6) (82.0, 89.4) (82.6, 89.5) (82.2, 91.0)

Rural n/a 97.4 n/a 97.4 n/a 97.0 74.5 74.5 84.3

(93.1, 99.1) (93.1, 99.1) (95.0, 98.2) (69.7, 78.7) (69.8, 78.7) (78.7, 88.7)

Would recommend that a client with a negative malaria blood test take an antimalarial










Yes – sometimes

Urban 58.1 7.5 76.1 30.1 55.8 65.2 41.8 47.8 44.9

(43.3, 71.6) (3.4, 15.7) (54.0, 89.7) (16.3, 48.8) (47.5, 63.7) (51.0, 77.1) (34.7, 49.2) (42.1, 53.5) (38.1, 51.8)

Rural 60.0 9.0 48.0 12.2 52.4 70.3 36.7 39.5 28.7

(45.3, 73.0) (4.7, 16.3) (28.4, 68.3) (7.2, 19.7) (44.6, 60.0) (51.2, 84.3) (32.2, 41.4) (35.0, 44.3) (23.4, 34.7)

Yes – always

Urban 5.6 0.0 0.0 1.8 9.7 3.6 6.0 7.2 6.3

(1.4, 20.3) - - (0.4, 8.4) (6.3, 14.8) (1.8, 7.2) (3.6, 9.8) (4.8, 10.7) (4.2, 9.6)

Rural 3.0 0.6 7.1 0.9 3.5 0.0 3.5 3.5 2.5

(1.2, 7.6) (0.2, 1.9) (1.7, 24.9) (0.4, 2.2) (1.9, 6.3) - (2.3, 5.4) (2.5, 5.0) (1.7, 3.5)

Circumstances cited for recommending antimalarial treatment to a client who tested negative for malaria:*










Patient has signs and symptoms of malaria.

Urban 89.4 100.0 100.0 93.3 95.5 94.3 93.7 94.5 94.4

(67.9, 97.1) - - (77.5, 98.2) (92.2, 97.4) (86.9, 97.6) (88.8, 96.6) (90.9, 96.8) (91.0, 96.6)

Rural 99.7 98.5 100.0 98.9 96.5 98.0 93.5 94.2 95.0

(98.0, 100.0) (91.1, 99.8) - (93.8, 99.8) (91.5, 98.6) (90.3, 99.6) (89.2, 96.2) (91.0, 96.4) (92.3, 96.8)



Table B13: Provider case management knowledge and practices, by outlet type, across urban/rural location




Facility

ALL Public / Not-

For-Profit

Private For-Profit


ALL Private

ALL Outlets


(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

When the patient asks for antimalarial treatment.

Urban 4.3 27.9 - 6.5 6.3 8.8 9.4 8.0 7.9

(0.9, 17.9) (18.5, 39.7) - (2.3, 17.1) (3.0, 12.7) (3.1, 22.4) (5.9, 14.6) (5.4, 11.8) (5.4, 11.4)

Rural 2.0 7.9 - 5.7 3.4 8.8 5.3 4.9 5.0

(0.3, 13.8) (3.5, 16.9) - (2.6, 12.3) (1.6, 7.1) (1.0, 47.5) (3.4, 8.4) (3.2, 7.6) (3.3, 7.6)

Provider doesn't trust the test results.

Urban 26.1 6.2 - 17.4 25.2 29.4 15.1 20.2 19.9

(12.7, 46.1) (0.6, 43.4) - (7.8, 34.3) (14.3, 40.5) (15.7, 48.3) (10.4, 21.4) (13.7, 28.7) (13.8, 27.7)

Rural 20.5 4.5 37.4 12.1 25.7 7.3 17.0 19.0 17.8

(12.5, 31.8) (1.1, 16.5) (15.1, 66.7) (6.0, 23.2) (19.0, 33.8) (1.6, 27.4) (12.8, 22.3) (14.9, 23.9) (14.0, 22.4)

Other (all other reasons)

Urban 17.1 26.7 38.2 23.3 21.7 10.7 27.9 24.4 24.3

(7.0, 36.3) (16.1, 40.7) (13.9, 70.2) (12.5, 39.0) (15.8, 29.1) (5.3, 20.2) (19.6, 38.0) (18.3, 31.7) (19.1, 30.3)

Rural 9.7 36.0 18.4 28.9 13.0 37.2 16.0 15.4 17.6

(4.4, 20.2) (19.8, 56.2) (2.8, 64.2) (17.1, 44.5) (8.1, 20.2) (20.6, 57.5) (11.5, 21.8) (11.6, 20.2) (13.4, 22.9)

Provider questions were administered to one staff member working in each outlet eligible for a full interview (current/recent antimalarial-stocking outlets or outlets providing malaria blood testing). * No providers were missing information on circumstances for recommending antimalarials to clients who tested negative for malaria.




Table B14: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location




Facility

ALL Public / Not

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of providers who: Urban N=136 Rural N=144









Correctly state the national first-line

treatment for uncomplicated malaria

Urban 93.1 81.5 93.6 86.2 87.7 91.3 81.3 84.0 84.3

(81.9, 97.6) (47.2, 95.6) (64.4, 99.2) (66.5, 95.2) (80.0, 92.8) (85.6, 94.9) (73.8, 87.1) (78.7, 88.1) (78.3, 88.9)

Rural 96.0 82.3 86.8 82.9 81.2 85.9 85.1 84.5 83.9

(91.6, 98.1) (68.7, 90.9) (68.7, 95.2) (70.0, 91.0) (71.0, 88.5) (75.3, 92.4) (80.2, 89.0) (79.2, 88.6) (77.1, 88.9)

Correctly state the first-line dosing regimen for an adult

Urban 92.5 69.7 80.1 77.8 85.5 87.9 80.4 82.5 81.7

(81.8, 97.2) (40.2, 88.8) (51.1, 93.9) (60.0, 89.1) (76.9, 91.2) (80.0, 92.9) (72.7, 86.3) (77.1, 86.8) (75.8, 86.5)

Rural 94.6 58.3 86.8 60.5 79.2 84.4 82.7 82.1 73.5

(88.7, 97.5) (45.5, 70.0) (68.7, 95.2) (47.8, 71.8) (68.8, 86.7) (74.9, 90.8) (77.6, 86.8) (76.6, 86.5) (65.0, 80.5)

Correctly state the first-line dosing regimen for a child

Urban 90.6 73.4 69.8 78.4 78.5 85.7 74.6 76.4 76.7

(79.5, 96.0) (42.9, 91.1) (38.9, 89.3) (59.8, 89.9) (69.3, 85.5) (77.5, 91.3) (67.7, 80.5) (71.2, 81.0) (70.6, 81.9)

Rural 92.0 65.0 78.6 66.4 73.1 68.3 75.3 74.9 71.5

(86.2, 95.5) (50.2, 77.4) (60.0, 90.0) (52.2, 78.1) (64.9, 80.0) (58.8, 76.5) (70.3, 79.7) (69.9, 79.4) (63.8, 78.2)

Report an ACT as the most effective antimalarial medicine for an adult

Urban 98.6 73.3 83.7 82.2 85.8 94.6 86.1 86.3 85.7

(95.9, 99.5) (47.0, 89.5) (54.1, 95.7) (66.1, 91.6) (79.6, 90.3) (88.7, 97.5) (81.0, 90.0) (82.1, 89.6) (81.1, 89.3)

Rural 94.3 79.2 92.7 80.1 84.7 92.9 84.4 84.5 82.8

(88.3, 97.3) (72.6, 84.5) (80.4, 97.5) (73.8, 85.3) (76.9, 90.2) (70.7, 98.6) (80.3, 87.8) (80.4, 87.9) (78.4, 86.4)

Report an ACT as the most effective antimalarial medicine for a child



Table B14: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location




Facility

ALL Public / Not

For-Profit

Private For-Profit


ALL Private

ALL Outlets

%

(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Urban 98.2 94.2 85.8 94.7 86.8 87.2 83.5 84.8 86.3

(88.7, 99.7) (80.3, 98.5) (53.6, 97.0) (85.5, 98.1) (81.7, 90.7) (79.0, 92.5) (76.0, 88.9) (79.5, 88.9) (80.8, 90.4)

Rural 95.5 98.0 97.8 97.9 76.7 89.2 81.5 80.7 87.5

(90.2, 98.0) (96.1, 98.9) (90.6, 99.5) (96.2, 98.8) (64.9, 85.4) (65.7, 97.2) (76.0, 85.9) (74.6, 85.5) (83.0, 90.9)

Report an ACT as the antimalarial he/she most commonly recommends for adults

Urban 99.1 57.2 93.5 73.7 86.8 96.8 87.7 87.7 85.5

(96.8, 99.8) (47.7, 66.1) (68.7, 98.9) (59.8, 84.0) (82.1, 90.3) (89.7, 99.1) (81.4, 92.0) (83.6, 90.9) (80.7, 89.2)

Rural 97.7 60.9 93.3 63.2 88.2 100.0 87.0 87.3 77.7

(93.3, 99.3) (48.0, 72.4) (80.7, 97.9) (50.4, 74.4) (80.9, 93.0) - (82.9, 90.3) (83.1, 90.5) (68.4, 84.9)

Report an ACT as the antimalarial he/she most commonly recommends for children

Urban 98.1 93.6 73.1 93.1 87.4 92.2 83.3 85.1 86.4

(89.2, 99.7) (79.2, 98.3) (42.6, 90.9) (83.2, 97.3) (83.1, 90.7) (85.0, 96.1) (74.1, 89.7) (79.3, 89.5) (80.6, 90.6)

Rural 95.3 98.3 94.3 98.1 76.2 96.9 81.5 80.7 87.6

(88.3, 98.2) (96.1, 99.3) (79.7, 98.6) (96.1, 99.0) (64.2, 85.2) (85.9, 99.4) (75.4, 86.4) (74.2, 85.8) (82.9, 91.1)

At the time of the 2015 Uganda ACTwatch outlet survey, artemether lumefantrine was Uganda first line treatment for uncomplicated malaria. Numbers of providers (N) in this table are the total number of providers eligible for table indicators. The number of providers with missing information include:

37 providers were missing information on the national first-line treatment, the first-line dosing regimen for adults and children, 34 providers and 35 providers were missing information on the most effective antimalarial medicine for adults and children and on the most often recommended antimalarial for adults and children, respectively.




Results Section C: Core Indicators across Survey Round: 2010, 2011, 2013, 2015

Table C1: Availability of antimalarials, among all screened outlets, by outlet type, across survey round




Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


2010 N=805 2011 N=692 2013 N=703 2015 N=282

2010 N=788 2011 N=1,021 2013 N=3,989 2015 N=5,618

2010 N=35 2011 N=43 2013 N=32 2015 N=55

2010 N=1,628 2011 N=1,756 2013 N=4,724 2015 N=5,955

2010 N=426 2011 N=848 2013 N=410

2015 N=1,023

2010 N=376 2011 N=415 2013 N=471 2015 N=493

2010 N=946 2011 N=1,213 2013 N=1,084 2015 N=1,967

2010 N=7,762 2011 N=11,931 2013 N=1,241 2015 N=n/a

2010 N=15 2011 N=44 2013 N=2

2015 N=n/a

2010 N=9,525 2011 N=14,451 2013 N=3,208 2015 N=3,483

2010 N=11,153 2011 N=16207 2013 N=7,932 2015 N=9,438


2010 96.5 5.0 94.7 18.6 95.8 99.7 88.3 0.3 30.5 13.5 14.1

(93.9, 98.0) (1.0, 21.0) (82.0, 98.6) (10.5, 30.6) (90.4, 98.2) (99.3, 99.9) (83.0, 92.1) (0.1, 0.5) (15.1, 52.0) (11.7, 15.5) (12.4, 16.1)

2011 98.7 10.6 94.1 20.8 94.8 99.6 92.2 0.4 0.0 13.9 14.8

(96.4,99.6) (3.0,31.2) (76.7,98.7) (10.1,38.0) (91.0,97.0) (98.0,99.9) (88.4,94.9) (0.1,0.9) -- (12.4,15.5) (12.8,17.1)

2013 96.6 16.9 90.0 19.9 94.8 99.4 93.9 0.0 0.0 11.8 14.4

(93.6, 98.2) (9.2, 29.0) (68.3, 97.4) (12.0, 31.2) (89.7, 97.4) (97.7, 99.9) (92.0, 95.4) -- - (7.6, 17.9) (10.2, 19.9)

2015 97.6 11.2 97.8 12.6 93.1 98.3 93.4 -- - 93.4 31.7

(93.0, 99.2) (5.9, 20.1) (87.6, 99.6) (7.2, 21.1) (90.4, 95.1) (96.4, 99.2) (91.3, 95.0) -- - (91.8, 94.7) (25.1, 39.2)

Any ACT

2010 86.0 4.6 54.5 15.6 70.7 98.4 43.5 <.1. 12.2 7.3 8.3

(79.9, 90.4) (0.9, 20.8) (37.2, 70.7) (8.5, 26.9) (57.1, 81.3) (93.6, 99.6) (32.6, 55.1) (<0.1, 0.1) (6.4, 22.1) (5.4, 9.8) (6.5, 10.5)

2011 90.7 5.9 81.4 15.5 85.2 99.6 63.5 0.3 0.0 10.4 11.0

(85.7,94.0) (1.7,18.9) (58.8,93.1) (8.1,27.6) (78.9,89.9) (98.0,99.9) (54.6,71.6) (0.1,0.9) -- (8.7,12.4) (9.2,13.1)

2013 91.1 16.1 90.0 19.0 86.0 99.0 75.1 0.0 0.0 9.8 12.7

(85.7, 94.6) (8.8, 27.6) (68.3, 97.4) (11.5, 29.8) (78.2, 91.3) (97.4, 99.7) (69.4, 80.1) -- -- (6.2, 15.0) (8.8, 17.9)

2015 93.8 11.1 96.7 12.5 80.3 97.9 80.4 -- - 80.7 28.7

(89.1, 96.5) (5.9, 20.0) (88.0, 99.1) (7.1, 21.1) (74.2, 85.3) (96.1, 98.9) (76.9, 83.5) -- - (77.3, 83.6) (22.4, 35.9)

AL

2010 85.1 4.5 49.1 15.4 66.8 93.3 41.3 <0.1 12.2 7.1 8.1

(78.9, 89.71) (0.9, 20.6) (34.5, 64.0) (8.4, 26.5) (55.3, 76.6) (89.6, 95.8) (30.9, 52.6) (<0.1, 0.1) (6.4, 22.1) (5.2, 9.5) (6.4, 10.3)

2011 90.7 5.9 81.4 15.5 82.9 99.6 62.2 0.3 0.0 10.0 10.8

(85.7, 94.0) (1.7, 18.9) (58.8, 93.1) (8.1, 27.6) (76.6, 87.8) (98.0, 99.9) (53.3, 70.2) (0.8, 0.9) -- (8.4, 12.0) (9.1, 12.8)

2013 91.1 16.1 90.0 19.0 85.1 99.0 74.4 0.0 0.0 9.7 12.6

(85.7, 94.6) (8.8, 27.6) (68.3, 97.4) (11.5, 29.8) (77.5, 90.4) (97.4, 99.7) (68.7, 79.3) -- - (6.2, 14.9) (8.8, 17.8)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2015 93.8 11.1 96.7 12.5 75.1 97.8 79.1 -- - 78.4 28.2

(89.1, 96.5) (5.9, 20.0) (88.0, 99.1) (7.1, 21.1) (68.5, 80.7) (96.0, 98.8) (75.5, 82.3) -- - (75.0, 81.6) (22.0, 35.3)

ASAQ

2010 0.5 0.0 0.0 0.1 5.5 30.6 1.9 0.0 0.0 0.5 0.4

(0.1, 2.4) -- -- (<0.1, 0.2) (3.5, 8.7) (25.6, 36.1) (1.1, 3.5) -- -- (0.3, 0.8) (0.3, 0.7)

2011 0.2 0.0 11.3 0.3 19.3 57.6 5.7 0.0 0.0 1.5 1.3

(<0.1, 0.7) -- (4.8, 24.6) (0.1, 1.0) (16.2, 22.9) (46.9,67.6) (4.2, 7.8) -- -- (1.1, 2.0) (0.9, 1.9)

2013 0.1 0.0 4.3 0.1 12.0 43.3 6.0 0.0 0.0 1.0 0.7

(0.0, 0.5) (0.0, 0.2) (0.6, 26.5) (0.0, 0.4) (8.7, 16.5) (34.1, 52.9) (4.2, 8.6) -- -- (0.6, 1.6) (0.5, 1.1)

2015 1.4 0.0 8.3 0.1 26.4 59.1 15.2 -- - 18.5 4.4

(0.5, 3.6) - (3.2, 19.7) (0.0, 0.2) (21.6, 32.0) (47.9, 69.5) (12.5, 18.3) -- - (15.7, 21.6) (3.5, 5.6)

DHA PPQ

2010 1.6 0.0 8.2 0.5 20.4 83.6 5.2 0.0 0.0 1.5 1.3

(0.7, 3.4) -- (3.5, 18.2) (0.2, 1.4) (14.9, 27.2) (78.7, 87.5) (2.9, 9.2) -- -- (0.8, 2.6) (0.7, 2.4)

2011 3.7 0.0 11.6 0.6 21.5 91.4 5.2 0.0 0.0 1.6 1.5

(2.3, 5.9) -- (4.4, 27.6) (0.3, 1.4) (16.8, 27.1) (86.0, 94.9) (3.2, 8.3) -- -- (1.0, 2.5) (0.9, 2.3)

2013 1.8 0.0 14.5 0.2 25.3 90.7 9.2 0.0 0.0 1.8 1.3

(0.7, 4.7) (0.0, 0.2) (6.1, 30.8) (0.1, 0.4) (18.5, 33.4) (78.6, 96.3) (6.6, 12.7) -- - (1.0, 3.1) (0.8, 2.1)

2015 1.5 0.0 10.9 0.1 30.6 96.9 13.7 -- - 18.9 4.5

(0.7, 3.3) - (4.6, 23.5) (0.0, 0.2) (25.2, 36.5) (94.4, 98.3) (10.6, 17.6) -- - (15.3, 23.0) (3.3, 6.2)


2010 84.2 1.9 42.8 12.7 12.9 63.9 8.5 0.0 6.1 1.5 2.9

(77.8, 89.1) (0.5, 7.1) (27.6, 59.5) (7.7, 20.1) (9.6, 17.0) (49.4, 76.2) (5.4, 12.9) -- (3.2, 11.2) (1.0, 2.1) (2.3, 3.5)

2011 90.5 5.9 75.6 15.3 72.8 95.4 55.0 0.3 0.0 9.0 9.8

(85.5, 93.9) (1.6, 18.9) (53.9, 89.1) (8.0, 27.4) (67.9, 77.1) (90.5, 97.8) (47.2, 62.6) (0.1, 0.9) -- (7.6, 10.7) (8.3, 11.6)

2013 91.0 16.0 90.0 18.9 81.6 98.9 71.3 0.0 0.0 9.3 12.3

(85.7, 94.4) (8.8, 27.5) (68.3, 97.4) (11.4, 29.7) (75.2, 86.6) (97.0, 99.6) (65.8, 76.1) -- - (5.9, 14.2) (8.6, 17.4)

2015 93.8 11.1 93.6 12.5 69.5 94.8 72.3 -- - 72.0 26.6

(89.1, 96.5) (5.9, 20.0) (84.2, 97.5) (7.1, 21.0) (63.2, 75.1) (91.6, 96.8) (68.2, 76.0) -- - (68.2, 75.4) (20.8, 33.4)








Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2010 -- -- -- -- -- -- -- -- -- -- --

-- -- -- -- -- -- -- -- -- -- --

2011 82.2 1.2 37.0 9.5 68.2 89.9 50.6 0.3 0.0 8.4 8.4

(76.5, 86.8) (0.3, 5.1) (22.8, 53.8) (5.6, 15.7) (62.3, 73.5) (83.3, 94.2) (42.0, 59.1) (0.1, 0.9) -- (6.9, 10.1) (7.0, 10.0)

2013 39.7 11.0 45.2 12.2 75.6 98.3 65.1 0.0 0.0 8.5 9.7

(31.2, 48.9) (5.3, 21.8) (31.3, 59.8) (6.3, 22.2) (68.5, 81.5) (95.3, 99.4) (59.4, 70.4) -- - (5.4, 13.1) (6.5, 14.2)

2015 10.8 2.4 40.1 2.7 67.3 92.3 68.2 -- - 68.3 18.3

(6.5, 17.3) (1.1, 5.2) (25.5, 56.5) (1.4, 5.3) (61.2, 72.9) (87.3, 95.5) (63.6, 72.5) -- - (64.1, 72.3) (15.0, 22.1)


2010 83.4 1.9 39.1 12.8 12.3 59.6 7.9 0.0 0.0 1.4 2.8

(76.9, 88.3) (0.5, 7.0) (24.5, 55.9) (7.7, 19.9) (9.2, 16.4) (48.1, 70.2) (5.0, 12.3) -- -- (1.0, 2.0) (2.3, 3.5)

2011 4.1 1.9 0.0 2.1 0.3 <0.1 0.7 <0.1 0.0 0.1 0.4

(2.5, 6.8) (0.5, 6.7) -- (0.7, 5.8) (<0.1, 2.1) (<0.1, 1.6) (0.3, 1.5) (<0.1, <0.1) -- (<0.1, 0.2) (0.2, 0.7)

2013 87.1 5.1 70.8 8.1 12.5 31.3 9.9 0.0 0.0 1.4 3.5

(81.5, 91.1) (1.8, 13.5) (48.0, 86.4) (4.2, 15.0) (9.2, 16.7) (20.6, 44.4) (5.8, 16.4) -- -- (0.7, 2.4) (2.1, 5.8)

2015 92.8 8.8 64.5 10.0 6.9 20.6 5.8 -- - 6.3 9.1

(88.0, 95.8) (4.1, 18.1) (46.8, 78.9) (5.1, 18.7) (5.0, 9.5) (12.8, 31.5) (4.6, 7.3) -- - (5.1, 7.7) (5.2, 15.6)

Non-Quality Assured ACT non-QA ACT)

2010 7.7 3.1 34.7 4.6 68.7 98.2 39.7 <0.1 6.1 6.8 6.5

(4.8, 12.2) (0.4, 18.5) (19.1, 54.4) (1.4, 14.3) (54.4, 80.1) (93.5, 99.5) (28.7, 51.9) (<0.1, 0.1) (3.2, 11.2) (4.9, 9.4) (4.7, 9.0)

2011 5.8 <0.1 19.3 1.0 45.2 92.2 20.3 <0.1 0.0 4.5 4.0

(4.0, 8.4) (<0.1, 0.2) (8.0, 39.5) (0.5, 2.2) (34.6, 56.3) (87.2, 95.4) (14.4, 27.9) (<0.1, <0.1) -- (3.1, 6.4) (2.6, 6.0)

2013 3.3 0.2 19.4 0.4 43.0 96.3 18.9 0.0 0.0 3.2 2.3

(1.7, 6.3) (0.1, 0.4) (10.2, 33.8) (0.3, 0.7) (32.5, 54.1) (86.2, 99.1) (14.5, 24.2) -- - (1.9, 5.4) (1.5, 3.6)

2015 6.0 0.0 17.3 0.2 46.0 97.7 30.8 -- - 35.3 8.5

(2.5, 13.6) (0.0, 0.1) (9.3, 30.1) (0.1, 0.3) (39.8, 52.3) (95.6, 98.8) (26.4, 35.6) -- - (30.7, 40.2) (6.5, 11.1)








Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2010 93.4 0.2 94.5 14.0 95.6 98.0 86.3 0.2 24.4 12.8 13.0

(90.8, 95.3) (<0.1, 0.8) (81.5, 98.5) (8.6, 22.0) (90.0, 98.1) (96.2, 99.0) (81.1, 90.2) (0.1, 0.5) (12.3, 42.5) (11.2, 14.7) (11.6, 14.6)

2011 94.6 <0.1 94.0 11.0 91.7 99.1 87.8 0.1 0.0 12.9 12.6

(92.0, 96.3) (0.0, 0.2) (76.5, 98.7) (6.4,18.3)

(88.1, 94.3) (97.4, 99.7) (83.5, 91.1) (0.1, 0.3) -- (11.4,14.5) (11.0,14.4)

2013 83.3 0.2 85.9 3.4 90.1 99.1 87.2 0.0 0.0 11.0 8.6

(77.2, 88.0) (0.1, 0.4) (67.9, 94.6) (2.7, 4.3) (84.7, 93.8) (96.7, 99.8) (83.5, 90.2) -- - (7.1, 16.8) (6.3, 11.7)

2015 90.0 0.0 91.0 1.5 87.1 97.2 82.7 -- - 83.9 21.1

(84.8, 93.6) (0.0, 0.1) (80.1, 96.2) (1.2, 1.9) (83.0, 90.4) (94.7, 98.5) (78.7, 86.0) -- - (80.7, 86.7) (17.4, 25.3)


2010 82.6 0.1 68.2 11.8 66.3 74.1 48.5 0.1 0.0 7.6 8.2

(78.8, 85.9) (<0.1, 0.9) (49.9, 82.2) (7.2, 18.9) (57.8, 73.8) (68.7, 78.8) (40.0, 57.1) (<0.1, 0.2) -- (6.3, 9.2) (6.9, 9.6)

2011 87.8 <0.1 70.4 9.8 58.8 78.8 44.0 <0.1 0.0 7.1 7.4

(84.3, 90.6) (<0.1, 0.2) (56.7, 81.2) (5.8, 16.1) (52.7, 64.7) (71.1, 84.8) (35.4, 52.9) (<0.1, 0.1) -- (5.8, 8.7) (6.1, 8.9)

2013 80.0 0.1 50.0 3.0 55.8 85.8 44.3 0.0 0.0 6.0 5.0

(73.9, 84.9) (0.0, 0.4) (35.8, 64.3) (2.4, 3.8) (47.1, 64.1) (76.9, 91.6) (36.3, 52.7) -- - (3.7, 9.4) (3.6, 7.1)

2015 81.4 0.0 67.6 1.3 48.5 82.5 45.9 -- - 47.1 12.1

(75.0, 86.5) (0.0, 0.1) (53.1, 79.3) (1.0, 1.7) (42.1, 54.8) (76.3, 87.3) (40.3, 51.7) -- - (42.0, 52.1) (9.6, 15.3)

Oral Quinine

2010 40.4 0.0 78.0 7.3 82.8 86.7 76.8 0.2 24.4 11.7 11.1

(34.9, 46.1) (64.8, 87.2) (4.3, 12.0) (79.2, 85.8) (78.7, 92.0) (71.4, 81.4) (0.1, 0.4) (12.3, 42.5) (10.1, 13.4) (9.8, 12.6)

2011 41.3 0.0 70.4 5.5 78.4 97.3 79.8 0.1 0.0 11.6 10.6

(36.3, 46.5) -- (47.8, 86.1) (3.3,9.2) (73.3, 82.7) (94.2, 98.8) (74.5, 84.2) (<0.1, 0.3) -- (10.2,13.2) (9.2, 12.2)

