ACTwatch!Study!Reference!Document! …

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

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!Evidence!for!Malaria!Medicines!Policy!

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ACTwatch!Study!Reference!Document!Democratic!Republic!of!the!Congo!

!Outlet!Survey,!2015!. ..

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www.ACTwatch.info.............................Page.1..

Released'December'21,'2016''!

Suggested!citation!ACTwatch'Group'and'ASF..(2015)..ACTwatch'Study'Reference'Document:'The'Democratic'Republic'of'the'Congo'Outlet'Survey'2015..Washington.DC:.PSI.... .

Contact!Dr..Megan.Littrell.ACTwatch.Principal.Investigator..PSI.|[email protected]!

Dr..Godéfroid.Mpanya.Coordinateur.pays.du.programme.ACTwatch..Association.de.Santé.Familiale.4630,.Avenue.de.la.science,.Immeuble.USCT,.BLOC.C,.Kinshasa/[email protected]..

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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)....


Association!de!Santé!Familiale!Nestor.Ankiba..Dr..Louis.Akulayi.Jamie.Ciesla..Katie.MacDonald.Dr..Marcel.Lama..Dr..Godefroid.Mpanya.Willy.Onema.Darquenne.Tonduangu.Jean.Ilunga.Ngusumadi...

Ministère!de!la!Santé!Dr..Joris.Losimba.Likwela..Dr..Ghislain.Makan.Yav.Dr..Eric.Mukomena..Dr..Felix.Kabange.Numbi..

ACTwatch!Team!!Andrew.Andrada.Erick.Auko.Dr..Katie.Bates.Dr..Paul.Bouanchaud.Dr..Desmond.Chavasse.Robyn.Cyr.Kevin.Duff.Keith.Esch.Anna.Fulton.Tarryn.Haslam.Catharine.Hurley.Beth.Kangwana.Gloria.Kigo.Aliza.Lailari.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.

École!de!Santé!Publique!de!Kinshasa!Dr..Okito.Londa.Dr..Paulin.Mutombo.Dr..Aimee.Lulebo.Dr..Godefroid.Musema.Dr..Chrystelle.Mpembele..

Fieldwork!Supervisors!!Kankonde.Jennifer.Mashinda.Irenée.Mpundu.Jaques.Musoya.Alexis.Ntanga.Michel.Bukasa.Alex.Kazadi.Augustin.Bulimwengu.Marsy.Muntenge.Georges.Lukanka.Fridolin.Nsungu.Mireille.Bonsokie.Marc.Nkamba.Dalau.Kayaya.Antho.Ndaya.Anabelle.Mvuama.Nono.Kapongo.Bonny..

Fieldwork!Quality!Controllers!Abiba.Mornico.Viviane.Bondo.Kamwanya.Deborah.Kibozya.Judithe.Maweya.Nyaliwawa.Solange.Mputu.Nyunge.Françoise.Kyabululo.Florian.Mulombw.Papy.Kalonji.Eva.Maguy.Lutete.Kabongo.Charles.Muley.Nzey.Maguy.Lulebo.Mamie.Masevo.Zouzou.Kapuku.André.Yangongo.John.Bala.Alexandre.Ndjike.Arsene.

Fieldwork!Interviewers!!Adonis.Ciluila.Dieudonne.Kayembe.Tatiana.Seya.Blandine.Mashinda.Capitaine.Ngindu.Zozo.Ilunga.Fanfan.Ngoie.Gisele.Ngoie.Lydia.Mwape.Carine.Kigalu.Francine.Mihali.Louis.Kabombue.Jean.ilunga.Andre.Ilunga.Etienne.Wetu.Nicole.Alimasi.Marielle.Nkomayombi.Moise.Mafuta.Rachel.Mwamba.Nasha.Mombunga.Nadeige.Lenge.Michou.Ilunga.John.Lhudal.Serge.Kangudi.Rachel.Efoya.Faustine.Banza.Eric.Tshikaya.Jp.Kyungu.Baby.Singa.Martine.Kamwanya.Honore.Nyembo.Robert.Ndodji.Christian.Katungulu.Joseph.Bendafi.Bienvenu.Musongiela.Janvier.Kabasele.Dickson.Kabange.Timothee.Kialu.Christian.Kyangulu.Joel.Kongolo.Poly.Selenge.Josephine.Ndona!

.Florence.Kalenga.Godelive.Kasongo.Charles.Kasongo.Eric.Djamba.Annette.Mafuta.Ngalula.Pamela..Marie.Nsonga.Sandra.Ngondo.Hono.Kasongo.Patrick.Mpingabo.Lisette.Lemba.Dauphine.Mbombo.Hugo.Nsunda.Delphine.Nzuzi.Verro.Itoko.Dauphine.Mbombo.Myriam.Mbonze.Aurelie.Yandjo.Aristote.Diankenda.Christus.Kimbaza.Kwete.Kwongo.Josephine.Musau.Lomingo.Marlyse.Yves.Tshizungu.Engomba.Itoko.Serge.Abenete.Bofonda.Odette.Joseph.Musema.Marcel.Katembo.Joelle.Lusawovana.Evrard.lutonadio.Jocelain.Mbayo.


Table!of!Contents!.

LIST.OF.TABLES...................................................................................................................................................4.

LIST.OF.FIGURES.................................................................................................................................................7.

DEFINITIONS.....................................................................................................................................................10.

INTRODUCTION................................................................................................................................................12.

SUMMARY.OF.METHODS.AND.DATA.COLLECTION..........................................................................................13.

SUMMARY.OF.KEY.FINDINGS...........................................................................................................................17.

RESULTS.SECTION.A:.CORE.INDICATORS,.KATANGA.PROVINCE.......................................................................46.

RESULTS.SECTION.B:.CORE.INDICATORS,.KINSHASA.PROVINCE......................................................................64.

RESULTS.SECTION.C:.RESULTS.BY.URBAN/RURAL.LOCATION,.KATANGA.PROVINCE.......................................83.

RESULTS.SECTION.D:.RESULTS.BY.URBAN/RURAL.LOCATION,.KINSHASA.PROVINCE....................................109.

RESULTS.SECTION.E:.RESULTS.BY.SURVEY.YEAR,.KATANGA.PROVINCE.........................................................137.

RESULTS.SECTION.F:.RESULTS.BY.SURVEY.YEAR,.KINSHASA.PROVINCE.........................................................149.

ANNEX.1:.ACTWATCH.BACKGROUND............................................................................................................167.

ANNEX.2:.COUNTRY.BACKGROUND...............................................................................................................170.

ANNEX.3:.OUTLET.SURVEY.METHODS............................................................................................................175.

ANNEX.4:.SAMPLED.CLUSTERS.......................................................................................................................180.

ANNEX.5:.DETAILED.SAMPLE.DESCRIPTION...................................................................................................183.

ANNEX.6:.QUESTIONNAIRE.ANNEX................................................................................................................187.

ANNEX.7:.ANTIMALARIAL.REFERENCE...........................................................................................................204.

ANNEX.8:.RDT.REFERENCE.............................................................................................................................209.

ANNEX.9..SAMPLING.WEIGHTS......................................................................................................................211.

ANNEX.10:.INDICATOR.DEFINITIONS..............................................................................................................213.

ANNEX.11..ADULT.EQUIVALENT.TREATMENT.DOSE.(AETD)..........................................................................220.

ANNEX.12:.ANTIMALARIAL.VOLUMES............................................................................................................222.. .

. !


List!of!Tables!.Table.S1:.Key.results,.by.outlet.type,.2015,.Katanga.......................................................................................................17.Table.S2:.Key.results,.by.outlet.type,.2015,.Kinshasa......................................................................................................19.

Results.Core.Indicators,.Katanga.Province.Table.A1:.Availability.of.antimalarials,.among.all.screened.outlets,.by.outlet.type,.Katanga.........................................46.Table.A2:.Availability.of.antimalarials,.among.outlets.stocking.at.least.one.antimalarial,.by.outlet.type,.Katanga........48.Table.A3:.Types.of.qualitylassured.and.nonlquality.assured.ACTs.audited.in.the.public.and.private.sector,.Katanga...50.Table.A4:.Antimalarial.market.composition,.Katanga......................................................................................................51.Table.A5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.Katanga................................................................52.Table.A5b:.Price.of.prelpackaged.antimalarials,.by.outlet.type,.Katanga........................................................................53.Table.A6:.Availability.of.malaria.blood.testing.among.antimalariallstocking.outlets*,.by.outlet.type,.Katanga.............54.Table.A7:.Malaria.blood.testing.market.composition,.Katanga.......................................................................................55.Table.A8:.Price.of.malaria.blood.testing.for.adults,.by.outlet.type,.Katanga...................................................................56.Table.A9:.Antimalarial.market.share,.Katanga.................................................................................................................57.Table.A10:.Antimalarial.market.share.within.outlet.type,.Katanga.................................................................................59.Table.A11:.Malaria.blood.testing.market.share,.Katanga................................................................................................60.Table.A12:.Malaria.blood.testing.market.share,.within.outlet.type,.Katanga.................................................................61.Table.A13:.Provider.case.management.knowledge.and.practices,.by.outlet.type,.Katanga...........................................62.Table.A14:.Provider.antimalarial.treatment.knowledge.and.practices,.by.outlet.type,.Katanga....................................63.