2013 32.2 0.2 73.5 1.7 72.5 97.3 77.9 0.0 0.0 9.6 7.1

(26.4, 38.5) (0.1, 0.3) (44.8, 90.4) (1.3, 2.2) (66.5, 77.7) (93.4, 99.0) (73.3, 81.8) -- -- (6.2, 14.7) (5.2, 9.7)

2015 59.9 0.0 85.2 1.2 65.9 94.1 75.0 -- - 73.2 18.2

(50.1, 69.1) - (73.1, 92.4) (0.9, 1.5) (60.7, 70.8) (89.1, 96.8) (70.8, 78.9) -- - (69.5, 76.6) (15.0, 22.0)


2010 0.0 0.0 3.2 0.1 0.2 5.0 0.1 0.0 0.0 0.0 0.0

-- -- (0.4, 22.3) (<0.1, 0.8) (<0.1, 0.9) (3.4, 7.4) (<0.1, 0.6) -- -- (<0.1, 0.1) (<0.1, 0.1)

2011 0.0 0.0 0.0 0.0 0.1 0 0.0 0.0 0.0 <0.1 <0.1

-- -- -- -- (0.0, 0.8) -- -- -- -- (0.0, <0.1) (0.0,<0.1)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2013 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

-- -- -- -- -- -- -- -- -- -- --

2015 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - - - -


2010 1.2 0.1 17.9 0.8 27.0 61.3 4.1 0.0 0.0 1.5 1.4

(0.4, 3.4) (<0.1, 0.7) (6.0, 42.6) (0.3, 1.9) (20.8, 34.2) (54.6, 67.5) (2.0, 8.4) -- -- (0.9, 2.5) (0.8, 2.4)

2011 4.2 7.5 33.1 7.9 29.0 75.8 4.3 0.0 0.0 1.8 2.6

(2.8, 6.3) (2.1, 23.9) (16.0, 56.1) (2.6,21.4) (24.3, 34.3) (67.2, 82.7) (2.8, 6.6) -- -- (1.2,2.6) (1.7,4.1)

2013 5.4 4.3 20.8 4.5 45.6 72.4 8.0 0.0 0.0 2.2 2.9

(3.4, 8.4) (1.7, 10.6) (9.7, 39.1) (1.8, 10.4) (40.4, 50.9) (61.6, 81.1) (5.3, 12.0) -- -- (1.3, 3.7) (1.7, 4.8)

2015 71.4 0.3 61.4 1.4 47.7 84.0 10.9 -- - 20.6 5.9

(62.7, 78.7) (0.1, 0.6) (44.0, 76.3) (1.0, 1.9) (42.2, 53.3) (77.0, 89.2) (8.2, 14.4) -- - (17.5, 24.1) (4.7, 7.5)


2010 54.8 0.2 75.1 9.0 70.0 71.2 28.4 <0.1 0.0 5.7 6.2

(49.3, 60.2) (<0.1, 0.7) (63.9, 83.7) (5.6, 14.3) (66.9, 72.8) (58.2, 81.4) (23.2, 34.3) (<0.1, 0.1) -- (4.6, 7.2) (5.2, 7.2)

2011 47.9 7.5 77.8 13.0 75.6 87.2 30.1 0.0 0.0 6.4 7.2

(42.5, 53.3) (2.1, 23.9) (44.3, 93.9) (6.0,25.9) (71.7, 79.1) (79.3, 92.4) (24.6, 36.3) -- -- (5.1,7.8) (5.8,8.9)

2013 28.9 4.3 68.2 5.5 77.0 88.2 31.0 0.0 0.0 5.3 5.4

(24.2, 34.1) (1.7, 10.6) (42.0, 86.4) (2.7, 11.0) (72.7, 80.8) (79.3, 93.6) (24.5, 38.3) -- -- (3.3, 8.3) (3.7, 7.7)

2015 74.5 0.3 79.9 1.5 78.6 89.6 24.8 -- - 38.4 10.3

(66.0, 81.5) (0.1, 0.6) (64.0, 89.9) (1.1, 2.1) (74.2, 82.5) (84.0, 93.4) (21.0, 29.1) -- - (34.7, 42.2) (8.3, 12.6)

Artesunate IV/IM

2010 0.0 0.0 0.0 0.0 0.4 2.1 0.0 0.0 0.0 <0.1 0.02

-- -- -- -- (0.2, 1.3)) (1.3, 3.3)) -- -- -- (<0.1,0.1) (<0.1, 0.7)

2011 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 <0.1 <0.1

-- -- -- (0.0,0.0) (0.4, 0.6) (0.0, 0.0) -- -- -- (<0.1, <0.1) (<0.1, <0.1)

2013 3.7 0.0 6.9 0.2 7.1 27.7 0.4 0.0 0.0 0.3 0.3

(2.1, 6.4) - (2.0, 21.1) (0.1, 0.3) (4.4, 11.3) (16.7, 42.2) (0.2, 1.1) -- -- (0.2, 0.5) (0.2, 0.4)

2015 53.1 0.0 42.3 0.8 20.0 63.8 2.3 -- - 7.3 2.3

(42.8, 63.1) - (26.4, 59.9) (0.6, 1.1) (16.1, 24.6) (53.65 72.9) (1.0, 5.1) -- - (5.5, 9.8) (1.8, 3.1)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Rectal AS

2010 0.0 0.1 0.0 0.1 0.0 2.7 0.4 0.0 0.0 0.1 0.1

-- (<0.1, 0.7) -- (<0.1, 0.6) -- (1.3, 5.3) (0.1, 2.8) -- -- (<0.1, 0.3) (<0.1, 0.2)

2011 0.0 1.1 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1

-- (0.3, 4.7) -- (0.2, 4.1) -- -- -- -- -- -- (<0.1, 0.5)

2013 0.9 4.3 3.2 4.1 0.8 1.4 0.1 0.0 0.0 0.0 1.3

(0.3, 3.0) (1.7, 10.6) (0.4, 19.5) (1.6, 10.2) (0.3, 2.3) (0.4, 4.7) (0.0, 0.4) -- -- (0.0, 0.1) (0.5, 3.3)

2015 30.6 0.3 8.5 0.6 1.6 5.1 0.4 -- -- 0.7 0.7

(22.7, 39.9) (0.1, 0.6) (3.3, 20.2) (0.4, 1.0) (0.9, 2.6) (3.1, 8.4) (0.2, 1.0) -- -- (0.5, 1.2) (0.5, 0.9)

* The denominator includes outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).

Source: ACTwatch Outlet Survey, Uganda, 2010, 2011, 2013, 2015.



Table C2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type, across survey round




Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


2010 N=766 2011 N=678 2013 N=684 2015 N=275

2010 N=30 2011 N=84

2013 N=731 2015 N=719

2010 N=31 2011 N=41 2013 N=29 2015 N=53

2010 N=827 2011 N=803

2013 N=1,444 2015 N=1,047

2010 N=389 2011 N=807 2013 N=390 2015 N=956

2010 N=354 2011 N=399 2013 N=454 2015 N=476

2010 N=819 2011 N=1,112 2013 N=1,019 2015 N=1,849

2010 N=16 2011 N=18 2013 N=0

2015 N=n/a

2010 N=5 2011 N=0 2013 N=0

2015 N=n/a

2010 N=1,583 2011 N=2,336 2013 N=1,863 2015 N=3,281

2010 N=2,410 2011 N=3,139 2013 N=3,307 2015 N=4,328

Any ACT

2010 89.1 98.0 57.6 85.8 73.9 98.6 49.5 16.4 20.0 55.7 60.7

(84.3, 92.6) (74.6, 99.9) (37.3, 75.7) (75.3, 92.3) (61.7, 83.3) (92.4, 99.8) (38.2, 60.7) (6.3, 36.2) -- (43.6, 67.1) (50.9, 69.6)

2011 91.8 55.4 86.6 74.7 89.8 100 69.0 75.6 -- 75.6 75.4

(88.0, 94.5) (27.8, 80.0) (71.2, 94.4) (53.7, 88.3) (85.2, 93.1) -- (61.2, 75.8) (38.9, 93.8) -- (67.7,82.1) (68.4,81.3)

2013 94.3 95.4 100.0 95.4 90.7 99.6 80.0 -- -- 82.7 88.3

(90.2, 96.7) (89.4, 98.1) - (90.6, 97.8) (84.8, 94.5) (98.3, 99.9) (74.7, 84.4) -- -- (77.7, 86.7) (84.3, 91.3)

2015 96.1 99.7 98.9 99.4 86.3 99.7 86.1 -- - 86.4 90.3

(92.6, 98.0) (98.7, 99.9) (92.6, 99.8) (98.6, 99.7) (79.6, 91.0) (98.3, 99.9) (83.2, 88.6) -- - (83.3, 89.0) (87.8, 92.3)

AL

2010 89.1 98.1 53.6 85.1 71.8 98.7 48.4 3.8 100.0 54.4 59.5

(84.3, 92.6) (74.6, 99.9) (35.6, 70.6) (74.5, 91.8) (60.3, 81.0) (92.4, 99.8) (37.3, 59.7) (0.7, 17.6) -- (42.7, 65.7) (50.1, 68.3)

2011 91.8 55.4 86.6 74.7 87.4 100 67.5 73.7 -- 73.9 74.0

(88.0, 94.5) (27.8, 80.0) (71.2, 94.4) (53.7, 88.3) (82.7, 90.9) -- (59.7, 74.4) (36.6, 93.1) -- (66.0, 80.5) (67.2, 79.8)

2013 94.3 95.4 100.0 95.4 89.8 99.6 79.2 -- -- 81.9 87.8

(90.2, 96.7) (89.4, 98.1) - (90.6, 97.8) (84.1, 93.6) (98.3, 99.9) (74.0, 83.5) -- -- (77.1, 85.9) (83.9, 90.9)

2015 96.1 99.7 98.9 99.4 80.7 99.5 84.7 -- - 84.0 88.7

(92.6, 98.0) (98.7, 99.9) (92.6, 99.8) (98.6, 99.7) (73.9, 86.0) (98.3, 99.9) (81.8, 87.3) -- - (80.8, 86.7) (85.9, 90.9)

ASAQ

2010 0.5 0.0 0.0 0.3 6.0 32.4 2.3 0.0 0.0 3.6 3.1

(0.1, 2.5) -- -- (0.1, 1.6) (3.8, 9.2) (26.2, 39.3) (1.3, 4.0) -- -- (2.3, 5.6) (2.0, 4.9)

2011 0.2 0.0 12.1 1.4 20.4 58.8 6.2 0.0 -- 10.9 9.1

(<0.1, 0.8) -- (4.7, 27.7) (0.4, 4.9) (17.2, 23.9) (47.2, 67.8) (4.6, 8.4) -- -- (8.5, 14.0) (6.5, 12.4)

2013 0.1 0.2 4.8 0.3 12.7 43.6 6.4 -- -- 8.5 4.9

(0.0, 0.5) (0.0, 1.5) (0.6, 28.9) (0.0, 2.2) (9.1, 17.6) (34.4, 53.1) (4.5, 9.1) -- -- (6.5, 11.1) (3.3, 7.3)

2015 1.4 0.0 8.5 0.5 28.4 60.2 16.2 -- - 19.8 13.9

(0.6, 3.7) - (3.3, 20.0) (0.2, 1.4) (23.0, 34.5) (48.8, 70.5) (13.4, 19.5) -- - (16.8, 23.1) (11.1, 17.3)

DHA PPQ







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2010 1.7 0.0 8.9 2.5 21.9 88.4 6.1 0.0 0.0 11.3 9.8

(0.8, 3.6) -- (3.8, 19.6) (1.0, 6.3) (16.3, 28.7) (79.1, 93.9) (3.4, 10.6) -- -- (6.6, 18.6) (5.6, 16.8)

2011 3.7 0.0 12.4 3.0 22.7 91.8 5.6 0.0 -- 11.7 10.0

(2.3, 6.0) -- (4.7, 28.6) (1.4, 6.5) (18.0, 28.2) (86.5, 95.1) (3.5, 8.9) -- -- (8.0, 16.9) (6.4, 15.3)

2013 1.9 0.3 16.2 1.0 26.6 91.2 9.8 -- -- 15.0 8.9

(0.7, 4.9) (0.1, 1.2) (6.6, 34.6) (0.5, 1.9) (20.0, 34.6) (78.3, 96.8) (7.0, 13.5) -- -- (11.0, 20.2) (6.0, 13.0)

2015 1.5 0.0 11.1 0.7 32.8 98.6 14.7 -- -- 20.2 14.3

(0.7, 3.4) (0.0, 0.2) (4.7, 24.0) (0.3, 1.6) (27.0, 39.2) (97.0, 99.3) (11.4, 18.7) -- -- (16.4, 24.6) (10.9, 18.6)


2010 87.3 40.1 45.5 70.3 13.4 64.1 9.6 3.8 0.0 11.3 21.0

(82.0, 91.3) (18.6, 66.1) (29.1, 62.9) (53.5, 83.0) (10.2, 17.5) (49.4, 76.6) (6.3, 14.5) (0.7, 17.6) -- (8.3, 15.2) (17.7, 24.6)

2011 91.7 55.2 80.4 73.9 76.6 95.8 59.7 73.7 -- 62.5 67.1

(87.9, 94.4) (27.8, 79.8) (62.5, 91.0) (53.3, 87.4) (72.8, 80.1) (90.7, 98.1) (52.6, 66.5) (36.6, 93.1) -- (59.2, 71.3) (61.1, 72.7)

2013 94.2 94.9 100.0 94.9 86.1 99.4 75.9 -- -- 78.6 85.7

(90.1, 96.6) (88.9, 97.7) - (90.2, 97.4) (81.3, 89.8) (98.1, 99.8) (71.0, 80.2) -- -- (74.2, 82.4) (81.7, 89.0)

2015 96.1 99.7 95.7 99.2 74.7 96.5 77.4 -- -- 77.1 83.8

(92.6, 98.0) (98.7, 99.9) (87.2, 98.7) (98.3, 99.6) (68.0, 80.3) (94.0, 97.9) (73.6, 80.9) -- -- (73.3, 80.4) (80.6, 86.6)


2010 -- -- -- -- -- -- -- -- -- -- --

2011 83.3 11.2 39.3 45.7 71.8 90.3 54.9 72.6 -- 60.7 57.7

(78.2, 87.3) (5.0, 23.2) (24.1, 56.8) (29.2, 63.1) (67.0, 76.2) (83.5, 94.5) (46.8, 62.7) (35.4, 92.8) -- (53.4, 67.5) (50.4, 64.7)

2013 41.1 65.3 50.2 61.1 79.7 98.9 69.4 -- -- 72.2 67.4

(32.4, 50.3) (35.7, 86.5) (34.7, 65.6) (37.5, 80.5) (73.7, 84.7) (97.1, 99.6) (63.7, 74.5) -- -- (66.9, 76.9) (55.5, 77.4)

2015 11.0 21.4 41.0 21.6 72.3 93.9 73.0 -- -- 73.2 57.6

(6.7, 17.7) (8.4, 44.6) (25.9, 57.9) (9.6, 41.4) (65.8, 78.0) (89.7, 96.5) (68.6, 77.0) -- -- (69.0, 77.0) (47.2, 67.3)


2010 87.1 40.1 42.6 69.5 13.2 62.9 9.2 0.0 0.0 10.9 20.5

(81.7, 91.2) (18.6, 66.1) (27.2, 59.6) (53.2, 82.0) (10.0, 17.3) (48.3, 75.5) (6.0, 14.0) -- -- (8.0, 14.7) (17.2, 24.2)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2011 4.2 18.0 0.0 10.0 0.3 0.0 0.7 1.0 -- 0.6 2.5

(2.5, 6.9) (5.5, 47.6) -- (4.4, 20.9) (<0.1, 2.3) -- (0.3, 1.7) (0.1, 8.0)

-- (0.3, 1.3) (1.3, 4.6)

2013 90.1 30.0 78.7 40.8 13.2 31.5 10.5 -- -- 11.5 24.3

(85.5, 93.4) (11.3, 59.0) (62.1, 89.2) (22.1, 62.6) (9.7, 17.7) (20.6, 44.8) (6.2, 17.3) -- -- (7.8, 16.6) (15.9, 35.2)

2015 95.1 78.8 65.9 79.5 7.4 21.0 6.2 -- - 6.7 28.8

(91.5, 97.2) (55.6, 91.7) (48.4, 79.9) (59.6, 91.0) (5.4, 10.2) (12.9, 32.2) (4.9, 7.9) -- - (5.5, 8.2) (18.9, 41.1)

Non-Quality Assured ACT non-QA ACT)

2010 8.0 65.9 36.7 25.4 71.8 98.5 45.1 12.6 20.0 52.0 47.6

(5.0, 12.6) (31.7, 89.0) (19.6, 58.1) (10.5, 49.9) (58.7, 82.0) (92.3, 99.7) (33.6, 57.2) (4.5, 30.2) -- (39.3, 64.4) (36.2, 59.4)

2011 6.0 0.2 20.8 5.1 52.6 98.1 25.4 1.9 -- 33.8 28.1

(4.1, 8.8) (0.0, 2.0) (8.9, 41.2) (2.3, 10.6) (41.5, 63.5) (95.1, 99.3) (18.7, 33.4) (0.2, 14.3) -- (24.3, 44.9) (19.2, 39.2)

2013 3.4 1.2 21.6 2.1 45.3 96.9 20.1 -- -- 27.1 16.2

(1.7, 6.5) (0.5, 2.5) (11.2, 37.5) (1.3, 3.5) (35.2, 55.9) (85.0, 99.4) (15.6, 25.6) -- -- (20.6, 34.8) (11.3, 22.6)

2015 6.1 0.1 17.7 1.5 49.4 99.4 33.0 -- - 37.8 26.8

(2.6, 13.9) (0.0, 0.6) (9.5, 30.7) (0.8, 2.8) (42.8, 56.1) (98.2, 99.8) (28.4, 37.9) -- - (33.0, 42.9) (21.6, 32.8)


2010 96.8 4.3 100.0 77.2 99.9 98.3 98.0 12.6 80.0 98.3 94.8

(95.3, 97.9) (0.4, 33.5) -- (42.6, 93.9) (99.5, 100.0)

(96.7, 99.1) (96.4, 98.9) (4.5, 30.2) --

(97.1, 99.0) (85.4, 98.3)

2011 95.8 0.2 100 53.0 96.6 99.5 95.3 42.2 -- 94.6 86.4

(93.7, 97.2) (<0.1, 2.0) -- (27.3,77.2) (95.2, 97.5) (97.9, 99.9) (93.1, 96.9) (21.6, 66.0) -- (92.2,96.3) (74.3,93.3)

2013 86.2 1.2 95.5 17.2 95.1 99.7 92.8 -- -- 93.5 60.1

(80.2, 90.6) (0.6, 2.5) (78.2, 99.2) (10.7, 26.5) (91.8, 97.1) (98.8, 99.9) (90.2, 94.8) -- -- (91.4, 95.1) (47.9, 71.1)

2015 92.3 0.2 93.0 12.2 93.6 98.9 88.5 -- - 89.9 66.3

(88.4, 94.9) (0.0, 1.2) (82.3, 97.5) (7.0, 20.0) (90.7, 95.6) (97.5, 99.5) (85.0, 91.3) -- - (87.2, 92.1) (55.4, 75.8)


2010 85.7 2.3 72.3 65.3 69.3 74.3 55.2 27.0 0.0 58.4 59.5

(81.6, 89.0) (0.1, 29.3) (53.7, 85.5) (39.6, 84.3) (61.8, 75.8) (69.0, 78.9) (47.1, 63.0) (9.2, 57.4) -- (50.5, 66.0) (51.7, 67.0)

2011 88.9 0.2 74.8 47.2 62 79.1 47.8 9.7 -- 51.1 50.7

(85.8, 91.4) (<0.1, 2.0) (57.9, 86.6) (25.3, 70.3) (56.2, 67.4) (71.3, 85.1) (39.2, 56.5) (1.7, 40.9) -- (43.4, 59.6) (43.1, 58.2)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

2013 82.8 0.7 55.6 15.0 58.9 86.3 47.2 -- -- 50.5 35.0

(76.9, 87.4) (0.3, 1.8) (40.5, 69.8) (9.4, 23.3) (51.2, 66.1) (77.6, 92.0) (39.0, 55.6) -- -- (43.1, 57.9) (28.2, 42.4)

2015 83.4 0.2 69.1 10.3 52.1 83.9 49.2 -- - 50.4 38.2

(77.4, 88.1) (0.0, 1.2) (54.2, 80.9) (6.0, 17.0) (45.7, 58.4) (77.6, 88.7) (43.5, 54.9) -- - (45.4, 55.4) (31.9, 45.0)

Oral Quinine

2010 42.3 0.0 85.1 40.2 88.9 91.7 90.0 80.2

80.0 89.5 81.4

(36.6, 48.2) -- (72.3, 92.6) (26.8, 55.4) (84.5, 92.2) (87.0, 94.8) (87.0, 92.3) (50.4,94.2)

-- (86.9, 91.7) (75.9, 85.9)

2011 41.8 0.0 74.9 26.6 82.6 97.7 86.6 25.6 -- 84.3 72.9

(36.8, 47.0) -- (53.6, 88.5) (15.0, 42.8) (78.7, 85.9) (94.5, 99.1) (83.4, 89.3) (14.3, 41.5) -- (81.5, 86.7) (64.5, 79.9)

2013 33.3 0.9 81.6 8.4 76.5 97.9 82.9 -- -- 81.7 49.6

(27.4, 39.7) (0.4, 2.1) (48.5, 95.4) (5.3, 13.1) (70.3, 81.7) (94.6, 99.2) (78.7, 86.4) -- -- (77.9, 85.0) (40.3, 59.0)

2015 61.4 0.0 87.1 9.3 70.8 95.7 80.4 -- - 78.4 57.4

(51.4, 70.5) (0.0, 0.2) (74.8, 93.9) (5.3, 15.8) (65.9, 75.3) (91.8, 97.8) (76.3, 83.8) -- - (74.9, 81.5) (48.4, 66.0)


2010 0.0 0.0 3.3 0.5 0.2 5.0 0.1 0.0 0.0 0.2 0.3

-- -- (0.4, 23.5) (0.1, 4.2) (<0.1, 0.9) (3.4, 7.4) (<0.1, 0.7) -- -- (0.1, 0.4) (0.1, 0.6)

2011 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 -- <0.1 <0.1

-- -- -- -- (0.0, 0.9) -- -- -- -- (<0.1,0.2) (<0.1,0.2)

2013 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -- -- 0.0 0.0

-- -- -- -- -- -- -- -- -- -- --

2015 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - - - -


2010 1.2 2.0 19.0 4.3 28.2 61.4 4.7 0.0 0.0 11.4 10.3

(0.4, 3.6) (0.1, 21.9) (6.2, 45.2) (1.9, 9.4) (22.2, 35.2) (54.9, 67.6) (2.3, 9.3) -- -- (7.1, 18.0) (6.3, 16.3)

2011 4.3 71.0 35.2 37.9 30.6 76.1 4.7 0.0 -- 13.1 18.0

(2.9, 6.3) (53.5, 83.9) (17.8, 57.6) (20.9,58.6) (25.8, 35.8) (67.4, 83.0) (3.0, 7.1) -- -- (9.5,17.8) (12.8,2.7)

2013 5.6 25.5 23.1 22.3 48.1 72.9 8.5 -- -- 18.5 20.2

(3.5, 8.7) (12.5, 44.9) (10.4, 43.7) (11.5, 38.8) (42.1, 54.1) (62.0, 81.5) (5.7, 12.6) -- -- (14.8, 22.8) (14.4, 27.6)

2015 73.2 2.3 62.8 11.0 51.3 85.5 11.7 -- - 22.1 18.7

(64.7, 80.2) (1.0, 5.6) (44.7, 77.9) (6.4, 18.3) (45.1, 57.4) (78.9, 90.3) (8.9, 15.3) -- - (18.8, 25.7) (15.3, 22.8)







Facility

ALL Public / Not

For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


2010 57.4 4.0 81.9 49.9 75.2 75.3 33.3 0.0 0.0 44.1 45.1

(52.0, 62.6) (0.4, 28.6) (66.1, 91.3) (33.7, 66.1) (71.6, 78.4) (64.5, 83.6) (27.3, 39.8) -- -- (38.1, 50.4) (39.5, 50.8)

2011 48.5 71.0 82.8 62.5 79.6 87.5 32.7 0.0 -- 46.2 49.4

(43.1, 54.0) (53.5, 83.9) (54.9, 95.0) (52.2,71.9) (76.5, 82.4) (79.6, 92.7) (26.6, 39.5) -- -- (40.0,52.5) (44.3,54.6)

2013 29.9 25.6 75.8 27.8 81.3 88.8 33.0 -- -- 44.7 37.3

(25.0, 35.3) (12.6, 45.0) (46.9, 91.7) (16.7, 42.6) (76.2, 85.5) (80.1, 94.0) (26.2, 40.5) -- -- (39.5, 50.0) (30.8, 44.3)

2015 76.3 2.3 81.7 12.2 84.5 91.1 26.6 -- - 41.1 32.4

(68.0, 83.0) (1.0, 5.6) (65.1, 91.5) (7.1, 20.2) (79.9, 88.2) (86.0, 94.5) (22.5, 31.1) -- - (37.3, 45.0) (27.1, 38.1)

Injectable AS

2010 0.0 0.0 0.0 0.0 0.5 2.2 0.0 0.0 0.0 0.2 0.1

-- -- -- -- (0.2, 1.3) (1.3, 3.6) -- -- -- (<0.1, 0.6) (<0.1, 0.5)

2011 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 -- <0.1 <0.1

-- -- -- -- (<0.1, 0.7) -- -- -- -- (<0.1, 0.2) (<0.1, 0.2)

2013 3.7 0.0 6.9 0.2 7.1 27.7 0.4 0.0 0.3 0.3 3.7

(2.1, 6.4) - (2.0, 21.1) (0.1, 0.3) (4.4, 11.3) (16.7, 42.2) (0.2, 1.1) - (0.2, 0.5) (0.2, 0.4) (2.1, 6.4)

2015 54.4 0.0 43.3 6.5 21.5 64.9 2.4 -- -- 7.8 7.4

(44.0, 64.5) - (26.8, 61.3) (3.5, 11.7) (17.1, 26.6) (54.7, 73.8) (1.1, 5.5) -- -- (5.8, 10.4) (5.6, 9.7)

Rectal AL

2010 0.0 2.0 0.0 0.4 0.0 2.8 0.4 0.0 0.0 0.4 0.4

-- (0.1, 21.9) -- (0.1, 3.1) -- (1.3, 5.8) (0.1, 3.2) -- -- (0.1, 2.0) (0.1, 1.6)

2011 0.0 10.8 0.0 4.9 0.0 0.0 0.0 0.0 -- 0.0 1.0

-- (3.4, 29.0) -- (1.6, 14.2) -- -- -- -- -- -- (0.3, 3.5)

2013 0.9 25.2 3.5 20.8 0.8 1.4 0.1 -- -- 0.3 9.3

(0.3, 3.1) (12.3, 44.7) (0.5, 21.3) (10.2, 37.9) (0.3, 2.5) (0.4, 4.8) (0.0, 0.4) -- -- (0.1, 0.6) (4.2, 19.2)

2015 31.4 2.3 8.6 5.0 1.7 5.2 0.4 -- -- 0.8 2.1

(23.3, 40.8) (1.0, 5.6) (3.3, 20.6) (2.8, 8.7) (1.0, 2.8) (3.1, 8.6) (0.2, 1.1) -- -- (0.5, 1.3) (1.5, 2.9)

*Antimalarial-stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet. The denominator includes 56 outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).




Table C4: Antimalarial market composition, across survey round





Facility

ALL Public / Not-

For-Profit

Private For-Profit


General Retailer

Itinerant Drug Vendor

ALL Private

% % % % % % % % % %

2010, N=1,434 outlets 10.1 3.6 2.8 16.4 21.3 1.1 59.4 1.5 0.4 83.6

(7.4, 13.6) (0.7, 15.7) (1.5, 5.2) (10.9, 24.1) (12.1, 34.8) (0.5, 2.4) (50.5, 67.7) (0.8, 2.8) (<0.1, 2.5) (75.9, 89.2)

2011, N=2,252 outlets 8.3 8.9 2.2 19.5 22.9 1.6 54.3 1.8 0.0 80.5

(6.1, 11.2) (3.0, 23.9) (1.5, 3.3) (11.8, 30.4) (14.1, 34.8) (1.0, 2.7) (45.4, 62.9) (0.6, 4.8) -- (69.6, 88.2)

2013, N=2,339 outlets 6.3 35.7 1.4 43.3 12.4 1.5 42.8 0.0 0.0 56.7

(4.9, 8.0) (24.6, 48.6) (0.8, 2.4) (32.6, 54.7) (9.5, 16.2) (0.9, 2.5) (33.9, 52.2) -- -- (45.3, 67.4)

2015, N=3,907 outlets 6.3 25.0 1.4 32.8 15.5 2.0 49.7 -- - 67.2

(5.1, 7.8) (15.6, 37.6) (1.0, 2.0) (23.5, 43.7) (12.4, 19.2) (1.3, 3.1) (41.7, 57.7) -- - (56.3, 76.5)





Table C5: Price of tablet formulation antimalarials, by outlet type, across survey round

Private

For-Profit Facility

Pharmacy Drug Store General Retailer Itinerant

Drug Vendor ALL

Private



Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Any ACT

2010 $4.64 $5.57 $3.25 $2.79 $2.32 $3.71

[3.25-6.27] (466) [3.71-9.29] (2,072) [2.32-4.64] (635) [2.79-3.71] (2) [1.86-2.79] (2) [2.79-5.57] (3,177)

2011 $3.13 $3.13 $1.96 $1.17 $- $2.35

[1.96-4.69] (1,758) [1.56-5.87] (3,093) [1.56-3.13] (1,524) [0.94-2.35] (14) [-] (0) [1.56-3.91] (6,389)

2013 $2.62 $2.46 $1.96 - - $1.96

[1.96-3.93] (841) [1.31-3.93] (3,814) [1.57-2.62] (1,602) - - [1.57-3.27] (6,257)

2015 $2.37 $2.66 $1.48 $- $- $1.78

[1.48-3.85] (2,352) [1.48-4.44] (4,158) [1.18-2.37] (3,714) [-] (0) [-] (0) [1.18-2.96] (10,224)

AL

2010 $3.71 $3.71 $3.02 $2.79 $2.32 $3.25

[3.02-4.64] (337) [2.79-4.64] (971) [2.32-3.71] (510) [2.79-3.71] (2) [1.86-2.79] (2) [2.79-4.64] (1,822)

2011 $2.74 $1.96 $1.96 $1.17 $- $1.96

[1.88-3.91] (1,163) [1.04-2.74] (1,480) [1.37-2.82] (1,190) [0.94-2.35] (14) [-] (0) [1.56-3.13] (3,847)

2013 $2.36 $1.64 $1.80 - - $1.96

[1.64-3.27] (620) [1.15-2.46] (2,102) [1.31-2.29] (1,301) - - [1.57-2.62] (4,023)

2015 $1.78 $1.48 $1.42 $- $- $1.48

[1.33-2.84] (1,392) [1.18-2.37] (1,828) [1.04-1.78] (2,623) [-] (0) [-] (0) [1.18-1.78] (5,843)

ASAQ

2010 $3.71 $6.97 $3.25 - - $3.71

[2.32-7.43] (17) [3.71-9.29] (163) [2.79-4.18] (20) - - [2.79-6.97] (200)

2011 $2.74 $1.56 $1.96 $- $- $2.35

[1.56-4.69] (298) [0.78-3.91] (427) [1.17-3.13] (178) [-] (0) [-] (0) [1.17-3.91] (903)

2013 $2.62 $1.64 $1.96 - - $1.96

[1.64-4.91] (77) [0.98-2.62] (274) [1.31-2.62] (109) - - [1.31-3.93] (460)

2015 $1.97 $1.18 $1.78 $- $- $1.78

[1.18-4.44] (437) [0.74-2.37] (415) [0.89-3.26] (504) [-] (0) [-] (0) [0.89-3.55] (1,356)

DHA PPQ




Private

For-Profit Facility


Drug Vendor ALL

Private



Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


2010 $6.79 $6.04 $6.79 - - $6.79

[6.04-7.84] (89) [5.22-6.97] (511) [5.22-7.84] (81) - - [5.22-7.84] (681)

2011 $5.87 $5.09 $5.48 $- $- $5.87

[4.69-6.60] (231) [3.96-5.87] (682) [3.91-7.04] (116) [-] (0) [-] (0) [4.40-6.60] (1,029)

2013 $4.91 $3.93 $4.91 - - $4.91

[3.93-5.89] (123) [3.27-4.91] (860) [3.93-4.91] (153) - - [3.93-4.91] (1,136)

2015 $4.44 $3.55 $4.44 $- $- $4.44

[3.55-4.74] (458) [2.96-4.44] (1,190) [2.96-4.44] (478) [-] (0) [-] (0) [2.96-4.44] (2,126)


2010 $3.71 $6.97 $2.32 - $2.79 $2.79

[2.79-4.64] (55) [3.71-9.29] (429) [1.39-3.25] (98) - (1) [1.39-3.71] (583)

2011 $2.35 $1.56 $1.88 $1.17 $- $1.96

[1.56-3.52] (1,028) [0.78-2.35] (1,251) [1.17-2.54] (999) [0.94-2.35] (13) [-] (0) [1.17-2.82] (3,291)

2013 $2.29 $1.31 $1.64 - - $1.96

[1.64-3.27] (559) [0.98-1.96] (1,685) [1.31-2.29] (1,235) - - [1.31-2.36] (3,479)

2015 $1.78 $1.18 $1.42 $- $- $1.48

[1.18-2.96] (1,365) [0.89-1.78] (1,467) [0.89-1.78] (2,446) [-] (0) [-] (0) [1.04-1.78] (5,278)


2010 $4.64 $3.25 $1.39 - $2.79 $2.79

(1) [2.79-12.07] (6) [1.39-6.97] (3) - (1) [1.39-4.64] (11)

2011 $2.35 $1.17 $1.88 $1.17 $- $1.96

[1.56-3.52] (934) [0.78-1.96] (980) [1.17-2.35] (907) [0.94-2.35] (11) [-] (0) [1.17-2.82] (2,832)

2013 $2.29 $1.31 $1.64 - - $1.96

[1.64-3.27] (498) [0.98-1.96] (1,400) [1.31-2.29] (1,118) - - [1.31-2.36] (3,016)

2015 $1.78 $1.18 $1.42 $- $- $1.48

[1.18-2.96] (1,280) [0.89-1.78] (1,229) [0.89-1.78] (2,302) [-] (0) [-] (0) [1.04-1.78] (4,812)





Private

For-Profit Facility


Drug Vendor ALL

Private



Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


2010 $3.71 $6.97 $2.32 - - $2.79

[2.79-4.64] (54) [3.71-9.29] (423) [1.39-3.25] (94) - - [1.39-3.71] (571)

2011 $2.35 $2.54 $1.96 $0.00 $- $1.96

[1.56-3.91] (93) [1.37-5.87] (271) [1.17-2.74] (92) [0.00-0.00] (2) [-] (0) [1.37-3.13] (458)

2013 $1.96 $1.96 $1.75 - - $1.96

[1.53-2.62] (60) [1.31-2.62] (285) [1.64-2.09] (113) - - [1.60-2.29] (458)

2015 $1.48 $5.92 $1.18 $- $- $1.33

[1.18-2.96] (84) [2.37-7.40] (237) [0.89-1.48] (133) [-] (0) [-] (0) [0.99-1.78] (454)


2010 $4.64 $5.57 $3.34 $2.79 $1.86 $3.71

[3.25-6.27] (411) [3.71-8.36] (1,643) [2.79-4.64] (537) [2.79-3.71] (2) (1) [2.79-5.57] (2,594)

2011 $3.91 $4.69 $3.13 $0.78 $- $3.91

[2.82-5.87] (730) [3.13-7.82] (1,842) [2.35-4.69] (525) (1) [-] (0) [2.74-5.87] (3,098)

2013 $4.91 $3.93 $3.93 - - $3.93

[3.27-5.89] (282) [2.78-7.86] (2,129) [2.62-4.91] (367) - - [2.75-4.91] (2,778)

2015 $3.55 $3.55 $2.96 $- $- $2.96

[2.37-4.44] (987) [2.66-5.92] (2691) [1.48-4.44] (1268) [-] (0) [-] (0) [1.78-4.44] (4,946)

SP

2010 $0.70 $0.70 $0.70 $0.46 - $0.70

[0.70-0.93] (297) [0.49-0.93] (391) [0.42-0.70] (494) [0.42-0.46] (4) - [0.46-0.70] (1,186)

2011 $0.59 $0.59 $0.59 $0.59 $0.59

[0.59-0.78] (529) [0.51-0.59] (369) [0.47-0.78] (616) [0.59-0.78] (3) [0.59-0.78] (1,517)

2013 $0.65 $0.49 $0.49 - - $0.49

[0.49-0.82] (247) [0.34-0.65] (471) [0.49-0.65] (528) - - [0.49-0.65] (1,246)

2015 $0.59 $0.44 $0.44 $- $- $0.44

[0.44-0.74] (605) [0.44-0.59] (587) [0.44-0.59] (1,122) [-] (0) [-] (0) [0.44-0.59] (2,314)

Oral Quinine

2010 $3.22 $3.22 $3.22 $3.22 $1.61 $3.22

[3.22-4.83] (274) [3.22-4.03] (297) [3.22-4.03] (567) [2.42-3.22] (8) (1) [3.22-4.03] (1,147)




Private

For-Profit Facility


Drug Vendor ALL

Private



Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


2011 $4.93 $3.29 $4.11 $3.29 $- $4.11

[3.29-4.93] (507) [3.29-4.11] (377) [3.29-4.93] (723) [3.29-4.93] (5) [-] (0) [3.29-4.93] (1,612)

2013 $0.63 $0.63 $0.63 - - $0.63

[0.32-0.79] (53) [0.32-0.63] (197) [0.48-0.63] (221) - - [0.48-0.63] (471)

2015 $3.11 $2.49 $3.11 $- $- $3.11

[2.49-3.73] (454) [2.49-3.73] (384) [2.49-3.73] (1,116) [-] (0) [-] (0) [2.49-3.73] (1,954)


Figures in this table are derived using audited products with price information.




Table C6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across survey round




Facility

ALL Public/Not For-Profit

Private For-Profit



ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of outlets** stocking

2010 N=780 2011 N=682 2013 N=698 2015 N=280

2010 N=34 2011 N=107 2013 N=836 2015 N=900

2010 N=32 2011 N=41 2013 N=29 2015 N=53

2010 N=846 2011 N=830

2013 N=1,563 2015 N=1,233

2010 N=396 2011 N=816 2013 N=394 2015 N=966

2010 N=355 2011 N=399 2013 N=453 2015 N=467

2010 N=878 2011 N=1,158 2013 N=1,058 2015 N=1,914

2010 N=n/a 2011 N=n/a 2013 N=n/a 2015 N=n/a

2010 N=1,665 2011 N=2,397 2013 N=1,907 2015 N=3,347

2010 N=2,511 2011 N=3,227 2013 N=3,470 2015 N=4,580


2010 35.0 11.8 53.6 32.3 46.8 23.9 4.0 14.4 17.3

(29.2, 41.4) (1.0, 65.3) (21.9, 82.7) (21.4, 45.5) (42.1, 51.6) (19.3, 29.3) (2.4, 6.8) (9.3, 21.8) (12.7, 23.2)

2011 74.9 70.2 95.6 74.6 54.5 30.5 7.1 -- 20.3 31.4

(69.2,79.9) (36.4,90.6) (76.8,99.2) (59.4,85.5) (49.1,59.8) (21.9,40.6) (5.0,9.9) -- (15.2,26.5) (24.5,39.2)

2013 90.3 53.4 100 59.9 67.6 55.7 12.3 24.9 40.8

(87.0, 92.8) (30.2, 75.1) -- (39.3, 77.6) (60.6, 73.8) (40.1, 70.3) (9.3, 16.1) (20.9, 29.4) (31.5, 50.8)

2015 95.4 58.2 96.1 62.3 70.1 51.4 20.9 -- 32.6 42.6

(89.5, 98.1) (35.5, 77.9) (87.6, 98.9) (41.8, 79.1) (63.1, 76.3) (44.1, 58.6) (17.8, 24.4) - (29.2, 36.3) (34.2, 51.4)

2010 N=780 2011 N=682 2013 N=695 2015 N=279

2010 N=34 2011 N=107 2013 N=832 2015 N=900

2010 N=32 2011 N=41 2013 N=29 2015 N=53

2010 N=846 2011 N=830

2013 N=1,556 2015 N=1,232

2010 N=396 2011 N=816 2013 N=394 2015 N=966

2010 N=355 2011 N=399 2013 N=451 2015 N=467

2010 N=878 2011 N=1,158 2013 N=1,055 2015 N=1,914

2010 N=n/a 2011 N=n/a 2013 N=n/a 2015 N=n/a

2010 N=1,665 2011 N=2,397 2013 N=1,902 2015 N=3,347

2010 N=2,511 2011 N=3,277 2013 N=3,458 2015 N=4,579


2010 31.9 1.7 52.2 27.7 41.0 4.0 2.5 11.7 14.3

(26.9, 37.4) (0.2, 15.5) (21.4, 81.4) (17.9, 40.3) (35.8, 46.4) (2.2, 7.3) (1.3, 4.8) (7.9, 17.0) (10.9, 18.5)

2011 40.5 1.6 77.2 24.6 43.5 0.8 2.6 -- 13.7 16.0

(36.0,45.1) (0.3,8.4) (46.2,92.2) (13.9,39.9) (39.2,47.9) (0.2,4.0) (1.4,4.7) -- (10.0,18.6) (12.5,20.2)

2013 38.8 0.1 54.8 7.2 46.6 0.2 2.5 11.9 9.8

(35.1, 42.7) (0.0, 0.6) (38.1, 70.4) (4.5, 11.2) (37.7, 55.7) (0.1, 0.7) (1.5, 4.1) (9.2, 15.3) (7.4, 12.9)

2015 55.7 0.0 64.4 6.4 41.1 0.6 1.2 - 10.3 9.0

(47.6, 63.5) - (47.0, 78.7) (3.8, 10.5) (34.3, 48.1) (0.2, 1.4) (0.6, 2.3) - (8.2, 12.8) (7.1, 11.3)

2010 N=780 2011 N=682 2013 N=698 2015 N=280

2010 N=34 2011 N=107 2013 N=836 2015 N=900

2010 N=32 2011 N=41 2013 N=29 2015 N=53

2010 N=846 2011 N=830

2013 N=1,563 2015 N=1,233

2010 N=396 2011 N=816 2013 N=394 2015 N=965

2010 N=355 2011 N=399 2013 N=453 2015 N=467

2010 N=878 2011 N=1,158 2013 N=1,058 2015 N=1,914

2010 N=n/a 2011 N=n/a 2013 N=n/a 2015 N=n/a

2010 N=1,665 2011 N=2,397 2013 N=1,902 2015 N=3,346

2010 N=2,511 2011 N=3,277 2013 N=3,470 2015 N=4,579



Table C6: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across survey round




Facility

ALL Public/Not For-Profit

Private For-Profit



ALL Private

ALL Outlets

%

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)


2010 3.7 11.8 8.6 6.5 10.4 21.7 1.7 4.0 4.4

(1.2, 10.5) (1.0, 65.3) (2.6, 24.7) (2.4, 16.3) (6.8, 15.7) (18.3, 25.6) (0.9, 3.4) (2.1, 7.6) (2.4, 8.0)

2011 53.0 70.2 51.3 61.5 20.8 30.1 4.6 -- 9.3 19.9

(44.7,61.2) (36.4,90.6 (29.2,72.9) (42.0,77.9) (16.0,26.6) (21.6,40.1) (3.1,6.7) -- (6.8,12.6) (12.9,29.5)

2013 79.2 53.4 80.4 57.8 31.4 55.6 10.2 15.5 34.7

(74.5, 83.3) (30.2, 75.1) (60.8, 91.6) (37.5, 75.8) (26.0, 37.2) (40.0, 70.2) (7.5, 13.6) (12.8, 18.6) (25.2, 45.5)

2015 81.7 58.2 86.5 61.0 47.7 51.4 20.1 - 26.8 38.3

(71.2, 89.0) (35.5, 77.9) (69.5, 94.7) (40.6, 78.1) (41.7, 53.8) (44.1, 58.6) (17.1, 23.4) - (23.9, 30.0) (29.7, 47.7)

* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked antimalarials in the previous 3 months. ** Results in this table are derived using responses captured among outlets with blood testing information.




Table C8: Price of malaria blood testing for adults, by outlet type, across survey round

Private

For-Profit Facility


Drug Vendor ALL

Private


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Microscopy for adults

2010 $0.93 $1.40 $0.70 $- $- $0.93

[0.70-0.93] (157) [0.93-1.62] (12) [0.46-0.93] (16) [-] (0) [-] (0) [0.70-0.93] (185)

2011 $0.78 $1.17 $0.39 $- $- $0.78

[0.78-1.17] (369) [0.78-1.17] (6) [0.39-0.98] (25) [-] (-) [-] (-) [0.78-1.17] (400)

2013 $0.82 $0.98 $0.33 $- $- $0.65

[0.65-0.98] (186) [0.98] (6) [0.33-0.65] (21) [-] (-) [-] (-) [0.65-0.98] (213)

2015 $0.89 $1.48 $0.59 $- $- $0.89

[0.59-0.89] (409) [0.89-1.48] (8) [0.44-0.89] (19) [-] (-) [-] (-) [0.59-0.89] (436)

Microscopy for children under five

2010 $0.93 $1.40 $0.70 $- $- $0.93

[0.70-0.93] (157) [0.93-1.40] (12) [0.46-0.93] (16) [-] (0) [-] (0) [0.46-0.93] (185)

2011 $0.78 $1.08 $0.39 $- $- $0.78

[0.78-1.17] (369) [0.78-1.17] (6) [0.39-0.78] (25) [-] (-) [-] (-) [0.59-1.17] (400)

2013 $0.82 $0.98 $0.33 $- $- $0.65

[0.65-0.98] (186) [0.98] (6) [0.33-0.65] (21) [-] (-) [-] (-) [0.65-0.98] (213)

2015 $0.89 $1.48 $0.59 $- $- $0.74

[0.59-0.89] (410) [0.89-1.48] (8) [0.44-0.89] (18) [-] (-) [-] (-) [0.59-0.89] (436)

Malaria RDT for adults

2010 $1.40 $1.16 $0.93 $- $- $1.40

[1.16-1.86] (48) [0.93-1.39] (72) [0.70-0.93] (19) [-] (0) [-] (0) [0.93-1.40] (139)

2011 $1.17 $0.86 $0.78 $- $- $1.17

[0.98-1.56] (181) [0.78-0.98] (108) [0.39-1.17] (60) [-] (-) [-] (-) [0.78-1.17] (349)

2013 $0.98 $0.82 $0.82 $- $- $0.98

[0.98-1.31] (141) [0.65-0.82] (145) [0.65-0.98] (106) [-] (-) [-] (-) [0.65-0.98] (392)

2015 $0.89 $0.89 $0.59 $- $- $0.74

[0.59-0.89] (513) [0.30-0.89] (44) [0.59-0.89] (390) [-] (-) [-] (-) [0.59-0.89] (947)

Malaria RDT for children under five

2010 $1.39 $1.16 $0.93 $- $- $1.39

[1.16-1.86] (48) [0.93-1.39] (72) [0.70-0.93] (19) [-] (0) [-] (0) [0.93-1.39] (139)



Table C8: Price of malaria blood testing for adults, by outlet type, across survey round

Private

For-Profit Facility


Drug Vendor ALL

Private


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


Median [IQR]


2011 $1.17 $0.86 $0.78 $- $- $1.17

[0.78-1.56] (179) [0.78-1.02] (107) [0.39-1.17] (59) [-] (-) [-] (-) [0.78-1.17] (345)

2013 $0.98 $0.82 $0.65 $- $- $0.98

[0.82-1.31] (141) [0.65-0.82] (144) [0.65-0.98] (107) [-] (-) [-] (-) [0.65-0.98] (392)

2015 $0.89 $0.89 $0.59 $- $- $0.74

[0.59-0.89] (514) [0.30-0.89] (44) [0.59-0.89] (391) [-] (-) [-] (-) [0.59-0.89] (949)

* Total price to the consumer including consultation and/or service fees.

Source: ACTwatch Outlet Survey, Uganda 2010, 2011, 2013, 2015.



Table C9: Antimalarial market share, across survey round

AETDs sold or distributed in the previous week by outlet type and antimalarial type as a percentage of all AETDs sold/ distributed:




Facility

TOTAL Public/Not For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

TOTAL Private

ANTI-MALARIAL

TOTAL*

% % % % % % % % % % %

2010

1. Any ACT 36.3 0.3 1.9 39.0 4.3 1.4 6.0 <0.1 0.0 11.8 50.8

Quality Assured ACT (QA ACT) 36.0 <0.1 2.3 37.9 0.5 0.1 1.4 0.0 0.0 2.0 40.0

QA ACT with the “green leaf” logo -- -- -- -- -- -- -- -- -- -- --

QA ACT without the “green leaf” logo -- -- -- -- -- -- -- -- -- -- --

Non-Quality Assured ACT 0.4 0.3 0.3 1.0 3.8 1.3 4.7 <0.1 0.0 9.8 10.8

2. Any non-artemisinin therapy 19.7 <0.1 1.8 21.5 8.0 1.1 18.1 0.3 0.0 27.5 48.9

Sulfadoxine-Pyrimethamine 14.4 <0.1 1.2 15.6 5.6 0.7 10.6 0.2 0.0 17.1 32.8

3. Oral artemisinin monotherapy 0.0 0.0 <0.1 <0.1 0.0 0.0 0.0 0.0 0.0 0.0 <0.1

4. Non-oral artemisinin monotherapy 0.0 0.0 <0.1 <0.1 0.2 <0.1 <0.1 0 0 0.2 0.2

OUTLET TYPE TOTAL** 56.0 0.3 3.7 60.5 12.5 2.5 24.1 0.3 0.0 39.5 100.0

2011

1. Any ACT 33.3 0.3 3.1 36.7 15.2 4.4 11.6 0.1 0.0 31.4 68.1

Quality Assured ACT (QA ACT) 33.1 0.3 2.9 36.2 8.2 2.8 9.4 0.1 0.0 20.5 56.7

QA ACT with the “green leaf” logo 24.3 <0.1 1.0 25.4 7.0 2.5 8.4 0.1 0.0 18.0 43.3

QA ACT without the “green leaf” logo 8.8 0.2 1.9 10.8 1.2 0.3 1.0 0.0 0.0 2.5 13.4

Non-Quality Assured ACT 0.3 <0.1 0.2 0.5 7.0 1.7 2.2 0.0 0.0 10.9 11.4

2. Any non-artemisinin therapy 7.4 0.0 2.6 9.9 9.0 2.0 10.4 0.1 0.0 21.5 31.4

Sulfadoxine-Pyrimethamine 6.6 0.0 1.9 8.5 6.2 1.4 6.4 0.1 0.0 14.1 22.5

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy <0.1 <0.1 0.0 <0.1 0.0 0.0 0.0 0.0 0.0 0.0 <0.1


2013

1. Any ACT 26.3 3.9 2.4 32.7 10.4 7.4 14.3 0.0 0.0 32.0 64.7

Quality Assured ACT (QA ACT) 24.2 3.9 2.3 30.4 7.1 5.1 12.5 0.0 0.0 24.7 55.1

QA ACT with the “green leaf” logo 4.4 2.4 0.3 7.0 6.7 4.6 11.2 0.0 0.0 22.4 29.5

QA ACT without the “green leaf” logo 19.8 1.5 2.0 23.4 0.5 0.5 1.3 0.0 0.0 2.3 25.6

Non-Quality Assured ACT 2.1 0.0 0.1 2.3 3.2 2.3 1.8 0.0 0.0 7.3 9.6

2. Any non-artemisinin therapy 9.9 0.1 0.7 10.8 5.3 4.0 14.4 0.0 0.0 23.8 34.6

Sulfadoxine-Pyrimethamine 9.1 0.1 0.5 9.7 3.8 1.9 8.7 0.0 0.0 14.4 24.1

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy 0.1 0.0 0.0 0.1 0.4 0.1 0.1 0.0 0.0 0.6 0.7




Table C9: Antimalarial market share, across survey round





Facility

TOTAL Public/Not For-Profit

Private For-Profit


General Retailer

Itinerant Drug

Vendor

TOTAL Private

ANTI-MALARIAL

TOTAL*

% % % % % % % % % % %

2015

1. Any ACT 29.1 2.5 2.1 33.6 9.0 6.0 20.9 -- -- 35.9 69.6

Quality Assured ACT (QA ACT) 29.0 2.5 1.9 33.4 5.9 3.3 16.6 -- -- 25.8 59.2

QA ACT with the “green leaf” logo 0.9 0.5 0.5 2.0 5.2 3.3 15.2 -- -- 23.7 25.7

QA ACT without the “green leaf” logo 28.1 2.0 1.3 31.4 0.6 0.1 1.4 -- -- 2.1 33.5

Non-Quality Assured ACT 0.1 0.0 0.2 0.3 3.2 2.7 4.3 -- -- 10.1 10.4

2. Any non-artemisinin therapy 10.5 0.0 1.0 11.5 4.7 2.5 10.3 -- -- 17.5 29.0

Sulfadoxine-Pyrimethamine 7.1 0.0 0.8 7.9 3.2 1.6 6.9 -- -- 11.6 19.5

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -- -- 0.0 0.0

4. Non-oral artemisinin monotherapy 0.5 0.0 0.1 0.5 0.4 0.3 0.2 -- -- 0.9 1.4

OUTLET TYPE TOTAL** 40.0 2.5 3.1 45.7 14.1 8.8 31.4 -- -- 54.3 100.0

* Row sum – market share for the specified antimalarial medicine. ** Column sum (within each survey round) – market share for the specified outlet type. Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column (within in survey round).