Results.Core.Indicators,.Kinshasa.Province.Table.B1:.Availability.of.antimalarials,.among.all.screened.outlets,.by.outlet.type,.Kinshasa.........................................64.Table.B2:.Availability.of.antimalarials,.among.outlets.stocking.at.least.one.antimalarial,.by.outlet.type,.Kinshasa.......66.Table.B3:.Types.of.qualitylassured.and.nonlquality.assured.ACTs.audited.in.the.public.and.private.sector,.Kinshasa.68.Table.B4:.Antimalarial.market.composition,.Kinshasa.....................................................................................................69.Table.B5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.Kinshasa...............................................................70.Table.B5b:.Price.of.prelpackaged.antimalarials,.by.outlet.type,.Kinshasa.......................................................................71.Table.B6:.Availability.of.malaria.blood.testing.among.antimalariallstocking.outlets*,.by.outlet.type,.Kinshasa............72.Table.B7:.Malaria.blood.testing.market.composition,.Kinshasa......................................................................................73.Table.B8:.Price.of.malaria.blood.testing.for.adults,.by.outlet.type,.Kinshasa..................................................................74.Table.B9:.Antimalarial.market.share,.Kinshasa................................................................................................................75.Table.B10:.Antimalarial.market.share.within.outlet.type,.Kinshasa................................................................................77.Table.B11:.Malaria.blood.testing.market.share,.Kinshasa...............................................................................................79.Table.B12:.Malaria.blood.testing.market.share,.within.outlet.type,.Kinshasa.................................................................80.Table.B13:.Provider.case.management.knowledge.and.practices,.by.outlet.type,.Kinshasa...........................................81.Table.B14:.Provider.antimalarial.treatment.knowledge.and.practices,.by.outlet.type,.Kinshasa...................................82.


Results.by.urban/rural.location,.Katanga.Province.Table. C1:. Availability. of. antimalarials,. among. all. screened. outlets,. by. outlet. type,. across. urban/rural. location,.

Katanga....................................................................................................................................................................83.Table. C2:. Availability. of. antimalarials,. among. outlets. stocking. at. least. one. antimalarial,. by. outlet. type,. across.

urban/rural.location,.Katanga.................................................................................................................................88.Table.C4:.Antimalarial.market.composition,.across.urban/rural.location,.Katanga........................................................93.Table.C5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.across.urban/rural.location,.Katanga...................94.Table.C5b:.Price.of.prelpackaged.antimalarials,.by.outlet.type,.across.urban/rural.location,.Katanga..........................96.Table. C6:. Availability. of. malaria. blood. testing. among. antimalariallstocking. outlets*,. by. outlet. type,. across.

urban/rural.location,.Katanga.................................................................................................................................98.Table.C8:.Price.of.malaria.blood.testing,.by.outlet.type,.across.urban/rural.location,.Katanga......................................99.Table.C9.1:.Antimalarial.market.share,.within.urban.location,.Katanga........................................................................100.Table.C9.2:.Antimalarial.market.share,.within.rural.location,.Katanga..........................................................................101.Table.C10.1:.Antimalarial.market.share.within.outlet.type,.within.urban.location,.Katanga........................................103.Table.C10.2:.Antimalarial.market.share.within.outlet.type,.within.rural.location,.Katanga..........................................104.Table.C13:.Provider.case.management.knowledge.and.practices,.by.outlet.type,.across.urban/rural.location,.Katanga

...............................................................................................................................................................................105.Table. C14:. Provider. antimalarial. treatment. knowledge. and. practices,. by. outlet. type,. across. urban/rural. location,.

Katanga..................................................................................................................................................................107.

Results.by.urban/rural.location,.Kinshasa.Province.Table. D1:. Availability. of. antimalarials,. among. all. screened. outlets,. by. outlet. type,. across. urban/rural. location,.

Kinshasa.................................................................................................................................................................109.Table. D2:. Availability. of. antimalarials,. among. outlets. stocking. at. least. one. antimalarial,. by. outlet. type,. across.

urban/rural.location,.Kinshasa..............................................................................................................................115.Table.D4:.Antimalarial.market.composition,.across.urban/rural.location,.Kinshasa.....................................................121.Table.D5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.across.urban/rural.location,.Kinshasa...............122.Table.D5b:.Price.of.prelpackaged.antimalarials,.by.outlet.type,.across.urban/rural.location,.Kinshasa.......................125.Table. D6:. Availability. of. malaria. blood. testing. among. antimalariallstocking. outlets*,. by. outlet. type,. across.

urban/rural.location,.Kinshasa..............................................................................................................................127.Table.D8:.Price.of.malaria.blood.testing,.by.outlet.type,.across.urban/rural.location,.Kinshasa..................................128.Table.D9.1:.Antimalarial.market.share,.within.urban.location,.Kinshasa......................................................................129.Table.D9.2:.Antimalarial.market.share,.within.rural.location,.Kinshasa........................................................................130.Table.D10.1:.Antimalarial.market.share.within.outlet.type,.within.urban.location,.Kinshasa.......................................131.Table.D10.2:.Antimalarial.market.share.within.outlet.type,.within.rural.location,.Kinshasa.........................................132.Table. D13:. Provider. case. management. knowledge. and. practices,. by. outlet. type,. across. urban/rural. location,.

Kinshasa.................................................................................................................................................................133.Table. D14:. Provider. antimalarial. treatment. knowledge. and. practices,. by. outlet. type,. across. urban. rural. location,.

Kinshasa.................................................................................................................................................................135.

Results.by.survey.year,.Katanga.Province.Table.E1:.Availability.of.antimalarials,.among.all.screened.outlets,.by.outlet.type,.across.survey.round,.Katanga......137.Table.E2:.Availability.of.antimalarials,.among.outlets.stocking.at.least.one.antimalarial,.by.outlet.type,.across.survey.

round,.Katanga......................................................................................................................................................140.


Table.E4:.Antimalarial.market.composition,.across.survey.round.Katanga...................................................................142.Table.E5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.across.survey.round,.Katanga............................143.Table. E6:. Availability. of.malaria. blood. testing. among. antimalariallstocking. outlets*,. by. outlet. type,. across. survey.

round,.Katanga......................................................................................................................................................144.Table.E8:.Price.of.malaria.blood.testing.for.adults,.by.outlet.type,.across.survey.round,.Katanga...............................145.Table.E9:.Antimalarial.market.share,.across.survey.round,.Katanga.............................................................................146.Table.E10:.Antimalarial.market.share.within.outlet.type,.across.survey.round,.Katanga.............................................147.Table.E14:.Provider.antimalarial. treatment.knowledge.and.practices,.by.outlet. type,.across. survey. round,.Katanga

...............................................................................................................................................................................148.

Results.by.survey.year,.Kinshasa.Province.Table.F1:.Availability.of.antimalarials,.among.all.screened.outlets,.by.outlet.type,.across.survey.round,.Kinshasa.....149.Table.F2:.Availability.of.antimalarials,.among.outlets.stocking.at.least.one.antimalarial,.by.outlet.type,.across.survey.

round,.Kinshasa.....................................................................................................................................................153.Table.F4:.Antimalarial.market.composition,.across.survey.round.Kinshasa..................................................................157.Table.F5a:.Price.of.tablet.formulation.antimalarials,.by.outlet.type,.across.survey.round,.Kinshasa...........................158.Table. F6:. Availability. of.malaria. blood. testing. among. antimalariallstocking. outlets*,. by. outlet. type,. across. survey.

round,.Kinshasa.....................................................................................................................................................160.Table.F8:.Price.of.malaria.blood.testing.for.adults,.by.outlet.type,.across.survey.round,.Kinshasa..............................161.Table.F9:.Antimalarial.market.share,.across.survey.round,.Kinshasa............................................................................162.Table.F10:.Antimalarial.market.share.within.outlet.type,.across.survey.round,.Kinshasa.............................................164.Table.F14:.Provider.antimalarial.treatment.knowledge.and.practices,.by.outlet.type,.across.survey.round,.Kinshasa

...............................................................................................................................................................................166.

Annexes.Table.X1..Sampled.Clusters............................................................................................................................................180.Table.X2:.Detailed.sample.description...........................................................................................................................183.Table.X3:.Number.of.antimalarials.audited...................................................................................................................204.Table.X4:.Qualitylassured.(QA.ACT).and.Nonlquality.assured.ACTs.Audited................................................................205.Table.X5:.Nationally.Registered.ACTs.............................................................................................................................207.Table.X6:.Severe.Malaria.Treatment.Audited................................................................................................................208.Table.X7:.Number.of.RDTs.audited................................................................................................................................209.Table.X8:.RDT.Brand.Names.and.Manufacturers*.........................................................................................................210.Table.X9:.Adult.Equivalent.Treatment.Dose.Definitions................................................................................................221.Table.X10:.Antimalarial.volumes,.by.outlet.type,.Katanga,.2015...................................................................................222.Table.X11:.Antimalarial.volumes,.by.outlet.type,.Kinshasa,.2015..................................................................................224..