Table C10: Antimalarial market share, across outlet type, across survey round





Facility

TOTAL Public / Not

For-Profit

Private For-Profit


General Retailer


TOTAL Private

% % % % % % % % % %

2010

1. Any ACT 70.3 97.0 55.0 69.3 33.7 56.2 23.5 10.6 0.0 28.6

Quality Assured ACT (QA ACT) 69.6 13.4 46.7 67.5 4.2 4.4 5.3 0.0 0.0 4.8

QA ACT with the “green leaf” logo -- -- -- -- -- -- -- -- -- --

QA ACT without the “green leaf” logo -- -- -- -- -- -- -- -- -- --

Non-Quality Assured ACT 0.7 83.6 8.3 1.8 29.6 51.9 18.2 10.6 0.0 23.7

2. Any non-artemisinin therapy 29.7 3.0 44.0 30.6 64.8 43.3 76.4 89.4 0.0 70.9

Sulfadoxine-Pyrimethamine 27.9 3.0 29.2 27.8 43.8 27.7 41.3 60.3 0.0 41.4

3. Oral artemisinin monotherapy 0.0 0.0 0.5 <0.1 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy 0.0 0.0 0.5 <0.1 1.5 0.5 0.1 0.0 0 0.5

2011

1. Any ACT 81.9 99.6 54.6 78.7 61.9 68.5 52.7 49.8 0.0 58.9

Quality Assured ACT (QA ACT) 81.3 99.1 50.5 77.6 33.3 43.0 42.7 49.8 0.0 38.5

QA ACT with the “green leaf” logo 59.8 14.6 17.9 54.4 28.3 38.2 38.1 46.1 0.0 33.7

QA ACT without the “green leaf” logo 21.5 84.5 32.6 23.2 5.0 4.8 4.6 3.7 0.0 4.8

Non-Quality Assured ACT 0.6 0.4 4.1 1.0 28.6 25.5 10.0 0.0 0.0 20.4

2. Any non-artemisinin therapy 18.1 0.0 44.8 21.3 36.6 30.7 47.1 50.2 0.0 40.3

Sulfadoxine-Pyrimethamine 16.2 0.0 33.1 18.1 25.3 21.0 29.0 38.5 0.0 26.4

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4. Non-oral artemisinin monotherapy <0.1 0.4 0.6 0.1 1.5 0.8 0.2 0.0 0.0 0.9

2013

1. Any ACT 72.5 96.0 75.6 74.9 64.6 64.3 49.5 -- 0.0 56.8

Quality Assured ACT (QA ACT) 66.6 95.4 72.0 69.7 44.4 44.5 43.3 -- 0.0 43.8

QA ACT with the “green leaf” logo 12.0 58.4 9.2 16.2 41.4 40.2 38.7 -- 0.0 39.8

QA ACT without the “green leaf” logo 54.6 36.9 62.9 53.6 2.9 4.3 4.5 -- 4.0 25.6

Non-Quality Assured ACT 5.9 0.7 3.5 5.2 20.2 19.8 6.2 -- 0.0 13.0

2. Any non-artemisinin therapy 27.3 3.6 23.5 24.8 33.0 34.9 50.1 -- 0.0 42.1

Sulfadoxine-Pyrimethamine 25.0 2.9 16.4 22.3 23.3 16.7 30.3 -- 0.0 25.5

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -- 0.0 0.0

4. Non-oral artemisinin monotherapy 0.2 0.3 1.0 0.3 2.3 0.9 0.4 -- 0.0 1.1



Table C10: Antimalarial market share, across outlet type, across survey round





Facility

TOTAL Public / Not

For-Profit

Private For-Profit


General Retailer


TOTAL Private

% % % % % % % % % %

2015

1. Any ACT 72.7 99.8 65.3 73.6 63.9 68.2 66.6 -- -- 66.1

Quality Assured ACT (QA ACT) 72.4 99.8 59.5 73.1 41.5 38.0 52.9 -- -- 47.5

QA ACT with the “green leaf” logo 2.3 21.1 16.8 4.3 36.9 37.1 48.4 -- -- 43.6

QA ACT without the “green leaf” logo 70.2 78.7 42.7 68.8 4.6 0.8 4.3 -- -- 3.8

Non-Quality Assured ACT 0.2 0.0 5.8 0.6 22.4 30.3 13.7 -- -- 18.6

2. Any non-artemisinin therapy 26.2 0.2 33.0 25.2 33.3 28.4 32.8 -- -- 32.2

Sulfadoxine-Pyrimethamine 17.6 0.2 26.4 17.3 22.3 18.1 21.8 -- -- 21.3

3. Oral artemisinin monotherapy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -- -- 0.0

4. Non-oral artemisinin monotherapy 1.2 0.0 1.6 1.1 2.9 3.4 0.7 -- -- 1.7

Categories 1 through 4 sum to 100% within each column (within each survey round).




Table C14: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round




Facility

ALL Public / Not

for-profit

Private For-Profit



ALL Private

ALL Outlets

%

(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of providers who:

2010 N=780 2011 N=682 2013 N=698 2015 N=280

2010 N=34 2011 N=107 2013 N=836 2015 N=899

2010 N=32 2011 N=41 2013 N=29 2015 N=53

2010 N=846 2011 N=830

2013 N=1,563 2015 N=1,232

2010 N=396 2011 N=816 2013 N=393 2015 N=962

2109 N=355 2011 N=399 2013 N=451 2015 N=463

2010 N=878 2011 N=1,158 2013 N=1,055 2015 N=1,904

2010 N=5 2011 N=0 2013 N=0

2015 N=n/a

2010 N=1,665 2011 N=2,397 2013 N=1,901 2015 N=3,329

2010 N=2,511 2011 N=3,227 2013 N=3,464 2015 N=4,561

Correctly state the national

first-line treatment for uncomplicated malaria

2010 95.3 96.6 92.8 95.2 68.9 88.3 75.6 60.0 73.7 77.2

(93.3, 96.8) (93.4, 98.3) (80.3, 97.6) (93.1, 96.8) (64.0, 73.4) (83.2, 92.0) (70.1, 80.5) (60.0-60.0) (69.0, 78.0) (72.4, 81.4)

2011 95.4 92.5 93.0 93.7 80.4 92.0 73.8 -- 74.5 78.4

(92.6, 97.2) (86.8, 95.9) (76.7, 98.2) (90.5, 95.9) (76.1, 84.1) (87.9, 94.8) (69.5, 77.8) -- (69.6, 78.8) (73.6, 82.6)

2013 95.2 90.7 94.6 91.4 82.0 72.9 77.2 -- 77.9 84.1

(92.5, 96.9) (87.4, 93.2) (80.4, 98.7) (88.6, 93.6) (76.6, 86.3) (48.7, 88.4) (73.6, 80.5) -- (74.6, 81.0) (81.1, 86.6)

2015 94.3 82.3 88.7 83.3 84.5 90.7 84.1 -- 84.3 84.0

(88.3, 97.3) (69.8, 90.3) (74.9, 95.3) (72.1, 90.7) (78.4, 89.1) (85.6, 94.1) (80.1, 87.5) - (80.5, 87.5) (78.9, 88.0)

Correctly state the first-line dosing regimen for a 2-year old child

2010 92.4 90.9 78.4 89.8 59.4 72.4 63.6 0.0 62.1 66.5

(89.7, 94.5) (84.0, 95.0) (62.6, 88.7) (85.8, 92.7) (53.7, 64.9) (66.2, 77.8) (57.4, 69.3) -- (56.4, 67.4) (60.6, 72.0)

2011 91.1 62.7 81.8 76.0 69.9 79.3 59.5 -- 61.3 64.3

(88.4, 93.2) (59.7, 65.6) (65.0, 91.6) (68.1, 82.4) (65.8, 73.7) (71.9, 85.1) (54.1, 64.8) -- (55.9, 66.4) (60.2, 68.1)

2013 90.9 79.5 85.5 81.3 73.1 66.9 67.7 -- 68.7 74.4

(87.4, 93.4) (71.8, 85.5) (69.5, 93.8) (75.0, 86.3) (66.7, 78.8) (46.3, 82.6) (64.0, 71.2) -- (65.3, 71.9) (70.1, 78.3)

2015 91.2 65.7 76.2 67.8 75.8 83.8 75.1 -- 75.4 72.9

(85.1, 94.9) (51.9, 77.3) (60.9, 86.8) (55.1, 78.4) (70.0, 80.8) (76.2, 89.3) (71.1, 78.7) - (71.7, 78.8) (66.9, 78.1)

Report an ACT as the most effective antimalarial medicine

ACT most effective for adults



Table C14: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round




Facility

ALL Public / Not

for-profit

Private For-Profit



ALL Private

ALL Outlets

%

(95% CI) %

(95% CI)

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI) %

(95% CI)

Proportion of providers who:

2010 N=780 2011 N=682 2013 N=698 2015 N=280

2010 N=34 2011 N=107 2013 N=836 2015 N=899

2010 N=32 2011 N=41 2013 N=29 2015 N=53

2010 N=846 2011 N=830

2013 N=1,563 2015 N=1,232

2010 N=396 2011 N=816 2013 N=393 2015 N=962

2109 N=355 2011 N=399 2013 N=451 2015 N=463

2010 N=878 2011 N=1,158 2013 N=1,055 2015 N=1,904

2010 N=5 2011 N=0 2013 N=0

2015 N=n/a

2010 N=1,665 2011 N=2,397 2013 N=1,901 2015 N=3,329

2010 N=2,511 2011 N=3,227 2013 N=3,464 2015 N=4,561

2010 86.9 54.7 70.0 76.2 58.1 88.9 52.4 20.0 53.4 57.1

(81.2, 91.0) (39.2, 69.3) (41.9, 88.3) (67.6, 83.1) (50.6, 65.3) (77.8, 94.8) (42.4, 62.2) (20.0-20.0) (44.3, 62.2) (49.7, 64.1)

2011 90.6 65.4 84.8 77.5 73.9 93.1 62.3 -- 65.9 68.3

(86.9, 93.4) (40.5, 84.1) (70.8, 92.8) (63.5, 87.1) (68.6, 78.5) (86.3, 96.7) (55.7, 68.4) -- (59.6, 71.8) (63.3, 72.9)

2013 92.1 81.8 92.6 83.5 76.4 87.4 75.9 -- 76.0 79.4

(89.2, 94.3) (75.7, 86.6) (72.7, 98.3) (78.2, 87.8) (70.9, 81.1) (77.3, 93.3) (72.6, 79.0) -- (73.3, 78.6) (76.6, 82.0)

2015 96.7 78.7 90.3 80.4 85.2 94.4 84.9 -- 85.1 83.5

(94.0, 98.3) (72.5, 83.8) (79.0, 95.8) (74.6, 85.1) (80.6, 88.9) (89.2, 97.2) (81.6, 87.6) - (82.1, 87.7) (80.1, 86.4)

ACT most effective for children

2010 88.4 96.4 78.5 88.8 54.3 86.6 47.6 40.0 49.0 55.4

(82.8, 92.4) (76.1, 99.5) (62.3, 88.9) (82.2, 93.1) (47.3, 61.1) (77.1, 92.5) (37.7, 57.8) (40.0-40.0) (40.2, 57.9) (47.4, 63.1)

2011 93.2 99.5 80.7 95.0 69.0 84.6 59.2 -- 62.2 68.9

(91.1, 94.8) (95.5, 99.9) (60.1, 92.1) (90.0, 97.6) (64.4, 73.2) (75.7, 90.7) (52.9, 65.2) -- (56.4, 67.6) (62.8, 74.3)

2013 94.3 99.4 85.4 98.3 74.2 85.6 78.3 -- 77.0 86.7

(92.0, 96.0) (98.7, 99.7) (64.3, 95.0) (97.3, 98.9) (69.2, 78.7) (76.2, 91.7) (73.7, 82.4) -- (73.3, 80.4) (83.0, 89.7)

2015 97.0 97.7 94.5 97.5 81.7 87.4 82.0 -- 82.0 87.2

(93.3, 98.7) (96.0, 98.6) (83.8, 98.3) (95.8, 98.5) (75.1, 86.8) (80.0, 92.3) (77.7, 85.6) - (77.7, 85.6) (83.7, 90.0)

At the time of the 2010, 2011 2013, and 2015 ACTwatch outlet surveys, artesunate amodiaquine was Uganda’s first line treatment for uncomplicated malaria. Numbers of providers (N) in this table are the total number of providers eligible for table indicators.




Annex 1: ACTwatch Background ACTwatch is a multi-country research project implemented by PSI (www.psi.org). Standardized tools and approaches are employed to provide comparable data across countries and over time. Project countries include: Benin, Cambodia, the Democratic Republic of Congo, Kenya, Laos, Madagascar, Myanmar, Nigeria, Tanzania (currently mainland only, previous work in Zanzibar), Thailand, Uganda, Vietnam, Zambia. The project was launched in 2008 with funding from the Bill and Melinda Gates Foundation (BMGF), and is currently funded through 2016 by the BMGF, UNITAID, and DFID. ACTwatch is designed to provide timely, relevant, and high quality antimalarial market evidence. 1F

2 The goal of providing this market evidence is to inform and monitor national and global policy, strategy, and funding decisions for improving malaria case management. ACTwatch is monitoring antimalarial markets in the context of policy shifts and investments in the scale-up of first-line ACT and blood testing using RDTs. This has included adaptation of project methods for the evaluation of the Affordable Medicines Facility-malaria (AMFm) pilot.2F

3 Project scale-up in the Greater Mekong sub-Region (GMS) in 2015 was designed to deliver key indicators for informing and monitoring strategies and policies for malaria elimination. The project implements a set of research tools designed to: 1) Provide a picture of the total market for malaria case management including: all providers carrying

antimalarials and RDTs and providing case management services; the relative antimalarial market share for each provider type; the antimalarial supply chain; and price markups within the supply chain for antimalarials and RDTs.

2) Monitor the readiness of market components for appropriate malaria case management, including: availability

of antimalarials and malaria blood testing; consumer price of antimalarial treatment and malaria blood testing; and provider qualifications, training and knowledge.

3) Monitor the performance of market components for appropriate malaria case management, including: the

relative market share for quality-assured ACT relative to other antimalarial medicines; the demand for appropriate malaria case management captured through consumer knowledge, attitudes, and fever treatment seeking behavior; and the quality of provider service delivery measured against national policies, guidelines and minimum standards.

ACTwatch research tools for malaria market monitoring include: 1. Outlet surveys Outlet surveys entail collecting quantitative data from all outlets and providers with the potential to sell or distribute antimalarials and/or provide malaria blood testing. These include health facilities, community health workers, pharmacies, drug stores, retail outlets, market stalls, and mobile providers. A screening process identifies outlets that provide antimalarials and/or malaria blood testing. Among these eligible outlets, service providers are interviewed and all antimalarials and RDTs are audited. The audit collects information about each antimalarial and RDT in stock (e.g. brand name, drug active ingredients and strengths, manufacturer, etc.) and retailer reports on consumer price and sale/distribution volumes for each product. A representative sample of outlets is identified within target study domains such that findings from the outlet survey provide estimates of antimalarial and RDT availability, price, and relative market share across the entire market as well as within key market channels.3F

4

2 Shewchuk T, O’Connell KA, Goodman C, Hanson K, Chapman S, Chavasse D. 2011. The ACTwatch project: methods to describe anti-malarial markets in seven countries. Malaria Journal, 10: 325. 3 AMFm Independent Evaluation Team. 2012. Independent evaluation of Phase 1 of the Affordable Medicines Facility – malaria (AMFm), multi-country independent evaluation report: final report. Calverton, MD and London: ICF International and London School of Hygiene and Tropical Medicine. 4 O’Connell KA, Poyer S, Solomon T, et al. 2013. Methods for implementing a medicine outlet survey: lessons from the anti-malarial market. Malaria Journal, 12: 52.


http://www.psi.org/


From 2008 through 2014, ACTwatch conducted 35 national outlet surveys across the 10 project countries. 4F

5 Reports are available at www.actwatch.info, and peer-reviewed publications have appeared in Malaria Journal and The Lancet. 5F

6 2. Supply chain studies Supply chain studies employ quantitative and qualitative research methods to effectively map the antimalarial supply chain in a given country. The supply chain is mapped from the antimalarial outlets (service delivery points) identified during an outlet survey to national importers and distributors with identification of all mid-level distributers in between. Retail prices are documented along the supply chain to facilitate calculation of commodity mark-ups. From 2008 through 2012, ACTwatch conducted 8 national supply chain studies. Reports are available at www.actwatch.info, and a peer-reviewed publication has appeared in PLoS One.6F

7 2015 outlet surveys in the Greater Mekong sub-Region include a component to collect additional information about the supply chain for oral artemisinin monotherapy (oral AMT, e.g. artesunate tablets). Oral AMT identified during the outlet surveys was further investigated and research teams identified and visited named suppliers to collect further information about the supply chain. 3. Population-based surveys Population-based surveys are conducted among consumers to document fever treatment-seeking behavior. A representative sample of the target population (caregivers of children and/or adults according to burden and risk) is identified, and a screening tool is used to identify individuals who have recently experienced fever. The surveys investigate the extent to which health care was sought, as well as common sources of care received. Respondent reports of malaria blood testing and antimalarials acquired are documented and summarized. The survey includes measures of demographic and other individual, household/family, and community characteristics that can be used to develop consumer profiles as well as monitor equity in access to malaria case management. From 2008 through 2012, ACTwatch conducted 14 household surveys focused on fever treatment-seeking behavior. Reports are available at www.actwatch.info, and a peer-reviewed publication has appeared in Malaria Journal.7F

8 4. Fever case management quality of care Fever case management quality of care is monitored using a set of research tools designed to measure aspects of the interaction between providers and clients. ACTwatch launched fever case management quality of care studies in 2015 in a subset of project countries. The following research tools were integrated into the outlet surveys in Cambodia and Uganda and were implemented among private sector outlets providing malaria testing and treatment:

Exit interviews conducted with target consumers immediately after receiving fever case management services in the private sector. A structured interview documented client reports about key aspects of service delivery including malaria blood testing, test results, medicines recommended/prescribed and obtained, counseling, and costs of services and commodities received. Exit interviews were also used to measure client recall and comprehension of provider counseling including instructions for completing prescribed drug regimens, as well as client satisfaction with services provided.

5 Surveys in the DRC (2) and Myanmar (3) were sub-national. 6 O’Connell K, Gatakaa H, Poyer S, et al. 2011. Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries. Malaria Journal, 10: 326. Tougher S, the ACTwatch Group, Ye Y, et al. 2013. Effect of the Affordable Medicines Facility-malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Lancet, 380: 1916-26. 7 Palafox B, Patouillard E, Tougher S, et al. 2014. Understanding private sector antimalarial distribution chains: a cross-sectional mixed methods study in six malaria-endemic countries. PLoS One, 9(4). 8 Littrell M, Gatakaa H, Evance I, et al. (2011). Monitoring fever treatment behavior and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries. Malaria Journal, 10: 327.






A consultation observation checklist was used to document aspects of the provider-client interaction in the private sector. A trained observer completed the checklist designed to document provider compliance with standard practice and procedures as well as aspects of client demand for specific products or services. The observer remained silent during the consultation.

ACTwatch in Uganda ACTwatch baseline surveys were conducted in Uganda in 2008 and 2009, followed by baseline and end line surveys for AMFm in 2010 and 2011, respectively. Additional surveys were conducted in 2013 and 2015. All reports are

available at www.actwatch.info.




Annex 2: Country Background

Uganda is a landlocked country in East Africa bordered by Kenya, South Sudan, Rwanda, Tanzania, and the Democratic Republic of the Congo. Uganda has an estimated population of 36.6 million people, the majority of whom live in rural areas8F

9. Uganda has made substantial progress in recent years towards attaining 2015 Millennium Development Goals (MDG). This progress has included early attainment of poverty reduction targets, and strong progress towards targets for reducing hunger and under-nutrition as well as reducing child morbidity and mortality9F

10. Despite incredible progress, mortality rates for children under five (69 per 1,000 live births) and infants (45 per 1,000 live births) remain high 10F

11. Administratively, Uganda is divided into 112 districts. Districts are further sub-divided into sub-counties and parishes. Over time, the numbers of districts and lower level administrative units have increased in number with the aim of making administration and delivery of social services easier and closer to the people11F

12. Since 1986, the government has acted to rehabilitate and stabilize the economy by undertaking currency reform, raising producer prices on export crops, increasing prices of petroleum products, and improving civil service wages. The policy changes are especially aimed at dampening inflation and boosting production and export earnings. Since 1990, economic reforms ushered in an era of solid economic growth based on continued investment in infrastructure, improved incentives for production and exports, lower inflation, better domestic security, and the return of exiled Indian-Ugandan entrepreneurs12F

13. From the mid-1980s to the 1990s, Gross Domestic Product (GDP) growth in Uganda averaged about 5.3 percent while population grew at about 3.2 percent per annum only. In the 2000s to 2014, GDP has increased to an average of 6.6 percent while average annual population growth has remained steady at around 3.3 percent. Additionally, per capita income increased from 180 USD in 1984 to 670 USD in 201413F

14.

Healthcare system The provision of health services in Uganda is decentralized, with districts and health sub-districts playing a key role in the delivery and management of health services at those levels. The government eliminated user fees in 2001, and services in public health facilities are thus free. User fees remain in place in private wings of public hospitals 14F

15. The public sector is organized into the following health services:

1. Village Health Teams (Health Center I) – Provide services at the community level. They facilitate and are

responsible for health promotion, community mobilization to improve health seeking behaviors and

treatment of diseases. After the adoption of the integrated community case management in 2010, two out

of five VHTs provide diagnosis and treatment.

2. Health Center II – Provide diagnosis, maternity care and are the first referral point in the sub-county.

3. Health Center III – In addition to providing basic preventative and curative care, Health Center IIIs provide

support and supervision to Health Center IIs.

9 Uganda Bureau of Statistics. (2014). 2014 Statistical abstract. Available: www.ubos.org/onlinefiles/uploads/ubos/statistical_abstracts/Statistical_Abstract_2014.pdf. Accessed October 22, 2014. 10 Ministry of Finance, Planning and Economic Development (2013). Millennium Development Goals report for Uganda 2013. Kampala: Ministry of Finance, Planning and Economic Development. 11 UNICEF. (2013). Uganda statistics. Available: www.unicef.org/infobycountry/uganda_statistics.html. Accessed October 22, 2014. 12 Ministry of Health. (2010). Health sector strategic & investment plan. Kampala: Uganda Ministry of Health. 13 CIA World Fact Book (2015). Africa: Uganda. Accessed, December 12, 2015. https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html 14 World Bank (2015). Uganda Databank. Accessed, December 12, 2015. http://databank.worldbank.org/data/reports.aspx?source=2&country=UGA&series=&period=# 15 Ibid.


http://www.ubos.org/onlinefiles/uploads/ubos/statistical_abstracts/Statistical_Abstract_2014.pdf.%20Accessed%20October%2022

http://www.unicef.org/infobycountry/uganda_statistics.html

https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html

http://databank.worldbank.org/data/reports.aspx?source=2&country=UGA&series=&period=


4. Health Center IV or General Hospitals – These facilities provide overall oversight of all the other lower level

health facilities. General Hospitals often provide pre-service training and provide services related to

prevention of diseases, blood transfusion and medical imaging.

5. Regional Referral Hospitals – These are often research and teaching hospitals and are involved in specialized

services such as medical imaging, psychiatry and surgery.

6. National Referral Hospital – These are often research and teaching hospitals, and are involved in provision of

specialized services.

Village Health Teams (VHT) became part of Uganda’s national health strategy in 2001. VHT volunteers serve as a community-based primary health contact with responsibilities including identifying community health needs; mobilizing resources; mobilizing community participation for public health campaigns (e.g. immunization, sanitation, health-seeking behavior, malaria control); birth and death registration; and community-based management of common childhood illnesses including malaria, diarrhea, and pneumonia. Four or five VHT volunteers are selected per village. The target of the 2010-2015 Health Sector Strategic and Investment Plan is to increase VHT coverage to 100 percent by 2015. As of 2009, 31 percent of districts had trained VHTs in all villages 15F

16. Uganda has a total of 155 hospitals – there are two referral hospitals, 14 regional referral hospitals and 139 general

hospitals. Out of the 155 hospitals countrywide, there are a total of 27 privately owned hospitals 16F

17.

The medicines distribution system in the public sector is centralized with procurement pooled at the national level and organized through the National Medical Stores, an agency of the Ministry of Health. Nearly all public sector procurements are imported (94 percent)17F

18. The private not-for-profit sector is also important in Uganda for medicines delivery and treatment. These outlets include mission/faith-based hospitals and clinics. Faith-based/mission not-for-profit facilities account for 41 percent of hospitals and 22 percent of lower level facilities complementing government facilities especially in rural areas18F

19. The private sector

The private sector plays a significant role in the health system in Uganda and is estimated to provide about half of health services in the country19F

20. The 2012 ACTwatch household survey in Uganda found that more than half of children with fever were taken to a private sector outlet for treatment 20F

21. Private sector outlets in Uganda include for-profit hospitals and clinics. Health professional working in these facilities commonly also have an affiliation with government/public health services. About half of doctors working in the private sector also work in the government

sector however more than 90 percent of the nurses, midwives and nursing assistants working in the private sector work full-time in the private sector. Private for-profit facilities have a large urban and peri-urban presence and

provide primary and secondary care. More than 90 percent of private for profit facilities offer malaria treatment21F

22. The private for-profit sector in Uganda also includes as pharmacies and drug stores (licensed and unlicensed). The pharmaceutical sector in Uganda is regulated by the National Drug Authority (NDA). Drug stores and pharmacies are licensed by the NDA and NDA licensing fees for these outlets recently increased significantly22F

23. Pharmacies must be staffed by registered pharmacist and may dispense prescription-only and over-the-counter (OTC) medicines. Licensed drug stores must be staffed by a provider with a health qualification (e.g. pharmacy technician, registered/enrolled nurse, clinical officer etc.). Drug stores are permitted to retail a range of OTC medicines but are

16 Ibid. 17 Ministry of Health (2015). Affiliated Institutions: Hospitals. Accessed, November 2, 2015. http://health.go.ug/affiliated-institutions/hospitals?page=1 18 Palafox B, Patoullard E, Tougher S, et al. (2012). ACTwatch 2009 supply chain survey results, Uganda. Nairobi: ACTwatch, PSI. 19 Ministry of Health. (2010). Health sector strategic & investment plan. Kampala: Uganda Ministry of Health. 20 Ibid. 21 ACTwatch Group and PACE. (2013). Household survey, Uganda, 2012 survey report. Washington DC: PSI. 22 Ministry of Health. (2010). Health sector strategic & investment plan. Kampala: Uganda Ministry of Health. 23 NDA doubles license fees for drug shop, pharmacies. (2013). Available: www.newvision.co.ug/news/647578-nda-license-fees-for-drug-shop-pharmacies.html. Accessed: October 22, 2014.


http://health.go.ug/affiliated-institutions/hospitals?page=1

http://health.go.ug/affiliated-institutions/hospitals?page=1

http://www.newvision.co.ug/news/647578-nda-license-fees-for-drug-shop-pharmacies.html

http://www.newvision.co.ug/news/647578-nda-license-fees-for-drug-shop-pharmacies.html

http://www.allafrica.com/stories/201309241369.html.%20Accessed:%20October%2022


not authorized to sell prescription-only medicines. ACTs were classified as OTC medicines in 200823F

24. The NDA monitors private outlets for the illegal sale of medicines including medicine sales by unlicensed drug stores and sale of government-procured medicines and supplies found outside of public health facilities. The crackdown on outlets illegally selling medicines has been a topic frequently covered by national media24F

25. There are several local drug manufacturers in Uganda including manufacturers of antimalarial medicines. In 2010,

the Kampala manufacturing site for Quality Chemicals Industries Limited became Africa’s first local supplier to

receive WHO pre-qualification to produce ACTs. The company is licensed to produce artemether lumefantrine

through the company Cipla Limited (www.cipla.com), based in India. Although local manufacturers are present in

Uganda, the majority (~90 percent) of pharmaceuticals are imported from Asian, Western, and other African

countries (Kenya, South Africa). Results of a mapping exercise undertaken in 2008 estimated that 93-95 percent of

imported medicines in Uganda are generic products 25F

26.

Malaria risk and burden The climate of Uganda is tropical and tempered by altitude. In most parts of Uganda, temperature and rainfall allow intense perennial malaria transmission. Malaria is highly endemic across 95 percent of the country, affecting approximately 90 percent of the population (see national control program map in Figure X1). These areas include the entire Central region and the majority of the Northern and Southern regions. Particularly high transmission rates have been documented in some areas of northern Uganda, where prior to indoor residual spray campaigns, entomological inoculation rates were documented as high as 1,600 infective bites per person per year. The 5 percent of the country (10 percent of the population) that does not have endemic malaria consists of unstable and epidemic-prone transmission areas in the highlands of the south- and mid-west, along the eastern border with Kenya, and the northeastern border with Sudan26F

27. Malaria continues to be a major public health problem in Uganda and is the leading cause of morbidity and mortality among children under age five27F

28. The most recent national Malaria Indicator Survey (MIS) indicated that malaria was responsible for 30 to 50 percent of outpatient hospital visits, and 9 to 14 percent of inpatient deaths in 2014 28F

29. The latest MIS report also documented a parasite prevalence of 19 percent among all children under five when testing with microscopy. Most malaria infections in Uganda are due to Plasmodium falciparum29F

30.

24 Palafox B, Patoullard E, Tougher S, et al. (2012). ACTwatch 2009 supply chain survey results, Uganda. Nairobi: ACTwatch, PSI. 25 Personal communication, 2013 ACTwatch Key Informant Interviews, Uganda. 26 UMOH (2008). Cited in Medicines Transparency (medicinestransparency.org): The role of local manufacturers in improving access to essential medicine (2010). Accessed May 6, 2016: http://www.medicinestransparency.org/fileadmin/uploads/Documents/MeTA-Uganda_AfricaHealth.pdf 27 Uganda Bureau of Statistics (UBOS) and ICF Macro. (2010). Uganda malaria indicator survey 2009. Calverton, MD: UBOS and ICF Macro. 28 Uganda Bureau of Statistics. (2014). 2014 Statistical abstract. Available: www.ubos.org/onlinefiles/uploads/ubos/statistical_abstracts/Statistical_Abstract_2014.pdf. Accessed October 22, 2014. 29 Uganda Ministry of Health. (2015). Malaria indicator survey, 2014-2015. Retrieved from: https://dhsprogram.com/pubs/pdf/MIS21/MIS21.pdf 30 Uganda Bureau of Statistics (2016). The National Population and Housin Census 2014 – Main Report, Kampala, Uganda Ibid.


http://www.cipla.com/

http://www.medicinestransparency.org/fileadmin/uploads/Documents/MeTA-Uganda_AfricaHealth.pdf

http://www.medicinestransparency.org/fileadmin/uploads/Documents/MeTA-Uganda_AfricaHealth.pdf

http://www.ubos.org/onlinefiles/uploads/ubos/statistical_abstracts/Statistical_Abstract_2014.pdf.%20Accessed%20October%2022


Figure X1. Map of malaria endemicity

Source: PMI FY2014 Malaria Operational Plan.

Malaria case management guidelines The revised Uganda Malaria Reduction Strategic Plan (UMRSP) 2014-2020 primary targets are to reduce malaria deaths to near zero, reduce malaria morbidity to 30 cases per 1,000 persons, and to reduce malaria parasite prevalence to less than 7 percent nationwide. The UMRSP objectives related to appropriate case management include:

1. At least 90 percent of all malaria cases receive prompt treatment according to national guidelines 2. At least 85 percent of the population practices correct malaria prevention and management measures

(including confirmatory diagnosis and treatment with AL) These goals are supported by specific activities, including strengthening health worker capacity for diagnosis and treatment through training and clinical audits, scaling up and sustaining parasitological diagnosis at all health levels, focusing on iCCM to reduce treatment gaps, and strengthening the management of malaria in pregnancy 30F

31. Diagnosis The current National Malaria Control Policy adopted in 2012 recommends that all suspected malaria cases receive

confirmatory blood testing using microscopy or a rapid diagnostic test in all health facilities and at the community

level. Microscopic testing is to be provided free-of-charge in public health facilities and made available at Health

Centre III and higher levels. RDTs are to be used at Health Centre III facilities without microscopy, Health Center II

facilities, and at community level31F

32. Training on the use of Malaria Rapid Diagnostic Tests has been performed at all

levels of care, including the VHT level32F

33. A cluster-randomized trial that introduced RDTs for malaria into registered

drug shops in central Uganda found that use of RDTs increased the appropriate treatment of malaria with ACTs 33F

34.

Policy recommendations have been made following this study regarding the continued scale-up of RDTs in the

private sector.

Treatment In 2004 the National Malaria Control Program (NMCP) adopted the Artemisinin-based Combination Therapy (ACT) Artemether Lumefantrine (AL) 20mg/120mg as the first-line treatment for uncomplicated malaria. The 2012 National Malaria Treatment Guidelines indicate that alternative first-line treatments include any ACT that has been recommended by the WHO and MOH and is registered with the NDA.

31 Ministry of Health. (2014). The Uganda Malaria Reduction Strategic Plan 2014-2020. The Republic of Uganda Ministry of Health. 32 Ministry of Health. (2012). Uganda clinical guidelines 2012.Available: www.sure.ug/?download=UCG%202012.pdf. Accessed October 22, 2014. 33 Key Informant 1. (2015). 34 Mbonye et al. (2015). Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: lessons learned and policy implications. Malaria Journal 14:448


http://www.sure.ug/?download=UCG%202012.pdf


Implementation of the new ACT policy in public sector facilities began in 2006 and was expanded to community-based services in 2008 through a home-based management of fever program run by community medicine distributors. This expansion followed the declassification of all ACTs to over-the-counter medicines, also in 2008. The second line treatments for uncomplicated malaria are dihydroartemisinin piperaquine (DHA PPQ) or oral quinine. Following on recent WHO guidelines 34F

35 stipulating the use of IV/IM artesunate as first-line treatment for severe malaria, the Uganda national program and its partners are now scaling up the use of IV/IM artesunate for severe malaria within health facilities. Rectal artesunate is indicated for pre-referral treatment for severe malaria35F

36. The sale of oral artemisinin monotherapy was banned in 2007 36F

37. The UMRSP also recommends Sulfadoxine Pyrimethamine (SP) for IPTp (intermittent preventive treatment in pregnancy) for malaria.

Financing and major initiatives to improve case management With funding through the Affordable Medicines Facility, malaria (AMFm) and Global Fund Round 10, Uganda has implemented strategies to increase access to malaria blood testing and appropriate treatment. The AMFm provided first-line buyers in the public and private sector with access to highly subsidized (co-paid) quality-assured ACTs. Medicines subsidized through the AMFm are marked with a ‘green leaf’ logo on the packaging. Phase 1 of the AMFm was implemented from 2010-2012. Uganda signed the AMFm grant in February 2011. Despite delays in grant signature and ordering approvals, significant quantities of co-paid ACTs had arrived in country by the end of 2011: 28 million treatment courses were delivered, mostly destined for the public sector (73 percent). The independent evaluation of the AMFm in Uganda showed a successful increase in availability and market share for quality-assured ACTs. However price data from the private sector indicated very high gross percentage and total retail markups (first-line buyer to retail selling price) and the price of quality-assured ACT remained more than three times higher than the most popular non-artemisinin therapy. It was noted by the independent evaluation team that the high price markups may had been influenced by a lack of awareness of the recommended retail price for co-paid ACTs among providers and consumer37F

38. Transitional funding was provided in Uganda and other AMFm pilot countries for co-paid ACTs through 2013. At that time, the program transitioned to the Global Fund co-payment mechanism subsidy program, which was available to the private sector only. The new program was implemented in 2014; the subsidy for first-line buyers reduced to 50 percent for adult courses and 70 percent for child courses. In 2015, the subsidy returned to 70 percent of the cost for both adult and child courses. Between the AMFm program and the co-payment system, there was a gap in funding. To cover this gap, DFID gave Uganda funding to cover the antimalarial medicines. Improved availability of ACTs and RDTs in public health facilities has been supported by efforts to strengthen supply chain management including improved routine information systems for commodity stocks. Higher-level health facilities operate on a ‘push’ supply system while lower level facilities operate on a ‘pull’ system. The Commodity Security Group is another effort to strengthen the supply of key health commodities in the country. Bringing together a variety of stakeholders in pharmacy, supply chain, and other partners, the group meets regularly to review commodity stock status and to mitigate issues. Specifically regarding RDT availability, the Global Fund and UNITAID have together distributed 17 million RDTs to the public sector through the CARESTART campaign. UNITAID also provided an additional 2 million RDT kits to the private sector 38F

39. In addition to support from the Global Fund, the Department for International Development (DFID) made a financial commitment in 2010 to increase support for malaria control in Uganda, and forged an arrangement with the U.S. Agency for International Development (USAID) to leverage a funding mechanism from the President’s Malaria

35 WHO. (2015). Guidelines for the Treatment of Malaria. Third Edition. World Health Organization. 36 Ibid 37 Palafox B, Patoullard E, Tougher S, et al. (2012). ACTwatch 2009 supply chain survey results, Uganda. Nairobi: ACTwatch, PSI. 38 AMFm Independent Evaluation Team. (2012). Independent evaluation of Phase 1 of the Affordable Medicines Facility – malaria (AMFm), multi-country independent evaluation report: Final report. Calverton MD and London: ICF International and London School of Tropical Medicine and Hygiene. 39 ACTwatch Key Informant Interviews. (2015). Uganda.



Initiative (PMI) to scale up contributions to malaria control. The Clinton Health Access Initiative (CHAI) has also provided technical assistance to the Uganda National Malaria Control Program (NMCP) to inform effective case management strategy. In support of the change in severe malaria treatment guideline to IV/IM artesunate, UNITAID invested USD 17 million in six countries to accelerate the adoption of this treatment. Working together with Clinton Health Access Initiative (CHAI) and Malaria Venture (MMV), additional vials of treatment will be distributed in Uganda, and a market for injectable artesunate created 39F

40 40F

41 41F

42. Community-based approaches to improving appropriate malaria case management coverage have been implemented for several years in Uganda. In recent years this approach has integrated management of other common childhood illnesses under integrated community case management (ICCM). In 2008 the Ministry of Health committed to revitalizing and expanding the VHT program to deliver ICCM. VHTs trainings began in 2010 and have been designed and implemented to cover diagnosis and treatment of pneumonia, malaria, diarrhea, and newborn care42F

43. ICCM training is typically provided for two of the four to five VHTs operating per village. The VHT ICCM health kit includes pre-packed AL, amoxicillin, oral rehydration salts and zinc, rectal artesunate, a respiratory timer, MUAC tape, and malaria RDTs. The United Nations Children’s Fund (UNICEF)/Uganda has supported iCCM activities in 19 districts43F

44.

40 Malaria Consortium. Reducing deaths from severe malaria, briefing note. http://www.malariaconsortium.org/media-downloads/328 41 Clinton Health Access Initiative. (2014). Case Study: Increasing uptake of the most effective treatment to reduce severe malaria mortality. Retrieved from: http://www.clintonhealthaccess.org/content/uploads/2015/08/Case-Study_Inj-AS-Uptake.pdf 42 UNITAID. Treating severe malaria in Uganda. Retrieved from: http://unitaid.org/en/resources/1536-treating-severe-malaria-in-uganda 43 Ministry of Health. (2010). Community case management of childhood malaria, pneumonia, and diarrhea: Implementation guidelines. As cited in KayemaKayemba CN, Sengendo HN, Ssekitooleko J et al. (2012). MJTMHIntroduction of newborn care within integrated community case management in Uganda. The American Journal of Tropical Medicine and Hygiene, 87(5 Suppl): 46-53. 44 President’s Malaria Initiative (2016). Uganda Malaria Operational Plan FY 2016. Accessed May 6, 2016. www.pmi.gov


http://www.pmi.gov/


Annex 3: Outlet Survey Methods

Design and Study Population ACTwatch implements repeat cross-sectional outlet surveys in project countries. The study population is defined as all outlets with the potential to sell or distribute antimalarial medicines and/or provide malaria blood testing. In Uganda, this includes the following outlet types:

Public health facilities

This category is comprised of government facilities including referral hospitals, county health centers (IV), sub-county health centers (III), and parish health centers (II).

Community health worker

Community medicine distributors including Village Health Team (VHT) workers. These health workers are community-based volunteers equipped with antimalarial treatment to be provided free of charge. They may be equipped with malaria rapid diagnostic tests. Community health workers are considered public sector outlets.

Private not-for-profit health facilities

Non-government or faith-based/mission health facilities including hospitals and health centers. These facilities provide diagnosis and treatment for a nominal service fee and are staffed by providers with health qualifications. They are considered public sector outlets.

Private for profit health facilities

Private hospitals, clinics, and diagnostic laboratories providing diagnosis and treatment at commercial rates. These facilities are typically registered and regulated by the Ministry of Health (Uganda Medical and Dental Practitioners Association and Nurses and Midwife Council).

Pharmacies Pharmacies are licensed and regulated by the National Drug Authority and are staffed by pharmacists and qualified health practitioners.

Drug stores Drug stores are smaller than pharmacies and typically stock a smaller range of medicines. Drug stores are authorized to sell over-the-counter medicines. These outlets should be registered and regulated by the National Drug Authority however an unknown proportion of drug stores are not registered. Licensed drug stores are staffed by qualified health dispensers or practitioners.

Stratification The national Uganda outlet survey was stratified to provide estimates for urban and rural areas. Explicit stratification by location (urban/rural) was used to ensure sufficient sample size for urban and rural estimates. Implicit stratification was used to achieve urban and rural samples that are similar to the population distribution with respect to malaria endemicity. Malaria endemicity classifications have been obtained from the National Malaria Control Program. Approximately 85% of Uganda is defined as holo- or hyper-endemic and for the purposes of this survey were classified as high endemic areas. Areas identified as hypo- or meso-endemic were classified as low endemic. The urban and rural sampling frames were sorted by malaria endemicity to achieve implicit stratification across malaria endemicity.

Eligibility Criteria The outlet survey conducted a census screening in sampled geographic areas of all outlets with the potential to sell or distribute antimalarials. This included all health facilities (public, private for-profit, private not-for-profit), village health team volunteers, pharmacies and drug shops. Outlets that were excluded from screening included service



providers that did not stock modern antimalarial medicine including traditional/spiritual healers and general retail outlets. Outlets that exclusively served the military and did not serve the general public were excluded from the study. Outlets were eligible for a provider interview and malaria product audit if they met at least one of three study criteria: 1) one or more antimalarials reportedly in stock the day of the survey; 2) one or more antimalarials reportedly in stock within the three months preceding the survey; and/or 3) provides malaria blood testing (microscopy or RDT). To participate in the study, the senior most provider at the outlet had to provide informed consent.

Sample Size The outlet survey was powered to detect a 15 to 20 percentage point change between 2013 and 2015 within each research domain (and nationally) in the indicator, the proportion of outlets that have quality-assured ACT in stock among all outlets with antimalarials in stock at the time of the survey. The required sample size for each research domain (urban and rural strata) was calculated in three steps: 1) determine the required number of antimalarial-stocking outlets; 2) determine the number of outlets to be enumerated to arrive at this number of antimalarial-stocking outlets; and 3) determine the number of clusters for the census to arrive at this number of outlets.

Required number of private sector antimalarial-stocking outlets The number of antimalarial-stocking outlets required to detect a change over time in availability of ACT between survey rounds is given by:

where:

n= desired sample size

P1= the proportion of antimalarial-stocking outlets with QA ACT/malaria blood testing available in stock in 2013 (see table below)

P2= the expected proportion of antimalarial-stocking outlets with QA ACT/malaria blood testing available in stock in 2015 (15 or 20 percentage point increase.

P= (P1+P2)/2

Zα/2= The standard normal deviate value for a α type I error (two-sided)

Z1-β= The standard normal deviate value for a β type II error

Deff= design effect anticipated due to the multi-stage cluster survey design. Design effects observed from the 2013 survey were used for sample size calculations.

QA ACT and malaria blood testing availability (weighted estimates), 2013 ACTwatch outlet survey, Uganda

QA ACT availability*

Malaria blood testing availability**

Urban

Public sector outlets 99.5% 66.7%

Public health facilities 98.5% 91.4%

Private sector outlets 89.0% 38.5%

Pharmacies 99.4% 56.3%

Drug shops 88.1% 8.9%

Rural

Public sector outlets 94.7% 59.5%

n = deff Za 2P(1- P) + Z1-b P1(1- P1)+ P2(1- P2 )éë

ùû

2

(P2 - P1)2



Public health facilities 93.5% 90.1%

Private sector outlets 74.1% 19.1%

Pharmacies 100% 51.2%

Drug shops 72.8% 13.2% * Among outlets with antimalarial(s) in stock on the day of the survey ** Among outlets with antimalarial(s) in stock on the day of they survey or within the past 3 months Required number of antimalarial-stocking outlets The estimated number of outlets enumerated needed for the QA ACT availability indicator was determined by the following formula for urban and rural domains separately:

where Pam is the proportion of outlets having antimalarial stocks at the time of the survey among all outlets enumerated. In this equation, the assumptions are as follows: N = desired sample size of all outlets for monitoring availability indicators, n is the number of outlets with antimalarial stocks at the time of the survey. Pam is the proportion of outlets having antimalarials in stock at the time of the survey among all outlets enumerated estimated from 2013 survey data for each of the urban and rural domains. The 2013 survey data indicate that 80% of urban outlets and 50% of rural outlets have antimalarials in stock at the time of the survey. The Pam values documented in the 2013 outlet survey and used for 2015 sample size calculations are summarized in the table below.

Proportion of enumerated outlets with antimalarials in stock, 2013 ACTwatch outlet survey (data not weighted), Uganda

In stock on the day of the survey

In stock on the day of the survey or within the

past 3 months

Urban

Public sector outlets 33% 38%

Public health facilities 97% 97%

Private sector outlets 89% 90%

Pharmacies 90% 90%

Drug shops 89% 91%

Rural

Public sector outlets 30% 32%

Public health facilities 96% 98%

Private sector outlets 84% 87%

Pharmacies 90% 90%

Drug shops 85% 86%

Required number of clusters (sub-counties) The primary sampling approach taken for ACTwatch outlet surveys entails sampling a set of administrative units (geographic clusters) with a population of approximately 10,000 to 15,000 inhabitants. Clusters were selected with cluster probability of selection proportionate to size (PPS). A census of all outlets with the potential to sell of distribute antimalarials was then conducted in sampled clusters. The most appropriate administrative unit in Uganda matching this desired population size was sub-county. In urban areas, sub-counties are town councils/divisions. In Kampala, parishes were used as the administrative unit for the sampling frame. The average numbers of outlets by outlet type in urban and rural sub-counties screened during the 2013 outlet survey were used to estimate the number of clusters required in 2015 to achieve the desired sample sizes. In 2013, the numbers of outlets per sub-county enumerated were as follows: all public 30.2 urban, 117.7 rural; public health facilities: 1.7 urban, 3.3 rural; all private: 79.2 urban, 26.7 rural; private for-profit health facilities: 33.6 urban, 3.2 rural; pharmacies: 5.1 urban, 0.1 rural; and drug shops: 40.5 urban, 23.5 rural. Considering sample size requirements

amPnN /



to detect change over time and average numbers of outlets across each outlet type, the optimal minimum number of sub-counties required to reach desired numbers of outlets was 14 urban and 34 rural sub-counties.

Sampling A representative sample of sub-counties (14 urban and 34 rural) was selected in each research domain. From a list of all sub-counties in each domain, the required number of sub-counties was selected with probability proportional to size (PPS). There are three levels of urbanicity in Uganda, in the order of increasing size: town council, municipality, and city. As Kampala and municipalities are large urban areas, the total population is typically far higher than the average populations in other sub-counties. As such for the urban sampling frame, town councils, divisions within municipalities, and parishes in Kampala were considered as sub-counties. This was necessary to harmonize population sizes in selected areas. Implicit stratification was used within each domain to ensure proportional allocation of sub-counties from high and low endemic areas. Selection of sub-counties with PPS was completed based on population estimates obtained from the 2014 Housing and Population Census. A sampling frame with population sizes was used for selecting the sample because accurate estimates on the total number of outlets per geographic/administrative unit that may be eligible for a medicine outlet survey do not exist. The major assumption in using population figures for sampling was that distribution of outlets and/or distribution of medicines moving through outlets in a given cluster was correlated with population size. Within each sub-county, a census of all outlets with the potential to sell or distribute antimalarials and/or provide malaria blood testing (excluding general retail outlets) was conducted. The census approach taken within 48 sub-counties yielded sufficient sample sizes for key outlet types including rural public health facilities. However, to achieve a sufficient sample size for estimating key indicators within urban public health facilities and pharmacies, the geographic area for the census of urban public health facilities and pharmacies was extended to the county level. To ensure that all urban public health facilities within the county were included in the study, a list of public health facilities was obtained from the MOH and verified at district health departments. A list of selected sub-counties is provided in Annex 4.

Data Collection Interviewers, supervisors, and quality controllers received training that included an orientation to the study, questionnaire, and classroom training on completing antimalarial and RDT audits, and a field exercise. Following training, data collection was implemented from May 18, 2015 to July 2, 2015. For all interviews, a structured questionnaire was administered electronically on Samsung Grand Neo phones using DroidDB (© SYWARE Inc., Cambridge, MA). The questionnaire is available in Annex 6. A series of screening questions were administered at all outlets to determine eligibility for the survey. Outlets where antimalarial medicines were reportedly sold and/or malaria blood testing was reportedly provided were invited to participate in the survey. Following informed consent procedures, an audit of all available antimalarial medicines and RDTs was conducted. Antimalarial audit information included formulation, package size, brand name, active ingredients and strengths, manufacturer, country of manufacture, reported sale/distribution in the week preceding the survey, retail price, and wholesale price. RDT audit information included brand name, manufacturer, country of manufacture, reported sale/distribution in the week preceding the survey, retail price, and wholesale price. Detailed descriptions of antimalarials and RDTs audited are provided in Annex 7 and Annex 8. In addition to the product audit, a series of questions was administered to the senior-most provider regarding malaria case management knowledge and practices as well as provider training and qualifications. Geo-coordinates were collected for each outlet using the mobile phone. Up to three visits were made to all outlets to complete the screening process, audit, and provider interview as needed (e.g. where outlets were closed or providers were not available).

Data Entry, Processing, and Analysis



Data collection was completed on Samsung Grand Neo phones using DroidDB (© SYWARE Inc., Cambridge, MA). All data cleaning and analysis was completed using Stata 13.1 (©StataCorp, College Station, TX). Sampling weights were applied to account for variations in probability of selection (see Annex 9) and standard error estimation accounted for clustering at the ward and district levels. Indicator definitions are provided in Annex 10.

Protection of Human Subjects The 2015 outlet survey protocol received ethical approval from the Ethical Review Board of Makerere University Medical School. Provider interviews and product audits were completed only after administration of a standard informed consent form and provider consented to participate in the study. Providers had the option to end the interview at any point during the study. Standard measures were employed to maintain provider confidentiality and anonymity.