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List!of!Figures!!

Figure.1..2015.DRC.Outlet.Survey.Study.Provinces..........................................................................................................13.Figure.2..Survey.flow.diagram,.DRC,.2015,.Katanga........................................................................................................15.Figure.3..Survey.flow.diagram,.DRC,.2015,.Kinshasa.......................................................................................................16.Figure.4..Market.composition:.outlet.type.distribution,.Kinshasa.and.Katanga,.2009l2015...........................................21.Figure.5..Market.composition:.outlet.type.distribution,.Kinshasa.and.Katanga,.2015....................................................22.Figure.6..Percentage.of.outlets.with.at.least.one.antimalarial.in.stock.on.the.day.of.the.survey,.Kinshasa.and.Katanga,.

2009l2015................................................................................................................................................................23.Figure.7..Percentage.of.outlets.with.at.least.one.antimalarial.in.stock.on.the.day.of.the.survey,.Kinshasa.and.Katanga,.

2015.........................................................................................................................................................................23.Figure. 8.. Percentage. of. antimalariallstocking. outlets. with. ACT. in. stock. on. the. day. of. the. survey,. Kinshasa. and.

Katanga,.2009l2015.................................................................................................................................................24.Figure. 9.. Percentage. of. antimalariallstocking. outlets. with. ACT. in. stock. on. the. day. of. the. survey,. Kinshasa. and....

Katanga,.2015..........................................................................................................................................................24.Figure.10.. Percentage.of. antimalariallstocking.outlets.with.qualitylassured.ACT. in. stock.on. the.day.of. the. survey,.

Kinshasa.and.Katanga,.2009l2015...........................................................................................................................25.Figure.11.. Percentage.of. antimalariallstocking.outlets.with.qualitylassured.ACT. in. stock.on. the.day.of. the. survey,.

Kinshasa.and.Katanga,.2015....................................................................................................................................25.Figure.12..Percentage.of.antimalariallstocking.outlets.with.nonlquality.assured.ACT.in.stock.on.the.day.of.the.survey,.

Kinshasa.and.Katanga,.2009l2015...........................................................................................................................26.Figure.13..Percentage.of.antimalariallstocking.outlets.with.nonlquality.assured.ACT.in.stock.on.the.day.of.the.survey,.

Kinshasa.and.Katanga,.2015....................................................................................................................................26.Figure. 14.. Types. of. qualitylassured. ACT. and. nonlquality. assured. ACT. audited. among. publicl. and. privatelsector.

outlets,.Kinshasa,.2015............................................................................................................................................27.Figure. 15.. Types. of. qualitylassured. ACT. and. nonlquality. assured. ACT. audited. among. publicl. and. privatelsector.

outlets,.Katanga,.2015.............................................................................................................................................28.Figure.16..Percentage.of.antimalariallstocking.outlets.with.nonlartemisinin.therapy.in.stock.on.the.day.of.the.survey,.

Kinshasa.and.Katanga,.2009l2015...........................................................................................................................29.Figure.17..Percentage.of.antimalariallstocking.outlets.with.nonlartemisinin.therapy.in.stock.on.the.day.of.the.survey,.

Kinshasa.and.Katanga,.2015....................................................................................................................................29.Figure. 18.. Percentage. of. antimalariallstocking. outlets.with. Sulfadoxine. Pyrimethamine. in. stock. on. the. day. of. the.

survey,.Kinshasa.and.Katanga,.2009l2015..............................................................................................................30.Figure. 19.. Percentage. of. antimalariallstocking. outlets. with. SP. in. stock. on. the. day. of. the. survey,. Kinshasa. and.

Katanga,.2015..........................................................................................................................................................30.Figure.20..Percentage.of.antimalariallstocking.outlets.with.oral.quinine.in.stock.on.the.day.of.the.survey,.Kinshasa.

and.Katanga,.2009l2015..........................................................................................................................................31.Figure.21..Percentage.of.antimalariallstocking.outlets.with.oral.quinine.in.stock.on.the.day.of.the.survey,.Kinshasa.

and.Katanga,.2015...................................................................................................................................................31.Figure.22..Percentage.of.antimalariallstocking.outlets.with.any.severe.malaria.treatment.in.stock.on.the.day.of.the.

survey,.Kinshasa.and.Katanga,.2009l2015..............................................................................................................32.Figure.23..Percentage.of.antimalariallstocking.outlets.with.any.severe.malaria.treatment.in.stock.on.the.day.of.the.

survey,.Kinshasa.and.Katanga,.2015........................................................................................................................32.Figure.24..Percentage.of.antimalariallstocking.outlets.with. injectable.artesunate. in.stock.on.the.day.of.the.survey,.

Kinshasa.and.Katanga,.2009l2015...........................................................................................................................33.


Figure.25..Percentage.of.antimalariallstocking.outlets.with. injectable.artesunate. in.stock.on.the.day.of.the.survey,.Kinshasa.and.Katanga,.2015....................................................................................................................................33.

Figure.26..Antimalarial.market.share,.Kinshasa.and.Katanga,.2009l2015.......................................................................34.Figure.27..Antimalarial.market.share.within.sector,.Kinshasa.and.Katanga,.2009l2015.................................................34.Figure.28..Antimalarial.market.share,.Kinshasa,.2015.....................................................................................................35.Figure.29..Antimalarial.market.share,.Katanga,.2015......................................................................................................35.Figure.30..Antimalarial.market.share,.Kinshasa.and.Katanga,.2015................................................................................36.Figure. 31.. Percentage. of. antimalariallstocking. outlets.with.malaria. blood. testing. available,. Kinshasa. and. Katanga,.

2009l2015................................................................................................................................................................36.Figure. 32.. Percentage. of. antimalariallstocking. outlets.with.malaria. blood. testing. available,. Kinshasa. and. Katanga,.

2015………………………………………………………………………………………………………………………………………………………………….37.Figure. 33.. Percentage. of. antimalariallstocking. outlets. with. malaria. microscopy. available,. Kinshasa. and. Katanga,.

2009l2015................................................................................................................................................................37.Figure. 34.. Percentage. of. antimalariallstocking. outlets. with. malaria. microscopy. available,. Kinshasa. and. Katanga,.

2015………………………………………………………………………………………………………………………………………………………………….38.Figure. 35.. Percentage. of. antimalariallstocking. outlets. with. malaria. RDTs. available,. Kinshasa. and. Katanga,. 2009l

2015………………………………………………………………………………………………………………………………………………………………….38.Figure.36..Percentage.of.antimalariallstocking.outlets.with.malaria.RDTs.available,.Kinshasa.and.Katanga,.2015........39.Figure.37..Malaria.blood.testing.market.share,.Kinshasa,.2015......................................................................................39.Figure.38..Malaria.blood.testing.market.share,.Katanga,.2015.......................................................................................40.Figure.39..Malaria.RDT.market.share.by.manufacturer,.within.sector,.Kinshasa.and.Katanga,.2015.............................40.Figure. 40.. Privatelsector. median. price. of. antimalarial. adult. equivalent. treatment. dosages. (AETD),. Kinshasa. and.

Katanga,.2009l2015.................................................................................................................................................41.Figure. 41.. Privatelsector. median. price. of. SP. and. QA. ACT. adult. equivalent. treatment. dosages. (AETD). and. prel

packaged.pediatric.qualitylassured.ACT.(PP.ped.QA.ASAQ),.Kinshasa.and.Katanga,.2015.....................................41.Figure. 42.. Privatelsector. median. price. of. SP. and. QA. ACT. adult. equivalent. treatment. dosages. (AETD). and. prel

packaged.pediatric.qualitylassured.artesunate.amodiaquine.(PP.ped.QA.ASAQ),.Kinshasa.and.Katanga,.2015....42.Figure. 43.. Median. privatelsector. consumer. prices. or. malaria. RDT. testing. for. adults. and. children,. Kinshasa. and.

Katanga,.2015..........................................................................................................................................................42.Figure.44..Median.privatelsector.prices.of.prelpackaged.qualitylassured.artesunate.amodiaquine.(PP.QA.ASAQ).and.

malaria.RDT.testing.for.children.and.adults,.Kinshasa.and.Katanga,.2015..............................................................43.Figure.45..Percentage.of.providers.who.correctly.state.the.firstlline.treatment.for.uncomplicated.malaria,.Kinshasa.

and.Katanga,.2013l2015..........................................................................................................................................43.Figure.46..Percentage.of.providers.who.correctly.state.the.firstlline.treatment.for.uncomplicated.malaria,.Kinshasa.

and.Katanga,.2015...................................................................................................................................................44.Figure.47..Percentage.of.providers.who.correctly.state.the.firstlline.dosing.regimen.for.uncomplicated.malaria.for.a.

twolyearlold.child,.Kinshasa.and.Katanga,.2013l2015............................................................................................44.Figure.48..Percentage.of.providers.who.correctly.state.the.firstlline.dosing.regimen.for.uncomplicated.malaria.for.a.

twolyearlold.child,.Kinshasa.and.Katanga,.2015.....................................................................................................45.Figure.X1..Prevalence.of.malaria.in.children.age.6l59.months.by.Division.Provinciale.de.la.Santé,.DRClDHS.II.2013.14…………………………………………………………………………………………………………………………………………………………………….……..168.Figure.X2..Map.of.the.Study.Provinces..........................................................................................................................176.Figure.X3..Maps.of.Study.Area.......................................................................................................................................182.. .