Annex 4: Sampled Sub-Counties

Table X1. Sampled Sub-Counties District County Sub-County Urban/Rural Endemicity Population

ABIM LABWOR MORULEM RURAL HIGH 23204

ALEBTONG MOROTO OMORO RURAL HIGH 43411

AMURIA AMURIA AMURIA TOWN COUNCIL URBAN HIGH 7,066

AMURU KILAK PABO RURAL HIGH 53997

ARUA AYIVU PAJULU RURAL HIGH 60210

BUDAKA IKI IKI IKI-IKI RURAL HIGH 18665

BUDUDA MANJIYA BUSHIKA RURAL LOW 31530

BUIKWE BUIKWE KAWOLO RURAL HIGH 40396

BULIISA BULIISA BIISO RURAL HIGH 16595

BUSHENYI

BUSHENYI-ISHAKA MUNICIPLE

COUNCIL CENTRAL DIVISION URBAN HIGH 16,646

BUTALEJA BUNYOLE BUSABA RURAL HIGH 24813

BUYENDE BUDIOPE KIDERA RURAL HIGH 64748

GULU GULU MUNICIPLE COUNCIL PECE DIVISION URBAN HIGH 48,405

GULU OMORO LALOGI RURAL HIGH 30117

HOIMA BUGAHYA KIGOROBYA RURAL LOW 68402

HOIMA HOIMA MUNICIPLE COUNCIL BUSIISI DIVISION URBAN LOW 19,261

ISINGIRO BUKANGA ENDIINZI RURAL LOW 23525

JINJA BUTEMBE MAFUBIRA RURAL HIGH 78895

KABALE NDORWA RUBAYA RURAL LOW 27727

KABAROLE BURAHYA KICWAMBA RURAL LOW 35100

KABAROLE

FORT PORTAL MUNICIPLE

COUNCIL EASTERN DIVISION URBAN LOW 18,625

KALANGALA BUJUMBA MUGOYE RURAL HIGH 12253

KAMPALA CAPITAL

CITY KAWEMPE DIVISION KAWEMPE II URBAN LOW 19,000

KAMPALA CAPITAL

CITY LUBAGA DIVISION KASUBI URBAN LOW 63,200

KAMPALA CAPITAL

CITY MAKINDYE DIVISION BUKASA URBAN LOW 28,500

KAMPALA CAPITAL

CITY MAKINDYE DIVISION NSAMBYA CENTRAL URBAN LOW 43,800

KAMPALA CAPITAL

CITY NAKAWA DIVISION MUTUNGO URBAN LOW 63,200

KAMULI BUGABULA KAMULI TOWN COUNCIL URBAN HIGH 17,725

KAMULI BUGABULA NABWIGULU RURAL HIGH 50488

KAMWENGE KITAGWENDA KICHECHE RURAL HIGH 26883

KASESE BUSONGORA MUHOKYA RURAL HIGH 19531

KIBAALE BUGANGAIZI MPASAANA RURAL LOW 23948

KIBOGA KIBOGA KIBIGA RURAL HIGH 25686

KIRUHURA KAZO KANONI RURAL LOW 16851

KIRYANDONGO KIBANDA KIGUMBA TOWN COUNCIL URBAN HIGH 18,698

KITGUM CHUA NAMOKORA RURAL LOW 14040

KOBOKO KOBOKO LUDARA RURAL HIGH 31821

KUMI KUMI MUKONGORO RURAL HIGH 53466

KYEGEGWA KYAKA KYEGEGWA TOWN COUNCIL URBAN LOW 18,729

KYENJOJO MWENGE KIHUURA RURAL LOW 29214

LUUKA LUUKA BUKANGA RURAL HIGH 41822

LWENGO BUKOTO LWENGO TOWN COUNCIL URBAN HIGH 15,527



LWENGO BUKOTO KISEKKA RURAL HIGH 49185

MANAFWA BUBULO SISUNI RURAL LOW 4044

MASAKA BUKOTO KYANNAMUKAAKA RURAL HIGH 31540

MAYUGE BUNYA KITYERERA RURAL HIGH 47320

MBARARA

MBARARA MUNICIPLE

COUNCIL KAKOBA URBAN LOW 55,519

MBARARA RWAMPARA MWIZI RURAL LOW 34798

MITYANA MITYANA SSEKANYONYI RURAL HIGH 38323

MOYO WEST MOYO MOYO TOWN COUNCIL URBAN HIGH 10,507

MUBENDE BUWEKULA KIYUNI RURAL HIGH 35629

MUKONO MUKONO MPUNGE RURAL HIGH 14549

NAKASONGOLA BURULI LWAMPANGA RURAL HIGH 29741

NAMAYINGO BUKOOLI NAMAYINGO TOWN COUNCIL URBAN HIGH 15,741

NAPAK BOKORA LORENGECORA RURAL HIGH 11099

NTUNGAMO RUHAAMA RWEIKINIRO RURAL LOW 36620

NWOYA NWOYA KOCH-GOMA RURAL HIGH 35649

PADER ARUU LAPUL RURAL HIGH 19295

RAKAI KOOKI DDWANIRO RURAL HIGH 33021

RUKUNGIRI RUJUMBURA BUGANGARI RURAL HIGH 30800

SOROTI SOROTI ARAPAI RURAL HIGH 40403

SOROTI SOROTI MUNICIPAL COUNCIL EASTERN DIVISION URBAN HIGH 18,695

TORORO TORORO OSUKURU RURAL HIGH 46612

WAKISO BUSIRO WAKISO TOWN COUNCIL URBAN LOW 60,911

WAKISO BUSIRO NSANGI RURAL LOW 197991

WAKISO KYADONDO KIRA TOWN COUNCIL URBAN LOW 313,761

WAKISO KYADONDO MAKIDYE-SSABAGABO RURAL LOW 284067

YUMBE ARINGA KURU RURAL HIGH 42682



Annex 5: Detailed Sample Description

Table X2: Detailed sample description




Facility

Private For-Profit


ALL Outlets

Number of outlets screened (Figure 1 Box B) 282 5618 55 1023 493 1967 9438

Urban 137 772 21 567 437 627 2561

Census 33 772 21 567 133 627 2153

Booster 104 0 0 0 304 0 408

Rural 145 4846 34 456 56 1340 6877

Census 145 4846 34 456 28 1340 6849

Booster 0 0 0 0 28 0 28

Number of outlets eligible and interviewed (Figure 1 Box D) 281 1012 54 980 476 1921 4724

Urban 136 139 20 539 422 614 1870

Census 33 139 20 539 129 614 1474

Booster 103 0 0 0 293 0 396

Rural 145 873 34 441 54 1307 2854

Census 145 873 34 441 28 1307 2828

Booster 0 0 0 0 26 0 26 Number of outlets eligible but not interviewed (interview non-participation) 0 3 0 19 15 19 56

Urban 0 1 0 13 13 9 36

Census 0 1 0 13 2 9 25

Booster 0 0 0 0 11 0 11

Rural 0 2 0 6 2 10 20

Census 0 2 0 6 0 10 18

Booster 0 0 0 0 2 0 2

Number of interviewed outlets with at least one antimalarial in stock on the day of the survey (Figure 1, Box D1) 275 719 53 956 476 1849 4328

Urban 134 104 20 524 422 597 1801

Census 32 104 20 524 129 597 1406

Booster 102 0 0 0 293 0 395

Rural 141 615 33 432 54 1252 2527

Census 141 615 33 432 28 1252 2501

Booster 0 0 0 0 26 0 26



Table X2: Detailed sample description




Facility

Private For-Profit


ALL Outlets

Number of interviewed outlets with at least one antimalarial in stock on the day of the survey or at least one antimalarial reportedly in stock in the previous 3 months (Figure 1 sum of Box 1 and Box 2) 280 900 54 967 476 1921 4598

Urban 136 120 20 528 422 614 1840

Census 33 120 20 528 129 614 1444

Booster 103 0 0 0 293 0 396

Rural 144 780 34 439 54 1307 2758

Census 144 780 34 439 28 1307 2732

Booster 0 0 0 0 26 0 26

Number of interviewed outlets that provide malaria blood testing, but do not stock antimalarial medicines (Figure 1 Box D3) 1 112 0 13 0 0 126

Urban 0 19 0 11 0 0 30

Census 0 19 0 11 0 0 30

Booster 0 0 0 0 0 0 0

Rural 1 93 0 2 0 0 96

Census 1 93 0 2 0 0 96

Booster 0 0 0 0 0 0 0

Proportion of eligible and interviewed antimalarial-stocking outlets with at least one provider with a health-related qualification*

100 95.82 100 99.47 99.35 97.22 97.93

Urban 100 99.04 100 99.42 99.27 98.65 99.16

Census 100 99.04 100 99.42 99.19 98.65 99.07

Booster 100 - - - 99.30 - 99.48

Rural 100 95.28 100 99.54 100 96.55 97.06

Census 100 95.28 100 99.54 100 96.55 97.03

Booster - - - - 100 - 100

* Health-related qualifications include: medical doctor, pharmacist, nurse, midwife, lab/pharmacy technologist.

Source: ACTwatch Outlet Survey, Uganda 2015.


OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


Annex 6: Questionnaire

ACTwatch Outlet Survey UGANDA 2015

Section 1: Census Information

Interviewer completes this section for all outlets.

Outlet ID: Interviewer-District- County-Sub-county-Outlet ID [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]

C1. Today’s date (dd/mm/yyyy) [___|___]-[___|___]-[_2_|_0_|_1_|_5_]

C2. Interviewer’s name [_______________________________________________] C2a. Interviewer’s code [___|___]

C3. District [________________________________________________________] C3a. District code [___|___]

C4. County [_________________________________________________________] C4a. County code [___|___|___]

C5. Sub-county [______________________________________________________] C5a. Sub-county code[___|___|___|___]

C6. Name of outlet If no name, record “no name” or owner’s name

[__________________________________________________________________] C6a. Outlet code [___|___|___]

C7. Type of Outlet

01 National Referral Hospital 02 Regional Referral Hospital 03 District / General Hospital 04 Health Centre IV – County 05 Health Centre III – Sub-county 06 Health Centre II – Parish

07 Community Medicine Distributor

08 Pharmacy 09 Drug shop / Drug store

10 Private hospital 11 Private clinic / domiciliary / midwife 12 NGO/Mission hospital 13 NGO/Mission clinic

14 Private diagnostics lab (lab only) 15 NGO/Mission diagnostics lab (lab only)

96 Other (specify)

[_______________________________]

[___|___]

C8. Is this area part of the booster sample? 1 = Yes 0 = No [___] Hello, my name is __________, I work on behalf of the Programme for Accessible Health, Communication and Education, PACE. We are conducting a study on the availability of antimalarial medicines and diagnostic testing services. The results will be used to improve the availability of appropriate antimalarial treatment in Uganda. I would like to ask you a few questions to see if you could be part of the survey.

Section 2: Screening & Eligibility

S1. Do you have any medicines in stock today?

1 = Yes Go to S3 0 = No

[___]

S2. Are there any medicines that are out of stock today, but that you stocked in the past 3 months?

1 = Yes Go to S4 0 = No Go to S5 8 = Don’t know Go to S5

[___]

S3. Do you have any antimalarial medicines in stock today?

1 = Yes Provide information sheet & gain consent. Record start time in C9. Proceed to Section 3: Antimalarial Audit.

0 = No Verify with prompt card. Go to S4

[___]

S4. Are there any antimalarial medicines that are out of stock today, but that you stocked in the past 3 months?

1 = Yes Provide information sheet & gain consent. Record start time in C9. Proceed to A16. 0 = No Verify with prompt card. Go to S5 8 = Don’t know Verify with prompt card. Go to S5

[___]

S5. Are you offering any diagnostic services or selling any diagnostic tests here today?

1 = Yes Go to S6 0 = No Verify with prompt card. Record details in C9 then complete Sec 7: ORS & Zinc then Sec X: Ending Interview

[___]

S6. Are any of these services or tests for suspected malaria?

1 = Yes Provide information sheet & gain consent. Record start time in C9. Proceed to Section 4: Diagnostic Audit

[___]


OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


0 = No Verify with prompt card. Record details in C9 then complete Sec 7: ORS & Zinc and Sec X: Ending Interview

Before proceeding to the full interview ensure you have given the respondent a study information sheet, explained the study and obtained informed consent C9: Result of Visit(s)

Date (dd/mm/yy)

Visit 1 Visit 2 Visit 3

[___|___]-[___|___]-[_1_|_5_] [___|___]-[___|___]-[_1_|_5_] [___|___]-[___|___]-[_1_|_5_]

Time started (in 24hr clock) [___|___]:[___|___] [___|___]:[___|___] [___|___]:[___|___]

Time completed (in 24hr

clock) [___|___]:[___|___] [___|___]:[___|___] [___|___]:[___|___] Result [___|___] [___|___] [___|___]

01 = Outlet eligible & survey completed go to E1 02 = Outlet ineligible: does not meet any screening criteria go to E1 03 = Interview interrupted go to C11 04 = Respondent not available/time not convenient go to C11 05 = Outlet not open at the time go to C11 06 = Outlet closed permanently go to E1 96 = Other

(specify):[_________________________________________________________] 97 = Refused go to C10

C10. If the provider refused, why?

1 = Client load Ask respondent for a time they would prefer to be interviewed and note in C11 2 = Thinks it’s an inspection / nervous about license go to E1 3 = Not interested go to E1 6 = Other (specify):[___________________________________________________________________] 7 = Refuses to give reason go to E1

[___]

C11. Use this space to record call back details. If it is not possible to complete the interview at another time, go to E1.

Section 7: ORS, Zinc & Amoxicillin: Read to the provider: I have just a few questions for you about availability of

treatments for diarrhea and pneumonia ORS1. Do you have any oral rehydration salts, also known as ORS in stock today? Verify with prompt card.

1 = Yes 0 = No

[___]

ORS2. Do you have any zinc tablets for treatment of diarrhea in children in stock today? Verify with prompt card.

1 = Yes 0 = No Go to AB1

[___]

ORS3. Which strength of zinc tablets for treatment of diarrhea in children do you have in stock today?

Read list, circle ALL that apply 10mg

20mg

Other(specify ):[______________________________________]

A

B

C

ORS4. Do you have any ORS that is packaged together with zinc treatment for diarrhea in children in stock today? Verify with prompt card

1 = Yes 0 = No

[___]

AB1. Do you have any antibiotics in stock today? 1 = Yes

0 = No

[___]

AB2. Do you have any amoxicillin dispersible tablets, also known as Amox DT? Show prompt card. Interviewer ask to see the product and verify that it is dispersible amoxicillin

1 = Yes 0 = No Go to C9 – Results of visit

[___]


OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


AB3. Which strength of amoxicillin dispersible tablets (Amox DT) do you have in stock today?

Read list, circle ALL that apply

125mg

250mg

Other(specify ):[______________________________________]

A

B

C

THANK THE PROVIDER AND END INTERVIEW

Section X: Ending the interview

E1. Name of interviewee:

[________________________________________________________]

5 = Not applicable, no respondent; 7 = Refused

E2. Physical address or location identifiers of outlet (not PO box)(Give detailed description that will help supervisor to find the outlet)

E3. Telephone number

[___|___|___|___|___|___|___|___|___|___]

9999999995 = N/A: no respondent or has no telephone 9999999997 = Refused

E4.Latitude: [__] - [___|___] . [___|___|___|___|___|___|___|___]

E5.Longitude: [_E_] - [___|___] . [___|___|___|___|___|___|___|___]

E7. Additional observations by interviewer (if any)



Section 3: Antimalarial Audit

A0. Read to the provider: Can you please show us the full range of antimalarials that you currently have in stock? Do you currently have any of the following? Prompt entire list using antimalarial prompt card; No response to be recorded.

Artemether lumefantrine, such as Lonart, Artefan, Lumartem, Coartem, Lumaren

Artesunate amodiaquine, such as DUAC, Coarsucam, Winthrop

Other artemisinin combination therapies, such as Arco

Artemether monotherapies, such as Larither, Artemether Rtitas, Artemedine, Artenam, Romether

Artesunate monotherapies, such as Plasmotrim, Artesun, G-Sunate

Chloroquine, such as Sugaquin, Mediquine, Kam quin, Bioquin, Renequin, Maxaquin, Oroquin

SP, such as Fansidar, Malaren, Kamsidar, Agosidar, Neosidar

Quinine, such as Quinas, Quine, Quinfer

Amodiaquine, such as Amobin

Mefloquine, such as Mephaquin, Meflotas

Syrups or suspensions, such as Quinine-K, Quinimix ,Requin, Ago-quinine ,Co-malartem suspension, Ago-CQ

Injectables, such as Rogoquin, Artemether, Quinax, Larither, Kwinil

Granules or powders, such as Artequin, Artesun

If the outlet has no antimalarials in stock cross-check screening results then proceed to question A16.

Proceed to the antimalarial audit. Different antimalarial audit sheets will be used to record the antimalarial information based on the dosage form of the medicine. Separate the antimalarials into two piles:

The first pile should contain all the antimalarials in the form of tablets, suppositories, or granules. Use the Tablets, Suppositories & Granules Drug Audit Sheet to record these.

The second pile should contain all the antimalarials in any form other than tablets, suppositories or granules. Use the Non-Tablet Drug Audit Sheet to record these.

If additional audit sheets are used, add these sheets after the ones provided and staple the questionnaire again. All pages should be in order before you move onto the next outlet. Number each drug by assigning a Product Number (starting from 1 for TSG drugs and again from 1 for NT drugs). Number each audit sheet used in the spaces provided at the bottom of the page.

ADDITIONAL NOTES ON THE SUB-OUTLET CODE

In all outlets, complete the Sub-Outlet Code (as well as the Product Number) for each drug audited. These codes are listed below.

SUB-OUTLET CODES

X ALL outlets that have only ONE dispensing/distribution point for medicines/diagnostics

A Outpatient department / dispensary/Main pharmacy (if used by all patients)

B Adult outpatient department / adult dispensary / adult clinic

C Child outpatient department / child dispensary / child clinic

D Antenatal / maternity clinic/MCH

E ART / HIV/AIDS clinic

G Private dispensing unit within a public health facility

L Laboratory (for RDT audit)

Z Other (specify the type in the space for audit comments –TSG 15 or NT 15)


TABLET, SUPPOSITORY & GRANULE DRUG AUDIT SHEET (TSG)OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


Sub-outlet code [_____] _______ Product number [__|__]

[__|__]

[__|__]

[__|__]

1. Generic name

2. Strength [__|__|__].[__]mg [__|__|__].[__]mg [__|__|__].[__]mg

2a. Is this base strength? [__] 1 = Yes [__] 0 = No 8 = Don’t know [__] If no, specify salt: [________________________]

3. Dosage form/formulation 1 = Tablet

2 = Suppository

3 = Granule

[___]

4. Brand name (Include weight and age information)

[__|__]

5. Manufacturer

6. Country of manufacture

7. Package size There are a total of [___|___|___|___] tablets/ suppositories/ granule sachets in each:

1 = Package

2 = Pot/tin

[___]

8. Is product a fixed-dose combination (FDC) 1 = Yes

0 = No

8 = Don’t know

[___]

9. Does product have the Green leaf logo? 1 = Yes

0 = No

8 = Don’t know

[___]

10. Amount sold/distributed in the last 7 days to individual consumers (Record # of packages / tins described in Q7 OR record the total # of tablets / suppositories / granule packs sold) This outlet sold [___|___|___] packages/ tins in the last 7 days OR This outlet sold [___|___|___] tablets/ suppositories or granule sachets in the last 7 days Not applicable = 995; Refused = 997; Don’t know = 998

11. Stocked out at any point in the past 3 months? 1 = Yes

0 = No

8 = Don’t know

[___]

[__|__|__]

12. Retail selling price [___|___|___] tablets, suppositories or granule sachets cost an individual customer [___|___|___|___|___] USH

13. Wholesale purchase price For the outlet’s most recent wholesale purchase [___|___|___|___] tablets, suppositories or granule sachets cost [___|___|___|___|___|___] USH

14. Why do you stock this medicine [SHOW PRODUCT]? Do not read list. Circle ALL responses given

Free supply A

Profitable B

Recommended by the government C

Low price D

Customer demand or preference E

Positive brand reputation F

Often prescribed by doctors G

Most effective for treating malaria H

Don’t know X

Other Z

specify [_________________________________]

15. Comments

Free = 00000 Refused = 99997 Don’t

know = 99998

Free = 000000 Refused = 999997

Don’t know = 999998

Tablet Audit Sheet [__|__] of [__|__]


TABLET, SUPPOSITORY & GRANULE DRUG AUDIT SHEET (TSG)OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]



[__|__]

[__|__]

[__|__]

1. Generic name

2. Strength [__|__|__].[__]mg [__|__|__].[__]mg [__|__|__].[__]mg

2a. Is this base strength? [__] 1 = Yes [__] 0 = No 8 = Don’t know [__] If no, specify salt: [________________________]

3. Dosage form/formulation 1 = Tablet

2 = Suppository

3 = Granule

[___]


[__|__]

5. Manufacturer

6. Country of manufacture

7. Package size There are a total of [___|___|___|___] tablets/ suppositories/ granule sachets in each:

1 = Package

2 = Pot/tin

[___]

8. Is product a fixed-dose combination (FDC) 1 = Yes

0 = No

8 = Don’t know

[___]

9. Does product have the Green leaf logo? 1 = Yes

0 = No

8 = Don’t know

[___]

10. Amount sold/distributed in the last 7 days to individual consumers (Record # of packages / tins described in Q7 OR record the total # of tablets / suppositories / granule packs sold) This outlet sold [___|___|___] packages/ tins in the last 7 days OR This outlet sold [___|___|___] tablets/ suppositories or granule sachets in the last 7 days Not applicable = 995; Refused = 997; Don’t know = 998


0 = No

8 = Don’t know

[___]

[__|__|__]

12. Retail selling price [___|___|___] tablets, suppositories or granule sachets cost an individual customer [___|___|___|___|___] USH

13. Wholesale purchase price For the outlet’s most recent wholesale purchase [___|___|___|___] tablets, suppositories or granule sachets cost [___|___|___|___|___|___] USH


Free supply A

Profitable B


Low price D





Don’t know X

Other Z

specify [_________________________________]

15. Comments

Free = 00000 Refused = 99997 Don’t

know = 99998

Free = 000000 Refused = 999997


Tablet Audit Sheet [__|__] of [__|__]


NON-TABLET DRUG AUDIT SHEET (NT): SYRUP, SUSPENSION, INJECTIONS & othersOUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-

[___|___|___]



[__|__]

[__|__]

[__|__]

1. Generic name

2. Strength [__|__|__|__].[__]mg/[__|__|__] .[__]mL [__|__|__|__].[__]mg/[__|__|__] .[__]mL [__|__|__|__].[__]mg/[__|__|__] .[__]mL (Note: no mL recorded for powder injection)

2a. Is this base strength? [__] 1 = Yes [__] 0 = No 8 = Don’t know [__] If no, specify salt: [______________________]

3. Dosage form/formulation 1 = Syrup

2 = Suspension

3=Liquid injection

4 =Powder injection

5 = Drops

6 = Other (specify) [___________]

[___] [__|__]


5. Manufacturer 6. Country of manufacture 7. Package size There are a total of [___|___|___|___].[__] mL (or mg for powder injections) in each:

1 = Bottle

2 = Ampoule/vial

[___]

9. Does this product have the Green leaf logo? 1 = Yes

0 = No

8 = Don’t know

[___]

10. Amount sold/ distributed in the last 7 days to individual consumers This outlet sold [___|___|___|___] bottles, ampoules or vials in the last 7 days Refused = 9997; Don’t know = 9998


0 = No

8 = Don’t know

[___]

[__|__|__]

12. Retail selling price [___|___|___] bottles ampoules or vials cost an individual customer [___|___|___|___|___] USH

13. Wholesale purchase price For the outlet’s most recent wholesale purchase: [___|___|___|___] bottles, ampoules or vials cost [___|___|___|___|___|___] USH


Free supply A

Profitable B


Low price D





Don’t know X

Other Z

specify [_________________________________]

15. Comments

Free = 00000 Refused = 99997


Free = 000000 Refused = 999997


Non-Tablet Audit Sheet [___|___] of [___|___]


NON-TABLET DRUG AUDIT SHEET (NT): SYRUP, SUSPENSION, INJECTIONS & othersOUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-

[___|___|___]



[__|__]

[__|__]

[__|__]

1. Generic name

2. Strength [__|__|__|__].[__]mg/[__|__|__] .[__]mL [__|__|__|__].[__]mg/[__|__|__] .[__]mL [__|__|__|__].[__]mg/[__|__|__] .[__]mL (Note: no mL recorded for powder injection)

2a. Is this base strength? [__] 1 = Yes [__] 0 = No 8 = Don’t know [__] If no, specify salt: [______________________]

3. Dosage form/formulation 1 = Syrup

2 = Suspension

3=Liquid injection

4 =Powder injection

5 = Drops

6 = Other (specify) [___________]

[___] [__|__]


5. Manufacturer 6. Country of manufacture 7. Package size There are a total of [___|___|___|___].[__] mL (or mg for powder injections) in each:

1 = Bottle

2 = Ampoule/vial

[___]

9. Does this product have the Green leaf logo? 1 = Yes

0 = No

8 = Don’t know

[___]

10. Amount sold/ distributed in the last 7 days to individual consumers This outlet sold [___|___|___|___] bottles, ampoules or vials in the last 7 days Refused = 9997; Don’t know = 9998


0 = No

8 = Don’t know

[___]

[__|__|__]

12. Retail selling price [___|___|___] bottles ampoules or vials cost an individual customer [___|___|___|___] KSH

13. Wholesale purchase price For the outlet’s most recent wholesale purchase: [___|___|___|___] bottles, ampoules or vials cost [___|___|___|___|___] KSH


Free supply A

Profitable B


Low price D





Don’t know X

Other Z

specify [_________________________________]

15. Comments

Free = 0000 Refused = 9997

Don’t know = 9998

Free = 00000 Refused = 99997


Non-Tablet Audit Sheet [___|___] of [___|___]


OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


Antimalarials recently in stock

A16. Are there any antimalarial medicines that are out of stock today, but that you stocked in the past 3 months?

1 = Yes go to A17 0 = No go to Section 4: Diagnostic Audit 8 = Don’t know go to Section 4: Diagnostic Audit

[___]

A17. What are the names of the treatments that are out of stock? Will accept generic or brand names. Record one medicine per line.

1 = Yes, specify

[_______________________________________] [_______________________________________]

[_______________________________________] [_______________________________________]

[_______________________________________] [_______________________________________]

[_______________________________________] [_______________________________________]

[_______________________________________] [_______________________________________]

0 = No, provider can’t remember

[___]

Interviewer: Go to Section 4: Diagnostic Audit


OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


Section 4: Diagnostic Audit This section is about availability of malaria blood testing. Completing the questions may require speaking with more than 1 staff member at the outlet. If the respondent does not know the answer to a question in this section, ask to speak with another staff member who can provide the information.

D1. Does this outlet/facility have disposable gloves available today for staff to use when seeing customers/patients?

1 = Yes 0 = No 8 = Don’t know

[___]

D2. Does this outlet/facility have a sharps container, also called a sharps disposal box or safety box, available today for staff to use?


[___]

D3. Is malaria microscopic testing available here today?

1 = Yes 0 = No go to D7

[___]

D4. How many people were tested for malaria at this facility/outlet using microscopy within the past 7 days?

997 = Refused; 998 = Don’t know [___|___|___]

D5. What is the total cost for a microscopic test for malaria for an adult: [___|___|___|___|___] USH

Free = 00000; NA =99995; Refused = 99997; Don’t know=99998

D6. What is the total cost for a microscopic test for malaria for a child under five: [___|___|___|___|___] USH

Free = 00000; NA = 99995; Refused = 99997; Don’t know=99998

D7. Malaria rapid diagnostic tests, also called RDTs, are small, individually wrapped blood tests that are able to quickly diagnose whether a person has malaria. Show RDT images in prompt card

Are malaria RDTs available here today?

1 = Yes 0 = No go to D9 Don’t know ask to speak with a respondent who has this information

[___]

D8. Please show us the full range of RDTs that you currently have in stock. Do you currently have any of the following? Read entire list; No response to be recorded.

SD Bioline, Wondfo One Step, Nova test, AStel P.f

First Response, ParaCheck, Maleriscan, CTK on site rapid test

Proceed to the RDT audit. If additional audit sheets are used, add these sheets after the ones provided and staple the questionnaire again. All pages should be in order before you move onto the next outlet.

Number each RDT by assigning a Product Number. Number each audit sheet used in the spaces provided at the bottom of the page.

Complete the Sub-outlet Code as well as the Product Number for each RDT audited. Sub-outlet codes are listed on page 4.


RAPID DIAGNOSTIC TEST AUDIT SHEET (RDT) OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


Sub-outlet code [_____] Product number [__|__]

1. Brand name

2. Antigen test

(circle ALL that apply)

HRP2 A

pLDH B

Aldolase C

Not indicated Z

3. Parasite species (circle ALL that apply)

Pf A

Pv B

Po C

pm D

pan E

vom/Pvom F

Other G

Specify [__________________]

Not indicated Z

4. Manufacturer

5. Country of Manufacture

5b. Product Catalogue Number

6. Lot Number 6b. Is this a self test kit, with each test kit co-packaged with its own buffer, pipette and lancet? 1 = Yes 0 = No 8 = Don’t know [___]

13. Number of tests sold/ distributed /used in the last 7 days to individual consumers (Record total # of tests) This outlet sold or distributed [___|___|___|___] tests in the last 7 days

Refused = 9997; Don’t know=9998

14. Has this test been stocked out at any point in the past 3 months? 1 = Yes 0 = No 8 = Don’t know

[___]

15a. Do you or other staff use this brand of RDT to test clients here at this facility/outlet?