Acronyms!!!.ACT. Artemisinin.combination.therapy..

AETD. Adult.equivalent.treatment.dose.

AL. Artemether.lumefantrine.

AMFm. Affordable.Medicines.Facility.–.malaria..

ASAQ. Artesunate.amodiaquine..

ASF. Association.de.Santé.Familiale.

BMGF. The.Bill.and.Melinda.Gates.Foundation..

CHW. Community.Health.Worker.

DHA.PPQ.. Dihydroartemisinin.piperaquine..

DHS. The.Demographic.and.Health.Survey..

DRC. The.Democratic.Republic.of.the.Congo.

EMA. European.Medicines.Agency..

GFATM. Global.Fund.to.Fight.AIDS,.TB,.and.Malaria..

ICCM..

IM.

IPTp.

Integrated.community.case.management..

Intramuscular.injection..

Intermittent.preventive.therapy.in.pregnancy..

IV. Intravenous.injection..

MOH. Ministry.of.Health..

NGO.

.......NMCP..

Nonlgovernmental.Organization.

.......National.Malaria.Control.Program..

Oral.AMT. Oral.artemisinin.monotherapy...

PMI.

Pf.

President’s.Malaria.Initiative.

Plasmodium'falciparum''

QA.ACT. Qualitylassured.artemisinin.combination.therapy..

QA.RDT. Qualitylassured.rapid.diagnostic.test..

RDT.

.......SP..

Rapid.diagnostic.test..

Sulfadoxine.Pyrimethamine..

UK.

USAID.

........

United.Kingdom..

United.States.Agency.for.International.Development.

..

.

. !


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.DRC,. they.were.defined.as.health.areas...

Censused!Cluster! A.health.area.where.field.teams.conducted.a.full.census.of.all.outlets.with.the.potential.to.sell.antimalarials..

GovernmentQsupported!health!facilities!

Public. health. facilities. and. private. facilities. that. receive. a. full. package. of. support. from. the.government..There.is.one.official.governmentlsupported.facility.per.health.area..

Booster!Sample! A.booster.sample.was.collected.by.selecting.additional.clusters.for.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.governmentlsupported.public.health. facilities. and. pharmacies.. See. Annex. 9. for. a. detailed. description. of. the. booster.sampling.methods....

.Malaria.Product.Indicator.Definitions...Antimalarial! Any. medicine. recognized. by. the. World. Health. Organization. (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..

ArtemisininQbased!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..

NonQartemisinin!therapy!

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

FirstQline!treatment!! The. governmentlrecommended. treatment. for. uncomplicated. malaria.. DRC’s. firstlline.treatment. for. uncomplicated. malaria. is. artemether. lumefantrine. (20mg. /. 120mg). or.artesunate.amodiaquine.(100mg./.270mg)..

SecondQline!treatment!

The. governmentlrecommended,. secondlline. treatment. for. uncomplicated. malaria.. DRC’s.secondlline.treatment.for.uncomplicated.malaria.is.quinine..

Nationally!registered!ACTs!

ACTs.registered.with.DRC’s.national.drug.authority.and.permitted.for.sale.or.distribution. in.DRC..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. firstlline. 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.prelreferral.treatment.in.children.under.6.years.of.age.0F

1.QualityQassured!ArtemisininQBased!Combination!Therapies!(QA!ACTs)!

QA.ACTs.are.ACTs.that.comply.with.the.Global.Fund.to.Fight.AIDS,.Tuberculosis.and.Malaria’s.(GFATM). Quality. Assurance. Policy.. A. QA. ACT. is. any. ACT. that. appeared. on. the. GFATM’s.indicative. list. of. antimalarials.meeting. the. GFATM’s. quality. assurance. policy. prior. to. data.collection. (see. http://www.theglobalfund.org/en/healthproducts/qualityassurance/). or. that.previously.had.Clstatus. in.an.earlier.GFATM.quality.assurance.policy..QA.ACTs.also. include.ACTs.that.have.been.granted.regulatory.approval.by.the.European.Medicines.Agency.(EMA).–.specifically.Eurartesim®.and.Pyramax®..

QualityQassured!ACT!with!the!“green!leaf”!logo,!or!“coQpaid!ACTs”!

The.“green.leaf”.logo.indicates.that.a.qualitylassured.ACT.was.acquired.through.a. colpayment. mechanism. administered. by. the. GFATM. (Affordable.Medicines.Facility,.malaria.–.or.AMFm)..

.QualityQassured!RDT!

QA.RDTs.are.RDTs.that.comply.with.the.GFATM’s.Quality.Assurance.Policy..A.QA.RDT.is.any.RDT. that. appeared. on. the. GFATM’s. indicative. list. of. RDTs. meeting. the. GFATM’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..


Introduction!!.This. country. reference. document. is. a. detailed. presentation. of. the. 2015. national. ACTwatch. outlet. survey. (OS).conducted.in.DRC..The.2015.OS.follows.previous.survey.rounds.conducted.by.ACTwatch.in.DRC.in.2009.and.2013....ACTwatch.is.a.multilcountry.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.highlquality.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.midl2016.by.the.BMGF,.UNITAID,.and.DFID..See.Annex.1.for.more.information.about.the.ACTwatch.project.....ACTwatch. antimalarial.market.monitoring. in. DRC. from. 2009. 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:..•! In. 2012,. a. forum. of. experts. convened. and. recommended. the. use. of. artemetherllumefantrine. (AL). as. an.

alternative. firstlline. treatment. to. Artesunate. amodiaquine. (ASAQ).. This. group. also. suggested. that. parenteral.artesunate.be.used.for.severe.malaria..These.recommendations.were.approved.by.the.MOH,.with.a.threelyear.period.to.transition.to.parenteral.artesunate.for.the.treatment.of.severe.malaria..

•! According.to.national.policy.and.in.line.with.WHO.recommendations,.all.patients.with.fever.should.be.tested.for.malaria,. either. using.microscopy. or. RDTs..Microscopy. is. expected. to. be. the. primary. diagnostic. procedure. in.hospitals.and.larger.health.centers,.while.RDTs.are.to.be.used.in.smaller.health.facilities.and.at.the.community.level..

•! Several.malaria.control.programs.financed.by.GFATM,.World.Bank,.DIFD.and.PMI,.together.with.a.government.commitment.of.approximately.$2.million.USD.per.year,.are. implemented.with. the.coordination.of. the.NMCP..These.programs.have. funds.earmarked.to. increase.procurement.and.distribution.of.ACT,.SP,. rectal.artesunate.and.malaria.RDTs..Further.support.is.provided.to.train.providers.in.malaria.case.management,.including.malaria.commodity.stocking.management.and.quality.assurance...

The.2015.OS.was.the.third.round.of.ACTwatch.outlet.surveys.conducted.in.DRC..This.report.presents.trend.lines.for.Kinshasa.province. (2009,. 2011,. 2013.outlet. surveys). and.Katanga.province. (2011.and.2013.outlet. surveys).. These.surveys.are.designed.to.monitor.key.antimalarial.market.indicators.at.the.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..

•! Outlet.types.with.few.outlets.screened.during.the.2015.DRC.outlet.survey.were.excluded.from.most.overall.results.(sections.A/B).and.results.by.urban/rural.location.report.tables.(sections.C/D):.•! There.were.8.pharmacies.screened.in.Katanga.province,.of.which.7.pharmacies.stocked.antimalarials.and.0.

pharmacies.stocked.malaria.diagnostics..•! There.were.12.community.health.workers.screened.in.Kinshasa.province,.of.which.5.community.health.

workers.stocked.antimalarials.and.2.stocked.malaria.RDTs..•! Community.health.workers.were.not.visited.during.the.2009.and.2013.DRC.outlet.surveys.but.were.screened.for.

eligibility.in.2015.to.capture.any.recent.efforts.to.equip.CHWs.with.malaria.testing.and.treatment..


•! In.2009.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..Previous.rounds.also.included.screening.of.itinerant.drug.vendors,.however.these.mobile.vendors.very.rarely.stocked.antimalarials.and.thus.were.excluded.in.2015..

•! 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.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!!!!!Provincially. representative. outlet. surveys. were. conducted. in. Katanga. and. Kinshasa. provinces. (figure. 1). between.October. 9th. and. December. 2nd,. 2015.. A. full. description. of. research. design. and.methods. is. provided. in. Annex. 3..Briefly,. a. representative. sample. of. health. areas.was. selected. from.urban. and. rural. domains. (see. sampled. health.areas.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. health. areas. were. selected. for. oversampling. of.governmentlsupported.public.health.facilities..A.full.census.of.pharmacies.was.conducted.in.Kinshasa.and.Katanga.provinces..This.booster.sampling.strategy.was.used.to.obtain.a.sufficient.sample.size.for.indicator.estimates.within.these.outlet.types...Figure!1.!2015!DRC!Outlet!Survey!Study!Provinces!!!.