1 = Yes 0 = No go to 16a 8 = Don’t know go to 16a

[___]

15b. If yes, what is the total cost for an adult to have a test conducted with this RDT, including RDT cost and service fee? [___|___|___|___|___] USH 15c. If yes, what is the total cost for a child under the age of five to have a test conducted with this RDT, including RDT cost and service fee? [___|___|___|___|___] USH

16a. Does this facility/outlet provide this brand of RDT for clients to take away for testing somewhere else?

1 = Yes 0 = No go to 17 8 = Don’t know go to 17 [___]

16b. If yes, what is cost of this RDT for an adult? [___|___|___|___|___] USH 16c. If yes, what is the cost of this RDT for a child under the age of five? [___|___|___|___|___] USH

17. Wholesale purchase price For the outlet’s most recent wholesale purchase: [___|___|___|___] tests

cost [___|___|___|___|___|___] USH

Free = 000000 NA = 999995

Refused = 999997 Don’t know=999998

18. Why do you stock this RDT [SHOW RDT]? Do not read list Circle ALL responses given Free supply A

Profitable B


Low price D



Don’t know X

Other Z

specify [_______________________________]

13. Comment

Free = 00000; NA = 99995; Refused = 99997; Don’t know=99998


RAPID DIAGNOSTIC TEST AUDIT SHEET (RDT) OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]


RDT Audit Sheet [___|___] of [___|___]



RDT stock outs

D9. Are there any malaria RDTs that are out of stock today, but that you stocked in the past 3 months?

1 = Yes 0 = No go to D11 8 = Don’t know go to D11

[___]

D10. What are the brand names of the malaria RDTs that are out of stock? Record one brand per line.

1 = Yes, specify

[____________________________________________________________________________]

[____________________________________________________________________________]

[____________________________________________________________________________]

0 = No, provider can’t remember

[___]

D11. Does this facility/outlet provide medicines or prescription for medicines? 1 = Yes go to Section 5: Provider Module 0 = No check that S1 is no and S2 is no (the outlet has no medicines/had no

medicines recently) and that C7 is 14 or 15. Go to Section 7: ORS and ZINC and then Go to Section 6: Audit Tracking Sheet.

[___]



Section 5: Provider Module This section is for the senior-most staff member who is responsible for providing treatment, prescriptions or medicines to clients/patients.

P1. Do your responsibilities at this outlet/facility include: providing prescriptions, treatment, or medicines to clients?

1 = Yes No ask to speak with the senior-most person at the outlet with 1 or more of these

responsibilities.

|___]

P2. For how many years have you worked in this outlet/facility? If less than 1 year, enter 01

[___|___]

P3. What age are you today? Write age in years 97 = Refused 98 = Don’t know

[___|___]

P4. Don’t read: Is respondent male or female?

1 = Male 2 = Female

[___|___]

P5. What is the highest level of education you completed?

1 = No formal education 2 = Some primary school 3 = Completed primary school 4 = Some secondary school 5 = Completed secondary school 6 = Some university/college 7 = Completed a university/college degree/diploma

[___]

P6. Have you received any training in the last 12 months that included a component on malaria diagnosis, including malaria rapid diagnostic tests or microscopy?

Include pre-service training and stand-alone workshops.


[___]

P7. Have you received any training in the last 12 months on the national treatment guidelines for malaria? Include pre-service training and stand-alone workshops.


[___]

P8. Do you have any of the following health qualifications? Read list. Record 1 for yes, 0 for no

I. Dispenser (diploma in Pharmacy) [___]

II. Pharmacist (Degree in Pharmacy) [___]

III. Medical doctor [___]

IV. Clinical Officer [___]

V. Nurse / Nursing Officer [___]

VI. Midwife [___]

VII. Laboratory technician / Lab assistant [___]

VIII. Pharmaceutical technologist [___]

IX. Pharmacy technician [___]

X. Public Health Technician/Officer [___]



XI. Health Assistant, Medical Assistant / Nursing Assistant / Nursing Aid [___]

XII. Community Medicine Distributor/Village Health Team [___]

P9. Not including yourself, do any other people working in this outlet or facility have the following health qualifications? Read list. Record 1 for yes, 0 for no, 8 for don’t know

I. Dispenser (Diploma in Pharmacy) [___]

II. Pharmacist (Degree in Pharmacy) [___]

III. Medical doctor [___]

IV. Clinical Officer [___]

V. Nurse / Nursing Officer [___]

VI. Midwife [___]

VII. Laboratory technician / Lab assistant [___]

VIII. Pharmaceutical technologist [___]

IX. Pharmacy technician [___]

X. Public Health Technician/Officer [___]

XI. Health Assistant, Medical Assistant / Nursing Assistant / Nursing Aid [___]

XII. Community Medicine Distributor/Village Health Team [___]

Interviewer: For the following questions record the antimalarial brand name or generic name, and dosage form, in the spaces provided. Ask the provider to show you the medicine if it is in stock to verify the name and dosage form.

P10. In your opinion, for treating uncomplicated malaria in adults, what is the most effective antimalarial medicine? Ask the provider to show you the medicine if it is in stock.

Generic or brand name

Dosage form/formulation

01 = Tablet 02 = Suppository 03 = Granule

04 = Syrup 05 = Suspension 06 = IM/IV Injection (liquid or powder)

07 = Drops 95 = None specified 98 = Don’t know

[______________________________________]

Don’t know = 98

[___|___]

P11. In your opinion, for treating uncomplicated malaria in children under five, what is the most effective antimalarial medicine?

Ask the provider to show you the medicine if it is in stock.






[_______________________________________]

Don’t know = 98 [___|___]



P12. What antimalarial medicine for treating uncomplicated malaria in adults do you most often recommend to customers? Ask the provider to show you the medicine if it is in stock.






[______________________________________]

Don’t know = 98

[___|___]

P13. What antimalarial medicine for treating uncomplicated malaria in children under five do you most often recommend to customers?







[______________________________________]

Don’t know = 98

[___|___]

P14. In your opinion, for treating severe malaria in children under five, what is the most effective antimalarial medicine? Ask the provider to show you the medicine if it is in stock.






[_____________________________________]

Don’t know = 98

[___|___]

P15. What antimalarial medicine for treating severe malaria in children under five do you most often recommend to customers?







[_____________________________________]

Don’t know = 98

[___|___]



P16. Please name the first line medicine recommended by the government to treat uncomplicated malaria. Do not read list. Only one response allowed.

01 = Artemether Lumefantrine (Lonart, Artefan, Lumartem, Coartem) …………………………… Go to P17

02 = ACT................................................................................................................................ Go to P17

03 = ACTm............................................................................................................................. Go to P17

04 = Artesunate Amodiaquine (DUAC, Coarsucam, Winthrop)

05 = Dihydroartemisinin Piperaquine (Duo-cotecxin, P-alaxin)

06 = Amodiaquine

07 = Artemether(Artenam, Paluther, Artesiane, Larither)

08 = Artemisinin

09 = Artesunate (Artesun, Larinate, Plasmotrim) Go to P19

10 = Chloroquine (Sugarquin)

11 = Quinine

12 = Sulfadoxine Pyrimethamine (Fansidar, SP, Orodar, Ekelfin, Metakelfin)

96 = Other specify: [______________________________________________]

98 = Don’t know

[___|___]

P17. Please explain the government recommended treatment regimen for this drug for an adult (60kg)

What is the dosage formulation?


04 = Syrup 05 = Suspension 06 = Injection (IV/IM)

07 = Drop 95 = None specified

96 = Not applicable 98 = Don’t know

If provider responded not tablet then skip to p18 Read the following 3 questions to the provider

I. How many tablets should they take at a time?

II. How many times per day?

III. Over how many days?

If respondent has the medicine available use the package to complete the table below. If the medicine is not available ask respondent to identify from prompt card. If identification not possible, ask respondent to recall medicine details.

Generic name Strength in mg Brand name

[__|__]

______________________________

______________________________

______________________________

[__|__|__].[__]mg

[__|__|__].[__]mg

[__|__|__].[__]mg

[__|__]

[__|__]

[___|___] Don’t know=999.8

[___|___]

[___|___].[___|___]

[___|___]

[___|___]

Don’t know = 98



Manufacturer

Is this drug a fixed-dose combination


[___]

Don’t know = 98



P18. Please explain the government recommended treatment regimen for this drug for a 2-year old child (10kg) Read the following 3 questions to the provider

What is the dosage formulation?


04 = Syrup 05 = Suspension 06 = Injection (IV/IM)

07 = Drop 95 = None specified

96 = Not applicable 98 = Don’t know

If provider responded not tablet then skip to p19 Read the following 3 questions to the provider

I. How many tablets should they take at a time?

II. How many times per day?

III. Over how many days?

If respondent has the medicine available use the package to complete the table below. If the medicine is not available ask respondent to identify from prompt card. If identification not possible, ask respondent to recall medicine details.

Generic name Strength in mg Brand name

[__|__]

___________________________

___________________________

___________________________

[__|__|__].[__]mg

[__|__|__].[__]mg

[__|__|__].[__]mg

[__|__]

[__|__]

[___|___] Don’t know=999.8

Manufacturer

Is this drug a fixed-dose combination


[___]

Don’t know = 98

[___|___]

[___|___].[___|___]

[___|___]

[___|___]

Don’t know = 98

P19. Please name the medicine recommended by the government to treat severe malaria. Do not read list. Only one response allowed.

01 = Artesunate (Artesun, Larinate, Plasmotrim) ………………………………………………………………. Go to P20

02 = Artemether (Artenam, Paluther, Artesiane, Larither) ..................................................... Go to P20

03 = Quinine............................................................................................................................ Go to P20

04 = ACT/ACTm

05= Artemether Lumefantrine (Lonart, Artefan, Lumartem, Coartem)

06 = Artesunate Amodiaquine (DUAC, Coarsucam, Winthrop)

07 = Dihydroartemisinin Piperaquine (Duo-cotecxin, P-alaxin) Go to P21

08 = Chloroquine (Sugarquin)

09 = Sulfadoxine Pyrimethamine (Fansidar, SP, Orodar, Ekelfin, Metakelfin)

96 = Other (specify): [ _________________________________________]

98 = Don’t know

[___|___]

P20. What is the drug formulation for the recommended medicine by the government to treat severe malaria? Do not read dosage form options

[___|___]


04 = Syrup 05 = Suspension 06 = IM/IV Injection (Liquid or powder)




P21. Malaria rapid diagnostic tests, also called RDTs, are small, individually wrapped blood tests that are able to quickly diagnose whether a person has malaria. Show RDT images in prompt card

Have you ever seen or heard of malaria RDTs?

1 = Yes Go to P22 0 = No Go to P29 8 = Don’t know Go to P29

[___]

P22. Have you ever tested a client for malaria using an RDT?


[___]

P23. Would you ever recommend a patient/customer take an antimalarial if a blood test using a rapid diagnostic test produced a negative test result for malaria? Read list. Record only one response.

1 = Yes, Sometimes 2 = Yes, Always 3 = No, Never go to P29 8 = Don’t know go to P29

[___]

P24. Under what circumstances would you recommend a patient/customer take an antimalarial following a negative RDT test for malaria? Do not read list. Prompt “anything else” until the respondent is finished. Circle ALL responses given

When they have signs/symptoms of malaria A

When they ask for antimalarial treatment B

When they are a child C

When they are an adult D

When they are a pregnant woman E

When I do not trust/believe the test F

When I know the patient/customer G

Other (specify) [_______________________________________________________] X



P29. What are the danger signs of severe illness in a child under 5?

Do not read list. Prompt “anything else” until the respondent is finished. Circle ALL responses given

Unable to drink /unable to breastfeed A

Vomits everything B

Convulsions C

Lethargic or unconscious D

Don’t know Z

Other (specify) [__________________________________________________________]

X

P30. What would you do if a 2-year old child was brought to this outlet with the danger signs of severe illness? Do not read list. Only one response allowed.

01 = Seek advice/help from someone in this facility

02 = Treat the child in this facility

03 = Refer to a health facility (clinic, hospital) with or without treating here

04 = Refer to a non health facility outlet (not a clinic or hospital) with or without treating here

05 = Send them away/home without medicine

06 = Send them away/home with medicine

96 = Other (specify): [__________________________________________________________]

98 = Don’t know

[___|___]

Complete the audit sheet tracker on the next page then follow the instructions for ending the interview.



Section 6: Audit Tracking Sheet

T1. Were there any antimalarial TABLETS/SUPPOSITORIES/GRANULES in stock at this outlet?

1 = Yes 0 = No go to T4 8 = Don’t know go to T4

[___]

T2. Total number of TABLET/SUPPOSITORY/GRANULE audit sheets completed

[___|___]

T3. Did you complete audit sheet information for all available TABLETS/SUPPOSITORIES/GRANULES? 1 = Yes, audit complete 0 = No, audit not complete

[___]

T4. Were there any antimalarial NON TABLETS (Syrups, suspensions, Injectables) in stock at this outlet?


[___]

T5. Total number of NON-TABLET audit sheets completed

[___|___]

T6. Did you complete audit sheet information for all available NON-TABLETS? 1 = Yes, audit complete 0 = No, audit not complete

[___]

T7. Were there any RDTs in stock at this outlet?


[___]

T8. Total number of RDT audit sheets completed

[___|___]

T9. Did you complete audit sheet information for all available RDT? 1 = Yes, audit complete 0 = No, audit not complete

[___]

T10. COMMENTS: Reason for incomplete audit sheets (if response is no to T3, T6, or T9):



Be sure to complete Section 7: ORS, Zinc & Amoxicillin, then to C9 and record the final

status of the interview and time completed and proceed to Section X: Ending the

Interview.

Annex 7: Antimalarial Reference

Table X3: Number of antimalarials audited




Facility

Private for-Profit


ALL Outlets

Urban 942 143 149 3466 7703 3308 15711

Census 206 143 149 3466 2427 3307 9698

Booster 736 0 0 0 5276 0 6012

Rural 695 1000 226 2615 1088 5324 10948

Census 695 1000 226 2615 548 5324 10408

Booster 0 0 0 0 540 0 540

TOTAL 1637 1143 375 6081 8791 8631 26658




Table X4: Quality Assured (QA ACT) and Non-Quality Assured ACTs


QA ACTs are ACTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s Quality Assurance Policy. A QA ACT is any ACT that appeared on the Global Fund's indicative list of antimalarials meeting the Global Fund's quality assurance policy* prior to data collection, or that previously had C-status in an earlier Global Fund quality assurance policy and was used in a program supplying subsidized ACTs. QA ACTs also include ACTs that have been granted regulatory approval by the European Medicines Agency (EMA) – specifically Eurartesim® and Pyramax®.

Artesunate Amodiaquine Tablets Artemether Lumefantrine Tablets

Apmod Adult +14 years^# Artefan 20/120 15-24kg^#

Apmod Child 6-13 years# Artefan 20/120 25-34kg^#

Apmod Infant 2-11 months# Artefan 20/120 35kg+ Adults^#

Apmod Toddler 1-5 years# Artefan 20/120 5-14kg^#

Artesun-Plus Adult +14 years# Artefan Dispersible 20/120 15-24kg^#

Artesun-Plus Child 6-13 years# Artefan Dispersible 20/120 5-14kg^#

Artesun-Plus Infant 2-11 months# Ipca Artemether + Lumefantrine 3-8 years^#

Artesun-Plus Toddler 1-5 years^# Ipca Artemether + Lumefantrine 9-14 years^#

Winthrop Adult +14 years^# Ipca Artemether + Lumefantrine < 3 years^#

Winthrop Child 6-13 years^# Ipca Artemether + Lumefantrine > 14 years^#

Winthrop Infant 2-11 months^# Coartem 20/120 15-25kg^#

Winthrop Toddler 1-5 years^# Coartem 20/120 25-35kg^#

Coartem 20/120 35kg and above^#

Coartem 20/120 5-15kg^

Coartem 80/480 35kg and above#

Coartem Dispersible 15-25kg^#

Coartem Dispersible 5-15kg^#

Combiart^#

Lumartem 15kg to <25kg^#


Lumartem 35kg and above^#


Non-Quality Assured ACT

ACTs that do not meet the definition of being quality-assured.

Artesunate Mefloquine Tablets Artemether Lumefantrine Tablets

Artequin 300/375 Child# Artrin#

Artequin 600/750 Adult# Aurother#

Co-Malartem#

Artemisinin Napthoquine Tablets Co-Mether^#

Arco 125mg/50mg^# Fantem 20/120 +35kg Adult#

Arco 250mg/100mg^# Laritem 80/480#

Lonart^#

Arterolane Piperaquine Tablets Lonart DS^#

Synriam^ Lonart Forte^#

Lumaren#

Artesunate Mefloquine Granules Lumether^#

Artequin paediatric#



Table X4: Quality Assured (QA ACT) and Non-Quality Assured ACTs

Dihydroartemisinin Piperaquine Tablets Artemether Lumefantrine Suspension

Arteraquin^# Artemether And Lumefantrine#

Co-Artemax# Co-Artesiane Pediatric^#

D-Artepp^# Co-Malaren#

Dipi Adult After 16 years# Co-Malartem#

Duo-Cotecxin 40/320 Adults & Children Over 6 years^# Co-Mether#

Duo-Cotecxin Children 5-20kg# Lonart Pediatric^#

Duoquin#

Malacur 40/320 Adults & Children Over 6 years# Dihydroartemisinin Piperaquine Suspension

P-Alaxin^# P-Alaxin^#

Ridmal 40/320#

* http://www.theglobalfund.org/en/procurement/quality/pharmaceutical ^ Product audited in the public sector # Product audited in the private sector


http://www.theglobalfund.org/en/procurement/quality/pharmaceutical


Table X5: Nationally Registered ACTs

ACT registered with Country’s national drug regulatory authority and permitted for sale or distribution in country.

Artesunate Amodiaquine Tablets Artemether Lumefantrine Tablets

Apmod Adult +14 years^# Artefan 20/120 15-24kg^#

Artesun-Plus Adult +14 years# Artefan 20/120 25-34kg^#

Artesun-Plus Child 6-13 years# Artefan 20/120 35kg+ Adults^#

Artesun-Plus Toddler 1-5 years^# Artefan 20/120 5-14kg^#

Winthrop Adult +14 years^# Artefan 80/480^#

Winthrop Child 6-13 years^# Ipca Artemether + Lumefantrine 3-8 years^#

Winthrop Infant 2-11 months^# Ipca Artemether + Lumefantrine 9-14 years^#

Winthrop Toddler 1-5 years^# Ipca Artemether + Lumefantrine < 3 years^#

Ipca Artemether + Lumefantrine > 14 years^#

Artemisinin Napthoquine Tablets Artrin#

Arco 250mg/100mg^# Co-Mether^#

Coartem 20/120 15-25kg^#

Dihydroartemisinin Piperaquine Tablets Coartem 20/120 25-35kg^#

Arteraquin^# Coartem 20/120 35kg and above^#

Duo-Cotecxin 40/320 Adults & Children Over 6 years^# Coartem 20/120 5-15kg^

Duo-Cotecxin Children 5-20kg# Coartem Dispersible 15-25kg^#

Duoquin# Coartem Dispersible 5-15kg^#

P-Alaxin^# Laritem 80/480#

Ridmal 40/320# Lonart^#

Lonart Ds^#

Artemether Lumefantrine Suspension Lonart Forte^#

Co-Artesiane Pediatric^# Lumaren#

Co-Mether# Lumartem 15kg To <25kg^#

Lonart Pediatric^# Lumartem 25kg To <35kg^#

Lumartem 35kg And Above^#

Dihydroartemisinin Piperaquine Susoension Lumartem 5kg To <15kg^#

P-Alaxin^# Lumether^#

^ Product audited in the public sector # Product audited in the private sector



Table X6: Severe Malaria Treatment

WHO recommends intravenous or intramuscular artesunate as first-line treatment in the management of severe falciparum malaria. If artesunate is not available, artemether in preference to quinine should be used for treating severe malaria cases. Rectal artesunate is suitable for pre-referral treatment in children under 6 years of age. 44 F

45

Quinine Liquid Injection (manufacturer) Artemether Liquid Injection (manufacturer)

Falcimax-600 (Jiangsu Pengyao Pharmaceutical Co. Ltd.)^# Arcomether (Strides Arco Labs)#

Quinax (Troikaa Pharmaceuticals Ltd.)# ARH-A (Lincoln Pharmaceuticals Ltd)^#

Quinine 600mg (Wuhan Grand Pharmaceutical Group Co Ltd (China) Co. Ltd.)^# Artemedine (Kunming Pharmaceutical Corp.)^#

Quinine Dihydrochloride (Ningbo Dahongying Pharmaceutical Co. Ltd.)^# Artemether Injection (Hebei Kaiwei Pharmaceutical Co. Ltd.)^#

Quinine Dihydrochloride Injection (Zhejiang Tianfeng Pharmaceutical Factory)^# Artenam (Arenco Pharmaceutica N.V.)#

Quinine Dihydrochloride Injection 600mg/2ml (Rotexmedica Gmbh Arzneimittelwerk)^# Artenam Paediatric (Arenco Pharmaceutica N.V.)#

Quinine Hcl 600mg (Sterop)# Artesiane 100 (Dafra Pharma Gmbh)#

Quinine Injectable Solution (Zhejiang Ruixin Pharmaceutical Co. Ltd.)^# Artesiane 20 Pediatric (Dafra Pharma Gmbh)^#

Rogoquin (Zhejiang Tianfeng Pharmaceutical Factory)^# Artesiane 40 (Dafra Pharma Gmbh)#

Sterile Quinine Dihydrochloride Concentrate Bp 300mg/Ml (Gland Pharma Ltd.)^# Artesiane 80 (Dafra Pharma Gmbh)^#

Arti (Swiss Parenterals Pvt. Ltd.)^#

Artesunate Powder Injection (manufacturer) Larither-80 (Ipca Laboratories Ltd)^#

Artesun 120mg (Guilin Pharmaceutical Co. Ltd)^# Lartrm (Sakar Healthcare Pvt. Ltd.)#

Artesun 30mg (Guilin Pharmaceutical Co. Ltd)^# Malasan (Pharmedic Laboratories (Pvt) Ltd.)#

Artesun 60mg (Guilin Pharmaceutical Co. Ltd)^# Romether (Zhejiang Tianfeng Pharmaceutical Factory)^#

Falci Care (Swiss Parenterals Pvt. Ltd.)^# Rtitas (Intas Pharmaceuticals Ltd.)^#

Larinate 120 (Ipca Laboratories Ltd)^

Larinate 60 (Ipca Laboratories Ltd)^#

Arteether Liquid Injection (manufacturer)

Artesunate Suppository (manufacturer) ARH 150mg/2ml Injection (Lincoln Pharmaceuticals Ltd)#

Gsunate 200 (Bliss Gvs Pharma Ltd)^# ARH Forte 225mg/3ml Injection (Lincoln Pharmaceuticals Ltd)#

Gsunate 50 (Bliss Gvs Pharma Ltd)^# Betamotil (Ipca Laboratories Ltd)^#

Plasmotrim-50 (Acino/ Mepha)^# E Mal (Themis Medicare Limited)#

Troyther (Troikaa Pharmaceuticals Ltd.)^#

Troyther (Troikaa Pharmaceuticals Ltd.)^#

* Guidelines for the treatment of malaria, 3rd edition. WHO. Geneva: 2015. ^ Product audited in the public sector # Product audited in the private sector

45 World Health Organization. (2015). Guidelines for the treatment of malaria, 3rd edition. Geneva: WHO.



Annex 8: RDT Reference

Table X7: Number of RDTs audited




Facility

Private for-Profit


ALL Outlets

Urban 155 113 18 292 228 151 957

Census 39 113 18 292 71 151 684

Booster 116 0 0 0 157 0 273

Rural 177 566 28 236 32 271 1310

Census 177 566 28 236 14 271 1292

Booster 0 0 0 0 18 0 18

TOTAL 332 679 46 528 260 422 2267




Table X8: RDT Brand Names and Manufacturers*

Brand Name Manufacturer

Abon# Abon Biopharm (Hangzhou) Co. Ltd

Accucare# Lab-Care Diagnostics (India) Pvt. Ltd

Astel^# Astel Diagnostics

Care Start^# Access Bio Inc.

Clearview^# British Biocell International Ltd

Diagnosticks# SSA Diagnostics & Biotech Systems

Ezdx# Advy Chemical Pvt. Ltd

Fastep# Polymed Therapeutics Inc

First Response^# Premier Medical Corporation Ltd

Humasis# Humasis Co. Ltd

ICT Malaria Cassette Test Dual# ICT Diagnostics

Malaria (Pf/Pv) One Step Rapid Test# Zhejiang Orient Gene Biotech Co. Ltd

One Step Malaria (Pf) Whole Blood Strip# Nantong Egens Biotechnology Co. Ltd

Malaria (Pf/Pv) Antibody Card Test# Shubham Diagnostics

Malascan# Zephyr Biomedicals

Maleriscan# Bhat Bio-Tech India Ltd

Meriscreen# Meril Diagnostics Pvt. Ltd

Necviparum^# Nectar Lifesciences Limited

Nova Test# Atlas Link Technology Co. Ltd

Onsite Rapid Test# CTK Biotech Inc.

Paracheck^# Orchid Biomedical Systems

Parahit# Span Diagnostics Ltd

Rapitest# Orem Access Bio Inc.

Rightsign# Hangzhou Biotest Biotech Co. Ltd

SD Bioline^# Standard Diagnostics Inc.

* 2267 RDTs were audited. No RDT was missing brand name information (missing or don’t know) and 65 were missing manufacturer name (missing or don’t know).

^ Product audited in the public sector # Product audited in the private sector



Annex 9. Sampling Weights Sampling weights were applied for analysis of the Uganda 2015 outlet survey data to account for variations in probability of selection as a result of the sampling design: 1) Stratification: Disproportionate allocation stratification was used to ensure adequate sample size within the

urban and rural domains to allow for domain-specific estimates. The research domains were based on national designation of urban and rural communes. A representative sample was selected within each domain.

2) One-stage cluster sampling: Sub-counties were selected from sampling frames within each domain with probability proportional to size (in Kampala, town councils, divisions and parishes were considered sub-counties). Within each sub-county, a census of all outlets with the potential to sell or distribute antimalarials and/or provide malaria blood testing was conducted.

3) Booster sample – public health facilities (PHFs): The geographic area for the outlet census was extended to the

county level for pharmacies and urban public health facilities. All urban public health facilities and pharmacies within counties in which the selected sub-counties were located were included in the study.

The sampling weights applied during analysis are the inverse of the probability of selection:

Where:

Mα = estimated cluster (population size)

ΣMα = sum of estimated cluster sizes (population size) in the entire stratum

a = number of clusters selected within the stratum

Sampling weights are calculated at the cluster level and are applied to all outlets within a given cluster, irrespective

of outlet type.