..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. Figures. 2. and. 3. for. Katanga. and. Kinshasa. provinces. respectively.. A. detailed. sample. summary. is.provided.in.Annex.5....


A. structured.paper. questionnaire.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. Annexes. 7. and. 8. for. detailed. summaries. of.antimalarials.and.RDTs.audited..Key.informant.interviews.were.conducted.with.specific.stakeholders.to.supplement.information.for.the.DRC.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. healthlarea. and. healthlzone. levels.. Standard. indicators. were. constructed. according. to.definitions.applied.across.ACTwatch.project.countries.(see.Annex.10)....The. 2015. OS. included. screening. and. auditing. for. all. available. family. planning. products. and. services.. Please. see.www.fpwatch.info.for.a.detailed.report.of.these.results...! !


Figure!2.!Survey!flow!diagram,!DRC,!2015,!Katanga!!.....

A!Outlets.enumerated*.

[1,088]..

B!Outlets.screened**.

[1,052]..

D!Outlets.interviewed***.. [1,036].! 1!=.[993].! 2!=.[34].! 3!=.[9]..

Outlets.not..screened.

[36]..

Outlets.that.did.not.meet.screening.

criteria.[16]..

Outlets.not.interviewed.

[1]..

!Respondent.not.available. . [3]..Outlet.closed.at.time.of.visit....... [6]..Outlet.closed.permanently.......... [20]..Refused. .......... [7].

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.

. [1,037].! 1!=.[993].! 2!=.[35].! 3!=.[9].

. !Outlet.closed.at.time.of.visit........ . [1].


Figure!3.!Survey!flow!diagram,!DRC,!2015,!Kinshasa!!.....

A!Outlets.enumerated*.

[1,357]..

B!Outlets.screened**.

[1,168]..

D!Outlets.interviewed***.. [1,138].! 1!=.[1,056].! 2=. [22].! 3=. [60].

.

Outlets.not..screened.[189].

.

Outlets.that.did.not.meet.screening.

criteria.[30]..

Outlets.not.interviewed.

[0]..

!Respondent.not.available. . [7]..Outlet.closed.at.time.of.visit....... [46]..Outlet.closed.permanently.......... [112]..Other. ........... [3]..Refused. .......... [21].

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.

. [1,138].! 1!=.[1,056].! 2!=.[22].! 3!=.[60].

.

www.ACTwatch.info....................Page.17.

Summary'of'Key'Findings''

Table'S1:'Key'results,'by'outlet'type,'2015,'Katanga'

'Public.Health.Facility.

Community.Health.Worker'

[email protected]'

ALL'Public'/'NotC'ForCProfit'

[email protected].

Drug.Store. ALL'Private1.

ALL'Outlets1'

' %.(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=266. N=35. N=23. N=324. N=152. N=568. N=728. N=1052.

Availability.of.malaria.blood.testing.86.5. 89.6. 93.2. 87.8. 56.5. 9.7. 19.4. 36.9.

(79.4,.91.4). (58.4,.98.1). (72.0,.98.7). (79.8,.93.0). (47.1,.65.5). (6.3,.14.6). (15.1,.24.5). (30.6,.43.8).

Availability.of.QA.ACT. 89.8. 89.6. 54.4. 86.9. 34.7. 50.3. 47.2. 57.4.(82.3,.94.4). (58.4,.98.1). (31.4,.75.8). (78.7,.92.3). (25.7,.44.9). (43.3,.57.2). (41.1,.53.5). (52.8,.61.9).

Availability.of.QA.ACT.and.malaria.blood.testing.

79.2. 87.9. 54.4. 79.5. 29.6. 5.9. 10.8. 28.4.(71.1,.85.5). (53.4,.97.9). (31.4,.75.8). (69.5,.86.9). (20.7,.40.2). (3.6,.9.6). (8.1,.14.2). (22.5,.35.2).

Availability.of.QA.ACT,.blood.testing.not.available..

10.6. 1.7. 0.0. 7.4. 5.1. 44.4. 36.4. 29.0.(6.1,.17.9). (0.2,.12.9). @. (3.9,.13.6). (2.4,.10.5). (38.0,.50.9). (30.8,.42.5). (23.6,.35.0).

[email protected].(artesunate.IV/IM)..

14.0. 0.0. 8.8. 9.9. 3.9. 4.2. 4.1. 5.6.(8.5,.22.1). @. (3.0,.23.0). (5.6,.17.0). (1.5,.9.8). (2.6,.6.8). (2.6,.6.4). (3.9,.7.9).

Readiness'for'malaria'case'management'Proportion(of(antimalarial4stocking(outlets(!(with:("

N=258. N=34. N=19. N=311. N=121. N=554. N=682. N=993.


(79.3,.91.6). (57.1,.98.2). @. (80.1,.93.4). (56.5,.75.9). (6.5,.15.2). (15.0,.24.7). (31.1,.45.5).

Availability.of.QA.ACT'91.7. 91.2. 61.4. 89.4. 48.1. 52.4. 52.0. 62.1.

(83.8,.95.9). (61.6,.98.5). (35.2,.82.3). (81.4,.94.2). (38.3,.58.0). (46.0,.58.7). (46.6,.57.4). (57.8,.66.3).Availability.of.QA.ACT.and.malaria.blood.testing'

80.9. 89.4. 61.4. 81.7. 41.0. 6.2. 11.9. 30.7.(72.5,.87.2). (57.1,.98.2). (35.2,.82.3). (72.0,.88.6). (30.3,.52.6). (3.8,.10.0). (9.0,.15.6). (24.2,.38.2).

Availability.of.QA.ACT,.blood.testing.not.available.'

10.8. 1.8. 0.0. 7.6. 7.1. 46.2. 40.1. 31.4.(6.2,.18.2). (0.2,.13.5). @. (4.0,.14.0). (3.5,.14.0). (40.3,.52.2). (34.8,.45.8). (25.9,.37.4).


14.3. 0.0. 9.9. 10.2. 5.4. 4.4. 4.5. 6.0.(8.7,.22.5). @. (3.3,.26.4). (5.7,.17.5). (2.0,.13.5). (2.8,.7.0). (2.9,.7.0). (4.2,.8.5).

Readiness'for'IPTp'Proportion(of(outlets(with:(' . . . . . . . .

Availability.of.sulfadoxine.pyrimethamine,.among.all.screened.outlets*.

44.7. 5.4. 33.6. 33.5. 25.4. 60.2. 52.6. 47.7.(35.2,.54.7). (0.6,.36.9). (16.1,.57.2). (21.9,.47.5). (17.4,.35.5). (53.1,.66.8). (46.8,.58.3). (41.1,.54.4).

. . . . . . . . .


Table'S1:'Key'results,'by'outlet'type,'2015,'Katanga'



[email protected]'


[email protected].

Drug.Store. ALL'Private1.

ALL'Outlets1'

Availability.of.sulfadoxine.pyrimethamine,[email protected].!.

45.7. 5.5. 37.9. 34.5. 35.2. 62.7. 57.9. 51.6.(35.9,.55.7). (0.6,.37.6). (18.0,.63.0). (22.4,.48.9). (24.4,.47.7). (55.7,.69.2). (52.0,.63.6). (44.5,.58.7).

'Antimalarial'market'share'within'outlet/sector'type''

%. %. %. %. %. %. %. %.

%.QA.ACT.market.share.^. 60.2. 94.7. 27.4. 57.3. 29.1. 20.5. 21.7. 31.2.

Private'sector'price**'Median.[IQR].(N).

Median.[IQR].(N).

Median.[IQR].(N).

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. n/a.

$0.00. $1.64. $1.53.n/a.[[email protected]].(144). [[email protected]].(543). [[email protected]].(692).

Median.price.for.one.sulfadoxine.pyrimethamine.AETD.(tablets). n/a. n/a. n/a. n/a. $0.33. $0.33. $0.38. n/a.

[[email protected]].(51). [[email protected]].(542). [[email protected]].(598).Median.price.for.one.pre@packaged.pediatric.QA.artesunate.amodiaquine.#' n/a. n/a. n/a. n/a.

$0.00. $0.66. $0.55.n/a.

[[email protected]].(39). [[email protected]].(90). [[email protected]].(129).

Median.price.for.an.adult.RDT.##. n/a. n/a. n/a. n/a.$1.10. $1.10. $1.10.

n/a.[[email protected]].(83). [[email protected]].(38). [[email protected]].(121).

1. Inclusive.of.8.screened,.7.antimalarial.stocking.and.0.malaria.diagnostic.stocking.pharmacies..*. The.denominator.includes.5.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..#. [email protected]..##. Price.inclusive.of.consultation./.service.fees..**..The.numbers.of.antimalarials.captured.in.audit.sheets.with.missing.price.information.are.as.follows:.7.adult.artemether.lumefantrine,.1.child.artesunate.amodiaquine..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'S2:'Key'results,'by'outlet'type,'2015,'Kinshasa'


[email protected]'

ALL'Public'/'NotC'ForCProfit1'

[email protected].

Pharmacy. Drug.Store. ALL'Private.

ALL'Outlets1'

' %..(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=205. N=79. N=296. N=237. N=61. N=574. N=872. N=1168.