Market share was calculated using the full census data at the sub-country level only (i.e. the booster sample was not

included in market share calculations). Sub-county sampling weights were created using the sampling weight

formula (Wi), where:

Mα = estimated sub-county population size

ΣMα = sum of estimated sub-county population size in the entire stratum

a = number of sub-counties selected within the stratum

The sub-county sampling weights were applied to all other indicators in the report for all outlet types with the

exception of pharmacies and urban public health facilities. Given that pharmacies and urban public health facilities

were included in the sample through a county-wide census, the weights applied to pharmacies and urban public

health facilities for all indicators other than market share were calculated using the sampling weight formula, where:

Mα = estimated county population size

ΣMα = sum of estimated county population size in the entire stratum

a = number of counties selected within the stratum



The population estimates used to select sub-counties with PPS and to create sampling weights were obtained from

the 2014 Housing and Population Census. A sampling frame with population sizes was used for selecting the sample

because accurate estimates on the total number of outlets per geographic/administrative unit that may be eligible

for a medicine outlet survey do not exist. The major assumption in using population figures for sampling and

weighting is that distribution of outlets and/or distribution of medicines moving through outlets in a given cluster is

correlated with population size.



Annex 10: Indicator Definitions Table 1: Availability of antimalarials, among all screened outlets Table 1 reports the proportion of all outlets enumerated that had any antimalarial in stock at the time of the survey visit. Antimalarial availability is reported among all outlets as well as among individual outlet types, all public outlets, and all private outlets. Availability is reported for any antimalarial as well as specific types of antimalarial medicines.

Numerator Number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by presence of at least one antimalarial (defined as a medicine with antimalarial ingredients) recorded in the antimalarial audit section.

Denominator Number of outlets screened.

Calculation Numerator divided by denominator.

Handling missing values

All screened outlets will contribute to the denominator. This includes outlets that were eligible for interview (including antimalarial audit) but: 1) were not interviewed; or 2) the interview was partially completed.

Notes and considerations

Given partial or non-completion of interviews among eligible outlets and the inclusion of these outlets in the denominator, these availability indicators can be considered conservative estimates of antimalarial availability.

Table 2: Availability of antimalarials, among outlets stocking at least one antimalarial Table 2 reports the proportion of antimalarial-stocking outlets with specific antimalarial in stock at the time of the survey visit. Antimalarial availability is reported among all outlets as well as among individual outlet types, all public outlets, and all private outlets. Availability is reported for any antimalarial as well as specific types of antimalarial medicines.

Numerator Number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by presence of at least one antimalarial (defined as a medicine with antimalarial ingredients) recorded in the antimalarial audit section.

Denominator Number of outlets with at least 1 antimalarial audited.



All outlets with at least one antimalarial recorded in the antimalarial audit sheet will contribute to the denominator. This includes outlets where the interview was not fully completed (partial interview).


Given partial completion of interviews among antimalarial-stocking outlets and the inclusion of these outlets in the denominator, these availability indicators can be considered conservative estimates of antimalarial availability.



Table 3: Types of quality-assured and Non-Quality Assured ACTs Table 3 reports the types of quality-assured (QA) and Non-Quality Assured (non-QA) ACTs audited in the public and private sector, including generic name and formulation.

Numerator By sector, the number of QA and non-QA ACTs audited within each generic and formulation category (e.g. number of QA artemether lumefantrine tablets audited in the public sector).

Denominator By sector, total number of QA and non-QA ACTs audited.

Calculation Numerator divided by the denominator within QA and non-QA ACTs for each sector.


By definition, the generic name of all ACTs is known. ACTs with missing formulation information are excluded.


Table 4: Antimalarial market composition Table 4 reports the distribution of outlet types among outlets with at least one antimalarial in stock on the day of the survey.

Numerator By outlet type, the number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by presence of at least one antimalarial (defined as a medicine with antimalarial ingredients) recorded in the antimalarial audit section.

Denominator Total number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by presence of at least one antimalarial (defined as a medicine with antimalarial ingredients) recorded in the antimalarial audit section.

Calculation Numerator for each outlet type divided by the denominator.


All outlets with at least one antimalarial recorded in the antimalarial audit sheet will contribute to the indicator. This includes outlets where the interview was not fully completed (partial interview).


Market composition is calculated among outlets located within the representative sample of clusters, and excludes the booster sample.

Table 5: Price of antimalarials Table 5a provides the median price of an adult equivalent treatment dose (AETD, see Annex 11) for select tablet formulation types of antimalarials across outlet types. The inter-quartile range (IQR) is provided as a measure of dispersion.



Calculation Median antimalarial AETD (see Annex 11) price in US dollars with inter-quartile range (25th and

75th percentiles).


Antimalarials with missing price information are excluded from the median price calculation.


Price in US dollars is calculated based on exchange rates available from www.oanda.com using the historical exchange rates tool. The average exchange rate over the entire data collection period is used for converting local currency captured during data collection to US dollars.

A. Table 5b also provides the median price of two pre-packaged QA ACT therapies: pediatric appropriate for a 10kg

child (2 years of age), and adult appropriate for a 60kg adult. The inter-quartile range (IQR) is provided as a measure of dispersion.

Calculation Median pre-packaged therapy price in US dollars with inter-quartile range (25th and 75th

percentiles.


Antimalarials with missing price information are excluded from the median price calculation.



Table 6: Availability of malaria blood testing among antimalarial-stocking outlets Table 6 reports the proportion of antimalarial-stocking outlets that had malaria blood testing available. Testing availability is reported among all outlets as well as among individual outlet types, all public outlets, and all private outlets. Availability is reported for any blood test as well as specific test types: microscopy and rapid diagnostic test (RDT) including quality-assured RDTs. Quality-assured RDTs are RDTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s Quality Assurance Policy.

Numerator Number of outlets with malaria blood testing available (any, microscopy, RDT, QA RDT).

Denominator Number of outlets with any antimalarial in stock at the time of the survey visit or reportedly stocked any antimalarial in the previous three months.



Antimalarial-stocking outlets with missing information about both availability of microscopy and availability of RDTs are excluded from malaria testing indicators. The number of such outlets is provided in a footnote.

Outlets with partial information about availability of blood testing (information about microcopy or RDTs) are included in the denominator of the indicator “any blood testing available.” The number of such outlets is provided in a footnote.

Indicators for RDT and microscopy availability exclude outlets with missing availability information respectively (i.e. outlets missing information about microscopy availability are excluded from the microscopy indicator).


Survey inclusion criteria extended to outlets providing blood testing but not stocking antimalarials (“diagnosis/testing-only outlets”). These outlets are excluded from this availability table.





Table 7: Malaria blood testing market composition Table 7 reports the distribution of outlet types among outlets with malaria blood testing (microscopy or RDT) available on the day of the survey.

Numerator By outlet type, the number of outlets with malaria blood testing (microscopy or RDT) available at the time of the survey visit, as confirmed by presence of at least one RDT recorded in the RDT audit section or microscopy available indicated in the diagnostics section.

Denominator Total number of outlets with malaria blood testing available at the time of the survey visit, as confirmed by presence of at least one RDT recorded in the RDT audit section or microscopy available indicated in the diagnostics section.

Calculation Numerator for each outlet type divided by the denominator.


All outlets with at least one RDT recorded in the RDT audit sheet or microscopy available recorded in the diagnostics section will contribute to the indicator. This includes outlets where the interview was not fully completed (partial interview).


Market composition is calculated among outlets located within the representative sample of clusters, and excludes the booster sample.

Table 8: Price of malaria blood testing Table 8 reports the median price of blood testing to consumers including any consultation or service fees. The inter-quartile range (IQR) is provided as a measure of dispersion.

Table 9: Antimalarial market share Antimalarial market share is the amount of adult equivalent treatment doses (AETD) reportedly sold or distributed in the previous week by outlet type and antimalarial type as a percentage of all AETDs sold/distributed in the previous week. Expressed as a percentage, market share is the amount of a specific antimalarial sold/distributed by a specific outlet type relative to the entire antimalarial market (all antimalarial types sold/distributed by all outlet types). Totals are reported per antimalarial medicine type and per outlet type. Across antimalarial medicine types and outlet types, percentages in the entire table sum to 100% (the total market).

Numerator Number of AETDs sold/distributed for a specific antimalarial drug category and outlet type.

Denominator Total number of AETDs sold/distributed.


Calculation Median total blood test price in US dollars with inter-quartile range (25th and 75th percentiles).


Microscopy-stocking outlets that are missing information about price of microscopy are excluded from this indicator. Audited RDTs with missing information about price of testing are excluded from this indicator.







AETDs sold/distributed are calculated among audited medicines with complete and consistent information. Antimalarials with incomplete or inconsistent information among key variables that define AETD sold/distributed (active ingredients, strength, formulation, package size, amount sold/distributed) are excluded from the calculation.


See Annex 11 for a description of AETD calculation.

Table 10: Antimalarial market share across outlet type Antimalarial market share across outlet type is the amount of adult equivalent treatment doses (AETD) reportedly sold or distributed in the previous week by antimalarial type within each outlet type as a percentage of all AETDs sold/distributed in the previous week within the specified outlet type. Expressed as a percentage, outlet-type market share is the amount of a specific antimalarial sold/distributed relative to the entire antimalarial market segment for the specified outlet type (all antimalarial types sold/distributed by the specific outlet type). Totals are reported per antimalarial medicine type for each outlet type. Across antimalarial medicine types within each outlet type, percentages sum to 100%.

Numerator Number of AETDs sold/distributed for a specific antimalarial drug category within the specified outlet type.

Denominator Total number of AETDs sold/distributed within the specific outlet type.



AETDs sold/distributed are calculated among audited medicines with complete and consistent information. Antimalarials with incomplete or inconsistent information among key variables that define AETD sold/distributed (active ingredients, strength, formulation, package size, amount sold/distributed) are excluded from the calculation.


See Annex 11 for a description of AETD calculation.

Table 11: Malaria blood testing market share Malaria blood testing market share is the number of malaria blood tests reportedly sold or distributed in the previous week by outlet type and malaria blood test type (RDT, microscopy) as a percentage of all malaria blood tests sold/distributed in the previous week. Expressed as a percentage, market share is the number of a specific malaria blood test type by a specific outlet type relative to the entire malaria blood testing market (all malaria blood tests sold/distributed by all outlet types). Totals are reported per test type and per outlet type. Across malaria blood test types and outlet types, percentages in the entire table sum to 100% (the total market).

Numerator Number of malaria blood tests sold/distributed for a specific blood test type (RDT, microscopy) and outlet type.

Denominator Total number of malaria blood tests sold/distributed.



Malaria blood tests sold/distributed are calculated among audited RDTs and microscopy services with complete and consistent information. RDTs and microscopy services with incomplete or inconsistent information about the amount sold/distributed) are excluded from the calculation.




Records and/or recall of testing with microscopy versus malaria RDT may differ within a given outlet, introducing an unquantifiable bias in estimating total tests performed.

Table 12: Malaria blood testing market share across outlet type Malaria blood testing market share across outlet type is the number of malaria blood tests reportedly sold or distributed in the previous week by blood test type within each outlet type as a percentage of all blood tests sold/distributed in the previous week within the specified outlet type. Expressed as a percentage, outlet-type market share is the amount of a specific malaria blood test sold/distributed relative to the entire blood testing market segment for the specified outlet type (all malaria tests sold/distributed by the specific outlet type). Totals are reported per test type for each outlet type. Across malaria blood test types within each outlet type, percentages sum to 100%. The market share for each RDT manufacturer is also reported across outlet type. Within each outlet type, the number of RDTs for a specific manufacturer sold/distributed relative to all RDTs distributed within that outlet type is reported as a percentage. Totals for RDT market share across all manufacturers’ sums to 100% within each outlet type.

Numerator Number of malaria blood tests sold/distributed for a specific blood test type (RDT, microscopy), or number of malaria RDTs sold/distributed for a specific manufacturer, within the specified outlet type.

Denominator Total number of malaria blood tests/RDTs sold/distributed within the specific outlet type.



Malaria blood tests sold/distributed are calculated among audited RDTs and microscopy services with complete and consistent information. RDTs and microscopy services with incomplete or inconsistent information about the amount sold/distributed) are excluded from the calculation.


Records and/or recall of testing with microscopy versus malaria RDT may differ within a given outlet, introducing an unquantifiable bias in estimating total tests performed.

Table 13: Provider case management knowledge and practices Table 13 reports key indicators of provider case management knowledge and practices. These include referral practices for severe malaria; and self-reported practices for managing clients who test negative for malaria.

Numerator A. Referral: respondents who indicated that they would refer to a health facility (response option #3). Note this numerator excludes providers located in a public or private health facility.

B. Recommends antimalarials to test-negative clients: respondents who indicated “yes, always,” or “yes sometimes.”

C. Circumstances for recommending an antimalarial: individual indicators for the most common responses provided to this open-ended question. Note this numerator excludes providers who did not respond to the previous question about recommending antimalarials to test-negative clients with “yes always” or “yes sometimes.”

Denominator A. Referral: respondents who provided a response to this question, including “don’t know.” Note this denominator excludes providers located in a public or private health facility.

B. Recommends antimalarials to test-negative clients: respondents who provided a response to this question, including “don’t know.”

C. Circumstances for recommending an antimalarial: respondents who provided at least 1



response to this question, including “don’t know” (i.e. at least 1 variable in this series is non-missing). Note this denominator excludes providers who did not respond to the previous question about recommending antimalarials to test-negative clients with “yes always” or “yes sometimes.”



A. Providers missing a response to this question will be excluded from the indicator. B. Providers missing a response to this question will be excluded from the indicator.

C. This indicator is assessed using an open-ended multiple response option question. Providers with at least one non-missing response in the variable series for this question will be included in the indicator. Among these sets of responses, missing will be treated as not mentioned.


In some cases, multiple providers were interviewed at one outlet. A provider with responsibilities related to diagnosis may have responded to questions about malaria diagnosis and diagnostics (indicators B and C in Table 9), while a different provider responsible for prescribing and/or dispensing medicines may have responded to questions about danger signs of severe illness and referral for severe malaria (indicator A in Table 8). In all cases, the questions assessing provider knowledge and practices were administered only one time per outlet. As such, indicators are tabulated at the outlet level.

Table 14: Provider antimalarial treatment knowledge and practices Table 14 reports key indicators of provider antimalarial treatment knowledge and practices. These include knowledge of the first-line treatment; knowledge of the first-line treatment dosing regimen for adults and children; citing ACT as most effective to treat malaria in adults and children; and citing ACT as most commonly recommended by the provider to manage malaria in adults and children.



Numerator A. State first-line: providers who responded to p17 with a generic or brand name consistent

with a national first-line treatment, or responded to p17 with “ACT,” or “ACTm” and in p18 provided a generic or brand name consistent with a national first-line treatment. In other words, providers must specifically name the first-line treatment using generic or brand name language in either p17 or p18.

B. First-line regimen, adult: providers who correctly stated the first-line generic ingredients and strengths in p18, and correctly stated: number of days, times per day, and tablets per dose to be taken.

C. ACT most effective, adult & child: Any response for this open-ended question whereby: 1) one medicine or a set of medicines to be used in combination is mentioned only i.e. multiple antimalarial medicines mentioned will be counted as incorrect; and 2) the combination of medicines is an ACT – defined either by using a brand name, generic name, “ACT,” or “ACTm.” If the provider mentions a correct ACT response and also mentioned an anti-pyretic (e.g. paracetamol), this response will be counted as correct. However, if the provider mentions a correct ACT response and also mentioned other drugs – such as an antibiotic – this answer will be counted as incorrect.

D. ACT most often recommended, adult & child: Any response for this open-ended question whereby: 1) one medicine or a set of medicines to be used in combination is mentioned only i.e. multiple antimalarial medicines mentioned will be counted as incorrect; and 2) the combination of medicines is an ACT – defined either by using a brand name, generic name, “ACT,” or “ACTm.” If the provider mentions a correct ACT response and also mentioned an anti-pyretic (e.g. paracetamol), this response will be counted as correct. However, if the provider mentions a correct ACT response and also mentioned other drugs – such as an antibiotic – this answer will be counted as incorrect.

Denominator A. State first-line: All providers who responded to p17 – please name the first-line medicine. B. First-line regimen, adult: All providers who responded to p17 (starting the series on first-line

knowledge). C. ACT most effective, adult & child: All providers who responded to p13/14, including providers

who responded with “don’t know,” who provided names of non-antimalarial medicines, and who responded with more than one antimalarial medicine not intended to be used as combination therapy.

D. ACT most often recommended, adult & child: All providers who responded to p13/14, including providers who responded with “don’t know,” who provided names of non-antimalarial medicines, and who responded with more than one antimalarial medicine not intended to be used as combination therapy.



A. Providers missing a response to this question will be excluded from this indicator. B. Providers with partial information for the regimen questions will be included in the

denominator (i.e. missing treated as not mentioned). C. Providers missing a response to this question will be excluded from the indicator. D. Providers missing a response to this question will be excluded from the indicator.



Annex 11. Adult Equivalent Treatment Dose (AETD) Definition Antimalarial medicines are manufactured using a variety of active pharmaceutical ingredients, dosage forms, strengths, and package sizes. ACTwatch uses the adult equivalent treatment dose (AETD) as a standard unit for price and sale/distribution analyses. One AETD is defined as the number of milligrams (mg) of an antimalarial drug required to treat an adult weighing 60 kilograms (kg). For each antimalarial generic, the AETD is defined as the number of mg recommended in treatment guidelines for uncomplicated malaria in areas of low drug resistance issued by the WHO. Where WHO treatment guidelines do not cover a specific generic, the AETD is defined based on peer-reviewed research or the product manufacturer’s recommended treatment course for a 60kg adult. Table X9 lists AETD definitions used in this report. While it is recognized that the use of AETDs may over-simplify and ignore many of the complexities of medicine consumption and use, this analytical approach was selected because it standardizes medication dosing across drug types and across countries (which may sometimes vary) thus permitting comparisons on both prices and volumes calculated on the basis of an AETD. Additional considerations:

Where combination therapies consist of two or more active antimalarial ingredients packaged together (co-formulated or co-blistered), the strength of only one principal ingredient issued. The artemisinin derivative is used as the principal ingredient for ACT AETD calculations.

Co-blistered combinations are generally assumed to be 1:1 ratio of tablets unless otherwise documented during fieldwork or through manufacturer websites.

Sulfamethoxpyrazine-pyrimethamine is assumed to have the same full course adult treatment dose as sulfadoxine-pyrimethamine.

Calculation Information collected on drug strength and unit size as listed on the product packaging was used to calculate the total amount of each active ingredient found in the package. The number of AETDs in a unit was calculated. 45F

46 The number of AETDs in a monotherapy is calculated by dividing the total amount of active ingredient contained in the unit by the AETD (i.e. the total number of mg required to treat a 60kg adult). The number of AETDs for a combination therapy was calculated by dividing the total amount of the active ingredient that was used as the basis for the AETD by the AETD.

46 The unit is dependent on the drug dosage form. The unit for antimalarials in tablet, suppository, or granule form is the package. The unit for injectable antimalarials is the ampoule. The unit for syrup and suspension antimalarials is the bottle.



Table X9: Adult Equivalent Treatment Dose Definitions

Antimalarial Generic [Ingredient used for AETD

mg dose value]

Dose used for calculating 1

AETD (mg required to treat a 60kg adult)

Source

Amodiaquine 1800mg WHO Model Formulary, 2008

Arteether / Artemotil 1050mg WHO Use of Antimalarials, 2001

Artemether 960mg WHO Use of Antimalarials, 2001

Artemether-Lumefantrine

[Artemether] 480mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Artemisinin-Naphthoquine

[Artemisinin] 2400mg WHO Use of Antimalarials, 2001

Arterolane-Piperaquine

[Arterolane] 450mg WHO CM Guidelines, 2015

Artesunate 960mg WHO Use of Antimalarials, 2001

Artesunate-Amodiaquine

[Artesunate] 600mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Artesunate-Mefloquine

[Artesunate] 600mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Atovaquone-Proguanil

[Atovaquone] 3000mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Chloroquine 1500mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Dihydroartemisinin-

Piperaquine

[Dihydroartemisinin]

360mg WHO Guidelines for the treatment of malaria 3rd edition, 2015

Hydroxychloroquine 2000mg Manufacturer Guidelines

(Plaquenil – Sanofi Aventis)

Mefloquine 1000mg

WHO Model Formulary, 2008

Primaquine 45mg WHO Guidelines for the treatment of malaria 2nd edition, 2010

Quinine 10408mg WHO Model Formulary, 2008

Quinine-Sulfadoxine-

Pyrimethamine

[Quinine]

10408mg WHO Model Formulary, 2008

Sulfadoxine-Pyrimethamine 1500mg WHO Model Formulary, 2008



Annex 12: Antimalarial Volumes

Table X10: Antimalarial volumes, by outlet type

AETDs sold or distributed in the previous week by outlet type and antimalarial type:*




Facility

ALL Public / Not

For-Profit

Private For-Profit


TOTAL Private

ALL Outlets

% (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)

1. Any ACT 280053.1 24097.5 19792.0 323942.6 86839.7 57753.0 201713.7 346306.3 670248.9

(192433.2, 367673.1)

(11178.0, 37017.0)

(11926.7, 27657.3)

(232425.4, 415459.8)

(67920.1, 105759.3)

(13990.6, 101515.3)

(150186.0, 253241.4)

(251875.6, 440737.1)

(533608.8, 806889.1)

AL

279697.4 24091.5 18068.7 321857.6 62336.3 34028.9 172825.8 269191.0 591048.6

(192138.5, 367256.3)

(11170.2, 37012.9)

(10917.2, 25220.1)

(230373.5, 413341.6)

(49826.4, 74846.2)

(14771.4, 53286.3)

(131307.9, 214343.7)

(209986.8, 328395.2)

(476214.2, 705882.9)

ASAQ 133.5 0.0 332.8 466.3 11066.2 6685.1 16365.5 34116.8 34583.1

- - - (0.0, 1176.0) (5892.4, 16239.9)

(0.0, 15484.3)

(9408.7, 23322.3)

(17476.8, 50756.7)

(17890.5, 51275.7)

DHA PPQ 222.2 6.0 1296.6 1524.8 12931.9 15118.2 11486.1 39536.3 41061.0

- - (0.0, 3615.4) (0.0, 3645.9) (8894.0, 16969.8)

(0.0, 31002.3)

(4436.1, 18536.2)

(16359.0, 62713.5)

(17869.8, 64252.3)


(191557.1, 367000.3)

(11170.2, 37012.9)

(10872.2, 25170.4)

(229750.4, 413032.7)

(44875.5, 67991.1)

(9565.3, 54687.8)

(121771.9, 198859.3)

(191706.8, 306044.2)

(455455.3, 685078.7)


8706.1 5092.7 5077.6 18876.4 50106.5 31435.2 146804.3 228346.0 247222.4

(727.5, 16684.7)

(1473.6, 8711.9)

(1938.8, 8216.4)

(10334.9, 27417.9)

(40072.9, 60140.2)

(9205.1, 53665.2)

(110423.7, 183184.8)

(176023.8, 280668.2)

(195170.6, 299274.1)


270572.7 18998.8 12943.7 302515.2 6204.6 691.4 13148.8 20044.8 322559.9

(182467.1, 358678.2)

(6338.0, 31659.6)

(6223.7, 19663.7)

(212221.0, 392809.3)

(2920.0, 9489.1)

(192.4, 1190.4)

(6552.9, 19744.7)

(11000.7, 29088.9)

(229120.7, 415999.1)


- - (0.0, 3902.6) (363.2, 4738.9)

(20562.6, 40250.2)

(4051.9, 47200.9)

(24690.6, 58105.4)

(55475.7, 139386.0)

(58099.3, 141864.6)


(191350.4, 366786.6)

(1807.9, 17303.9)

(11308.5, 26986.4)

(218343.9, 397199.8)

(57096.8, 91956.4)

(10670.5, 88210.0)

(116632.4, 203704.0)

(199877.4, 368392.8)

(466971.2, 716842.7)

2. Any non-artemisinin therapy

100882.6 48.8 10005.9 110937.3 45232.2 24036.6 99277.1 168545.9 279483.2

(39463.3, 162302.0) -

(4729.5, 15282.2)

(49709.4, 172165.2)

(28548.1, 61916.4)

(8495.0, 39578.2)

(77617.1, 120937.2)

(130149.8, 206942.1)

(205869.2, 353097.2)


(42697.4, - (3555.4, (50535.2, (19560.7, (4521.5, (51544.1, (87024.2, (150766.7,



Table X10: Antimalarial volumes, by outlet type

AETDs sold or distributed in the previous week by outlet type and antimalarial type:*




Facility

ALL Public / Not

For-Profit

Private For-Profit


TOTAL Private

ALL Outlets

% (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)

93216.5) 12449.1) 101480.8) 41198.0) 26184.5) 80523.0) 136507.5) 224781.0)

Oral Quinine 32522.5 0.0 1658.5 34181.0 8330.0 3176.6 22345.3 33851.9 68032.9

(0.0, 89407.7) -

(533.7, 2783.2)

(0.0, 90733.4)

(4754.8, 11905.2)

(17.3, 6335.9)

(16411.4, 28279.3)

(24897.2, 42806.7)

(11441.4, 124624.4)


- - - - (913.3, 5109.9) (0.0, 9503.9)

(2601.6, 10697.3)

(6566.6, 21155.3)

(6566.6, 21155.3)

3. Oral artemisinin monotherapy

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

- - - - - - - - -

4. Non-oral artemisin monotherapy

4542.3 3.6 494.1 5040.0 3898.9 2843.5 2057.4 8799.9 13839.9

(2102.7, 6982.0) (0.0, 9.6) (86.5, 901.8)

(2528.5, 7551.6)

(2082.0, 5715.8) (0.0, 5717.0)

(825.3, 3289.5)

(3433.0, 14166.8)

(7977.8, 19702.0)

Artesunate IV/IM # 2945.4 0.0 175.6 3120.9 1093.2 715.8 376.1 2185.1 5306.0

(1593.1, 4297.7) - (13.1, 338.0)

(1660.3, 4581.6)

(62.4, 2124.0) (0.0, 1672.9) (0.0, 829.8) (0.0, 4529.6)

(2589.0, 8023.1)


(263050.5, 507905.6)

(11241.4, 37058.4)

(19103.4, 41480.5)

(314344.2, 565495.7)

(103808.3, 168133.4)

(25513.7, 143752.5)

(236595.6, 369500.9)

(394793.2, 652511.1)

(773764.5, 1153379.8)

*A total of 74,749.61.114 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation.

At the time of the 2013 ACTwatch outlet survey artemether lumefantrine was Country's first line treatment for uncomplicated malaria. A total of 20,138 antimalarials were audited. Of these, 566 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information.

Source: ACTwatch Outlet Survey, Uganda, 2015


ACTwatch Study Reference Document Uganda Outlet Survey 2015

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