(88.2,.99.1). (72.5,.97.7). (72.0,.92.0). (83.2,.92.9). (5.2,.35.0). (0.7,.3.0). (21.2,.31.4). (28.1,.37.6).

Availability.of.QA.ACT.85.4. 29.3. 49.4. 20.2. 64.3. 18.6. 19.8. 23.2.

(78.3,.90.4). (19.5,.41.4). (40.2,.58.6). (12.4,.31.2). (46.1,.79.1). (14.7,.23.1). (15.9,.24.4). (19.6,.27.1).Availability.of.QA.ACT.and.malaria.blood.testing.

82.5. 27.9. 47.3. 19.6. 11.3. 0.5. 6.0. 10.7.(72.9,.89.3). (17.9,.40.7). (37.7,.57.1). (11.9,.30.4). (4.3,.26.8). (0.1,.2.6). (3.6,.9.9). (8.2,.13.9).

Availability.of.QA.ACT,.blood.testing.not.available..

2.8. 1.4. 2.1. 0.6. 52.9. 18.0. 13.8. 12.4.(0.6,.12.5). (0.5,.3.9). (0.9,.4.9). (0.1,.2.8). (42.1,.63.5). (14.6,.22.1). (11.1,.17.0). (9.9,.15.4).


17.9. 12.8. 13.1. 9.6. 37.4. 17.8. 15.8. 15.5.(10.4,.29.1). (5.1,.28.3). (7.1,.22.9). (6.1,.14.9). (27.1,.48.9). (15.0,.21.1). (12.9,.19.3). (12.6,.19.0).

Readiness'for'malaria'case'management'Proportion(of(antimalarial4stocking(outlets(!(with:("

N=201. N=63. N=269. N=163. N=61. N=563. N=787. N=1056.


(87.9,.99.3). (86.2,.98.6). (86.6,.97.6). (87.1,.96.5). (5.2,.35.0). (0.7,.3.1). (15.9,.24.9). (23.2,.32.5).

Availability.of.QA.ACT'86.7. 40.2. 63.7. 31.9. 64.3. 19.0. 22.4. 26.6.

(78.7,.92.0). (24.9,.57.6). (50.1,.75.4). (22.0,.43.8). (46.1,.79.1). (15.0,.23.7). (18.2,.27.2). (22.8,.30.8).Availability.of.QA.ACT.and.malaria.blood.testing'

83.8. 38.3. 61.0. 30.9. 11.3. 0.6. 6.8. 12.3.(73.1,.90.8). (22.7,.56.7). (47.4,.73.1). (21.1,.42.8). (4.3,.26.8). (0.1,.2.7). (4.2,.11.0). (9.6,.15.8).

Availability.of.QA.ACT,.blood.testing.not.available.'

2.9. 1.9. 2.7. 1.0. 52.9. 18.4. 15.6. 14.3.(0.6,.12.7). (0.7,.5.2). (1.1,.6.5). (0.2,.4.3). (42.1,.63.5). (14.8,.22.7). (12.5,.19.2). (11.4,.17.7).


18.2. 17.5. 16.9. 15.2. 37.4. 18.2. 18.0. 17.8.(10.6,.29.4). (7.1,.37.1). (9.2,.29.1). (9.5,.23.4). (27.1,.48.9). (15.4,.21.4). (15.0,.21.3). (14.8,.21.3).

Readiness'for'IPTp'Proportion(of(outlets(with:(' . . . . . . . .

Availability.of.sulfadoxine.pyrimethamine,.among.all.screened.outlets*.

45.6. 31.0. 33.9. 13.3. 72.4. 69.8. 54.1. 51.8.(35.3,.56.2). (19.9,.44.7). (24.9,.44.2). (8.6,.19.9). (60.4,.81.8). (62.8,.76.0). (47.7,.60.4). (46.0,.57.6).

Availability.of.sulfadoxine.pyrimethamine,[email protected].!.

46.3. 42.5. 43.7. 20.9. 72.4. 71.4. 61.3. 59.5.(36.0,.56.9). (27.0,.59.6). (32.3,.55.9). (14.6,.29.1). (60.4,.81.8). (64.8,.77.1). (56.1,.66.3). (54.5,.64.4).


Table'S2:'Key'results,'by'outlet'type,'2015,'Kinshasa'


[email protected]'

ALL'Public'/'NotC'ForCProfit1'

[email protected].


ALL'Outlets1'

'Antimalarial'market'share'within'outlet/sector'type''

%. %. %. %. %. %. %. %.

%.QA.ACT.market.share.^. 33.9. 24.3. 32.9. 16.2. 0.0. 1.3. 2.2. 6.5.

Private'sector'price**' Median. Median. Median. 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.

$0.00. $7.67. $6.47. $5.04.n/a.

[[email protected]].(92). [[email protected]].(53). [[email protected]].(134). [[email protected]].(279).Median.price.for.one.sulfadoxine.pyrimethamine.AETD.(tablets). n/a. n/a. n/a.

$0.33. $1.64. $0.44. $0.44.n/a.

[[email protected]].(44). [[email protected]].(68). [[email protected]].(761). [[email protected]].(873).Median.price.for.one.pre@packaged.pediatric.QA.artesunate.amodiaquine.#' n/a. n/a. n/a.

$0.00. $0.00. $1.64. $0.00.n/a.

[[email protected]].(21). (1). [[email protected]].(12). [[email protected]].(34).

Median.price.for.an.adult.RDT.##. n/a. n/a. n/a. $1.10. $0.00. $1.10. $1.10. n/a.[[email protected]].(73). (1). [[email protected]].(3). [[email protected]].(77).

1. Inclusive.of.12.screened,.5.antimalarial@.stocking.and.2.malaria.RDT.stocking.community.health.workers..*. The.denominator.includes.24.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..#. [email protected]..##. Price.inclusive.of.consultation./.service.fees..**..The.numbers.of.antimalarials.captured.in.audit.sheets.with.missing.price.information.are.as.follows:.4.adult.artemether.lumefantrine,.1.adult.artesunate.amodiaquine,.4.child.artemether.lumefantrine,.1.child.artesunate.amodiaquine..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


.

.

Figure'4.'''Market'composition:'outlet'type'distribution,'Kinshasa'and'Katanga,'2009C2015'""Among"all"outlets"with"at"least"one"antimalarial"in"stock

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The.majority.of.antimalarial@stocking.outlets.over.time.and.across.provinces.were.drug.stores..In.2015,.one.in.four.antimalarial@[email protected],.including.public.health.facilities.(19.6%).and.CHWs.(7.1%)..In.contrast,.only.8.4.%[email protected]@sector.outlets,[email protected]....... .

1.7% 3.1%

15.7%

0.4%

79.1%

Kinshasa'2013N=917

1.3% 1.5%

14.9%

2.6%

79.8%

Kinshasa'2009'N=766

Public.Health.Facility

Community.Health.Worker

[email protected]

[email protected]

Pharmacy

Drug.Store

General.Retailer

8.4%0.5%4.7%

17.5%

0.4%68.5%

Kinshasa'2015N=852

19.6%

7.1%1.9%

12.1%

0.7%

58.5%

Katanga'2015N=843

15.0%

6.5%

17.8%60.9%

Katanga'2013N=771


.

Figure'5.'''Market'composition:'outlet'type'distribution,'Kinshasa'and'Katanga,'2015'"Among"all"outlets"with"at"least"one"antimalarial"in"stock,"across"urban/rural"location

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Drug.stores.were.the.most.common.type.of.antimalarial@stocking.outlet.in.urban.and.rural.areas.of.both.provinces,.and.they.accounted.for.over.70%.of.antimalarial@stocking.outlets.in.urban.areas.in.Kinshasa.and.Katanga..In.rural.areas.in.Kinshasa.and.Katanga,.drug.stores.accounted.for.a.smaller.fraction.but.were.still.the.most.common.outlet.type.stocking.antimalarials,.at.49%.and.52%,.respectively..The.public.sector.accounted.for.a.greater.percentage.of.outlets.with.antimalarials.in.rural.areas.compared.to.urban.areas..In.Kinsahsa,.15%.of.antimalarial@stocking.outlets.in.rural.areas.were.public.sector.compared.with.8%.in.urban.areas..Similairly.in.Katanga,.more.than.one.in.three.antimalarial@stocking.outlets.were.public.sector.in.rural.areas.compared.with.11%.in.urban.areas.....

8.1%3.3%

16.9%

0.5%

71.2%

Kinshasa'UrbanN=552



[email protected]

[email protected]

Pharmacy

Drug.Store

10.7%

4.4%

14.5%

21.3%

49.1%

Kinshasa'RuralN=300

8.4%2.8%

14.0%

2.2%

72.6%

Katanga'UrbanN=458

25.1%

10.5%

1.5%

11.2%

51.7%

Katanga'Rural'N=385


.

Figure'6.'''Percentage'of'outlets'with'at'least'one'antimalarial'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'2009C2015(Among"all"screened"outlets,"across"survey"round"

.

.In.2015,.98.5%.of.public.health.facilities.in.Kinshasa.and.98%.in.Katanga.had.antimalarials.in.stock.at.the.time.of.the.survey..The.majority.of.private@sector.outlet.types.were.stocking.antimalarials.in.2015.within.each.province,.but.with.notable.gaps.among.private.for@profit.health.facilities.in.Kinshasa.(63.4%).and.Katanga.(72.1%).*.In.2009.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'7.'''Percentage'of'outlets'with'at'least'one'antimalarial'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'2015(

"Among"all"screened"outlets,"across"urban/rural"location".

..

Antimalarial.availability.was.similar.in.urban.versus.rural.areas.of.Kinshasa..Data.trends.show.higher.availability.in.rural.versus.urban.areas.for.all.public.sector.outlets.due.to.availability.among.private.not@[email protected],.alongside.rural.CHWs,.included.in.the.“all.public”.category..In.Katanga,.antimalarial.availability.was.similar.in.urban.versus.rural.areas.for.most.outlet.types..Exceptions.include.higher.availability.among.private.for@profit.health.facilities.in.urban.(84%).versus.rural.areas.(64%),.and.drug.stores.in.urban.(99%).versus.rural.areas.(94%)..

0102030405060708090100



Private.not@[email protected].

Facility

All.Public [email protected].

Facility

Pharmacy Drug.Store General.retailer All.Private* Public.Health.Facility


Private.not@[email protected].

Facility


Facility

Drug.Store General.retailer All.Private*

Kinshasa Katanga

Percen

tage.of.o

utlets

2009 2013 2015

0102030405060708090100

Public.Health.Facility Private.not@[email protected]

All.Public [email protected]

Drug.Store All.Private Public.Health.Facility. Private.not@[email protected].


Drug.Store All.Private

Kinshasa Katanga

Percen

tage.of.o

utlets

Urban Rural

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.

.

.

Figure'8.'''Percentage'of'antimalarial3stocking'outlets'with'ACT'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200932015!!!Among!all!antimalarial,stocking!outlets,!across!survey!rounds!

.

..

ACT.availability.among.antimalarial:stocking.public.health.facilities.in.2015.was.95%.in.Kinshasa.and.94%.in.Katanga..In.Kinshasa,.this.was.an.increase.from.the.previous.survey.round.of.36%..In.the.private.sector,.ACT.availability.was.87%.in.Kinshasa.and.72%.in.Katanga,.and.these.2015.results.were.similar.to.those.observed.in.2013.....Figure'9.'''Percentage'of'antimalarial3stocking'outlets'with'ACT'in'stock'on'the'day'of'the'survey,'Kinshasa'and''''

Katanga,'2015!!Among!antimalarial,stocking!outlets,!across!urban/rural!location!

.

..

There.was.a.trend.for.a.higher.percentage.of.antimalarial:stocking.outlets.with.ACTs.in.stock.on.the.day.of.the.survey.in.urban.versus.rural.areas.in.both.Kinshasa.and.Katanga.across.outlet.types.(with.the.exception.of.public.health.facilities.in.Katanga,.where.the.urban.percentage.was.lower.than.the.rural)..Urban:rural.differences.were.particularly.striking.for.private.not:for:profit.health.facilities.in.Kinshasa.(urban,.82%;.rural,.59%),.and.drug.stores.in.Katanga.(urban,.90%;.rural,.64%)...... .

0102030405060708090100


Private.not:for:profit.

Health.Facility

All.Public Private.for:profit.Heath.

Facility

Pharmacy Drug.Store All.Private Public.Health.Facility.


Health.Facility.


Facility.


Kinshasa Kinshasa

Percen

tage.of.o

utlets

2009 2013 2015

0102030405060708090

100


Private.not:for:profit.Health.

Facility


Facility

Drug.Store All.Private Public.Health.Facility.


Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets

Urban RuralKINSHASA' KATANGA'

KINSHASA' KATANGA'


.

Figure'10.'' Percentage'of'antimalarial3stocking'outlets'with'quality3assured'ACT'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200932015'

!!Among!all!antimalarial,stocking!outlets,!across!survey!rounds!.

..

Availability. of. quality:assured. ACT. (QA. ACT). among. antimalarial:stocking. public. health. facilities. in. 2015. was. 87%. in. Kinshasa,. as.compared.with.59%.in.2013,.and.92%.in.Katanga,.as.compared.with.71%.in.2013..QA.ACT.availability.was.much.lower. in.the.private.sector,.particularly.in.Kinshasa.(22%),.but.relatively.higher.in.Katanga.(53%)..In.Kinshasa,.private:sector.QA.ACT.availability.increased.to.22%.in.2015.from.12%.in.2013,.with.notable.increases.among.private.for:profit.health.facilities.(2013,.25%;.2015,.32%).and.drug.stores.(2013,.9%;.2015,.19%).....Figure'11.'' Percentage'of'antimalarial3stocking'outlets'with'quality3assured'ACT'in'stock'on'the'day'of'the'

survey,'Kinshasa'and'Katanga,'2015'!!Among!antimalarial,stocking!outlets,!across!urban/rural!location!

.

..

Data.trends.suggest.higher.QA.ACT.availability.in.urban.versus.rural.public.health.facilities.in.Kinshasa.(urban,.64%;.rural,.52%),.while.Katanga.shows.the.opposite.pattern.(rural,.91%;.urban,.77%)..Within.the.private.sector,.data.trends.suggest.higher.availability.in.urban.areas.compared.with.rural.areas.in.both.Kinshasa.and.Katanga.... .

0102030405060708090100



Health.Facility


Facility



Health.Facility.


Facility.


Kinshasa Kinshasa

Percen

tage.of.o

utlets

2009 2013 2015

0102030405060708090

100



Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets


KINSHASA' KATANGA'


.

.

Figure'12.' Percentage'of'antimalarial3stocking'outlets'with'non3quality'assured'ACT'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200932015'Among!all!antimalarial,stocking!outlets,!across!survey!rounds!

.

..

The.availability.of.non:quality:assured.ACT.(non:QA.ACT).increased.over.time.in.Kinshasa..Within.the.public.sector,.2015.availability.was.39%.compared.with.23%.in.2013.and.20%.in.2009..In.the.private.sector,.2015.availability.was.83%.compared.with.82%.in.2013.and.61%.in.2009..There.was.a.notable.increase.among.drug.stores.over.time:.2009,.73%;.2013,.91%;.and.2015,.91%...Availability.of.non:QA.ACTs.was.generally.lower.in.Katanga.over.time.compared.with.Kinshasa..In.2015,.public:sector.availability.was.11%,.as.compared.with.26%.in.2013,.and.private:sector.availability.was.53%.....Figure'13.' Percentage'of'antimalarial3stocking'outlets'with'non3quality'assured'ACT'in'stock'on'the'day'of'the'

survey,'Kinshasa'and'Katanga,'2015'Among!antimalarial,stocking!outlets,!across!urban/rural!location!

.

..

There.was.a.trend.for.higher.levels.of.availability.of.non:QA.ACTs.in.urban.versus.rural.areas.of.both.Kinshasa.and.Katanga,.across.all.outlet.types..Urban:rural.differences.were.particularly.striking. in.the.public.sectors.of.Kinshasa.(urban,.44%;.rural,.29%).and.Katanga.(urban,.40%;.rural,.7%),.as.well.as.the.private.sector.in.Katanga.(urban,.79%;.rural,.34%),.which.was.driven.by.differences.in.drug.stores.(urban.86%,.rural,.38%)..

0102030405060708090100



Health.Facility


Facility



Health.Facility.


Facility.


Kinshasa Kinshasa

Percen

tage.of.o

utlets

2009 2013 2015

0102030405060708090

100



Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets


KINSHASA' KATANGA'


.

Figure'14.''Types'of'quality5assured'ACT'and'non5quality'assured'ACT'audited'among'public5'and'private5sector'outlets,'Kinshasa,'2015'Among&all&ACT&medicines&audited&in&Kinshasa

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.

.Quality8assured.ACT.(QA.ACT).available.in.the.public.sector.was.primarily.artesunate.amodiaquine.(ASAQ).in.Kinshasa.(99%)..Quality8assured.ACTs.available.in.the.private.sector.included.both.ASAQ.

and.artemether.lumefantrine.(AL).in.Kinshasa.(AL,.53%;.ASAQ,.47%)..Most.non8QA.ACTs.audited.in.the.public.and.private.sector.were.tablet.formulation,.although.suspensions.accounted.for.44%.

of.non8QA.ACTs.in.the.public.sector.and.40%.in.the.private.sector..Although.a.variety.of.non8QA.ACT.generic.combinations.were.audited,.AL.was.the.most.commonly.audited.non8QA.ACT.in.the.

public.(39%.AL.tablets,.36%.AL.suspensions).and.private.sector.(35%.AL.tablets,.32%.AL.suspensions)...

.

. .

1.2%

98.8%

Quality8assured.Public.Sector

N=562

34.6%

1.4%

3.8%0.4%

9.7%7.2%

0.2%2.9%

32.4%

7.4%

Non8quality8assured.Private.Sector

N=6,999

38.8%

0.9%

1.2%

4.9%5.1%4.8%

0.8%

36.3%

7.2%

Non8quality8assured.Public.Sector

N=390

53.4%

46.6%

Quality8assured.Private.Sector

N=291

Artemether.lumefantrine.tablet Artemisinin.napthoquine.tablet Artemisinin.piperaquine.tablet

Artesunate.amodiaquine.tablet Artesunate.mefloquine.tablet Artesunate.sulfadoxine.pyrimethamine.tablet

Dihydroartemisinin.piperaquine.tablet Dihydroartemisinin.piperaquine.trimethoprim.tablet Dihydroartemisinin.piperaquine.SP.tablet

Artemether.lumefantrine.suspension Dihydroartemisinin.piperaquine.suspension


1.6%

98.4%

Quality8assured.Public.Sector

N=801

.

Figure'15.''Types'of'quality5assured'ACT'and'non5quality'assured'ACT'audited'among'public5'and'private5sector'outlets,'Katanga,'2015'Among&all&ACT&medicines&audited&in&Katanga

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Quality8assured.ACT.(QA.ACT).available.in.the.public.sector.was.primarily.artesunate.amodiaquine.(ASAQ).in.Katanga.(98%)..Quality8assured.ACTs.available.in.the.private.sector.included.both.ASAQ.

and.artemether.lumefantrine.(AL).in.Katanga.(AL,.42%;.ASAQ,.58%)..Most.non8QA.ACTs.audited.in.the.public.and.private.sector.were.tablet.formulation,.although.suspensions.accounted.for.30%.of.

non8QA.ACTs.in.the.public.sector.and.34%.in.the.private.sector..Although.a.variety.of.non8QA.ACT.generic.combinations.were.audited,.AL.was.the.most.commonly.audited.non8QA.ACT.in.the.public.

(48%.AL.tablets,.28%.AL.suspensions).and.private.sector.(45%.AL.tablets,.31%.AL.suspensions)..

.

. .

42.2%

57.8%

Quality8assured.Private.Sector

N=706

Artemether.lumefantrine.tablet Artemisinin.napthoquine.tablet Artemisinin.piperaquine.tablet

Artesunate.amodiaquine.tablet Artesunate.mefloquine.tablet Artesunate.sulfadoxine.pyrimethamine.tablet

Dihydroartemisinin.piperaquine.tablet Dihydroartemisinin.piperaquine.trimethoprim.tablet Dihydroartemisinin.piperaquine.SP.tablet

Artemether.lumefantrine.suspension Dihydroartemisinin.piperaquine.suspension

44.5%

1.5%3.7%

7.3%

1.8%

7.2%

30.6%

3.3%

Non8quality8assured.Private.Sector

N=1877

48.4%

1.6%

10.4%

5.5%0.5%

3.5%

28.4%

1.6%

Non8quality8assured.Public.Sector

N=148


\..

Figure'16.' Percentage'of'antimalarial4stocking'outlets'with'non4artemisinin'therapy'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200942015!Among&all&antimalarial,stocking&outlets,&across&survey&rounds&

.

..

The.majority. of. antimalarial:stocking. outlets. in. Kinshasa. and. Katanga. stocked. non:artemisinin. therapies. across. survey. rounds.. This.includes.more.than.90%.of.private:sector.outlets.and.more.than.80%.of.public.health.facilities.during.each.round,.except.for.Katanga.public:sector. outlets. in. 2013.. The. trend. in. declining. availability. among. all. public. outlets. in. Katanga. from.84%. to. 65%. is. due. to. low.availability.among.antimalarial:stocking.CHWs.....Figure'17.' Percentage'of'antimalarial4stocking'outlets'with'non4artemisinin'therapy'in'stock'on'the'day'of'the'

survey,'Kinshasa'and'Katanga,'2015!Among&antimalarial,stocking&outlets,&across&urban/rural&location&

.

..

Non:artemisinin. therapy. availability. across. urban. and. rural. areas. was. generally. similar. across. outlet. types.. The. notable. difference.between.Katanga.all.public:sector.availability.in.urban.(93%).versus.rural.areas.(60%).is.due.to.low.availability.among.rural.CHWs.... .

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Kinshasa Katanga

Percen

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KINSHASA' KATANGA'


.

.

Figure'18.' Percentage'of'antimalarial4stocking'outlets'with'Sulfadoxine'Pyrimethamine'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200942015!Among&all&antimalarial,stocking&outlets,&across&survey&rounds&

.

..

According.to.national.policy,.SP.is.used.for.intermittent.preventive.therapy.in.pregnancy.(IPTp).and.administered.to.all.pregnant.women.during.each.ANC.visit.after.the.first.trimester..In.2015,.SP.was.available.among.fewer.than.half.of.antimalarial:stocking.health.facilities.in. Kinshasa,. including. public. health. facilities. (46%),. private. not:for:profit. facilities. (43%),. and. private. for:profit. facilities. (21%).. In.Katanga,.SP.availability.among.these.facilities.was.46%,.38%,.and.35%,.respectively..Data.trends.from.Kinshasa.suggest.an.increase.in.public.health.facility.availability.between.2013.(27%).and.2015.(46%),.but.a.decrease.among.public.health.facilities. in.Katanga.(2013,.58%;.2015,.46%)..SP.availability.among.antimalarial:stocking.drug.stores.was.high.in.Kinshasa.(71%).and.Katanga.(63%).in.2015.....Figure'19.' Percentage'of'antimalarial4stocking'outlets'with'SP'in'stock'on'the'day'of'the'survey,'Kinshasa'and'

Katanga,'2015!Among&antimalarial,stocking&outlets,&across&urban/rural&location&

.

..

Data. trends. in.Kinshasa.suggest.higher.SP.availability. in.urban. (48%).versus. rural. (36%).public.and.not:for:profit.health. facilities.and.rural.(82%).versus.urban.(70%).drug.stores..In.Katanga,.trends.suggest.higher.availability.in.urban.(47%).versus.rural.(33%).public.and.not:for:profit.health.facilities.and.urban.(68%).versus.rural.(60%).drug.stores....... .

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2009 2013 2015

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Facility


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Facility.


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Kinshasa Katanga

Percen

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KINSHASA' KATANGA'


.

.

Figure'20.' Percentage'of'antimalarial4stocking'outlets'with'oral'quinine'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200942015!Among&all&antimalarial,stocking&outlets,&across&survey&rounds&

.

..

Oral.quinine,. including. tablets,. syrups,. and.drops,. is.widely.available. in. the.public. and.private. sectors.of.Kinshasa.and.Katanga..This.includes.64%.of.public.health.facilities.in.Kinshasa.and.65%.of.public.health.facilities.in.Katanga.in.2015..In.the.private.sector,.availability.of.oral.quinine.has.remained.high.over.time,.at.more.than.80%.....Figure'21.' Percentage'of'antimalarial4stocking'outlets'with'oral'quinine'in'stock'on'the'day'of'the'survey,'

Kinshasa'and'Katanga,'2015!Among&antimalarial,stocking&outlets,&across&urban/rural&location&

.

..

Data.trends.suggest.higher.availability.of.oral.quinine.in.urban.versus.rural.areas,.across.outlet.types,.with.the.exception.of.public.and.private.for:profit.health.facilities.in.Kinshasa,.and.private.not:for:profit.health.facilities.in.Katanga..'. .

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2009 2013 2015

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Facility


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Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets


KINSHASA' KATANGA'


.

.

Figure'22.' Percentage'of'antimalarial4stocking'outlets'with'any'severe'malaria'treatment'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200942015!Among&all&antimalarial,stocking&outlets,&across&survey&rounds&

.

..

Treatments.for.severe.malaria.include.artesunate.IV/IM,.quinine.IV/IM,.artemether.IV/IM,.or.artemotil.IV/IM..2015.availability.of.severe.malaria.treatment.among.public.health.facilities.was.67%.in.Kinshasa,.down.from.79%.in.2013,.and.67%.in.Katanga,.down.from.76%.in.2013..Data.trends.suggest.increasing.availability.among.public.not:for:profit.health.facilities.in.Kinshasa.(2009,.35%;.2013,.63%;.2015,.73%).and.Katanga.(2013,.60%;.2015,.97%)..In.the.private.sector,.availability.was.high.among.private.for:profit.health.facilities.in.2015.in.Kinshasa.(70%).and.Katanga.(74%)......Figure'23.' Percentage'of'antimalarial4stocking'outlets'with'any'severe'malaria'treatment'in'stock'on'the'day'

of'the'survey,'Kinshasa'and'Katanga,'2015!Among&antimalarial,stocking&outlets,&across&urban/rural&location&

.

..

Data.trends.in.Kinshasa.suggest.higher.availability.of.severe.malaria.treatment.in.facilities.in.rural.versus.urban.areas,.including.public.health. facilities. (rural,. 80%;. urban,. 64%). and. private. for:profit. health. facilities. (rural,. 86%;. urban,. 68%).. In. Katanga,. severe.malaria.treatment.was.more.commonly.available.in.urban.(87%).versus.rural.(64%).public.health.facilities,.and.availability.was.similar.in.urban.and.rural.private.for:profit.health.facilities.... .

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2009 2013 2015

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Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets


KINSHASA' KATANGA'


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.

Figure'24.' Percentage'of'antimalarial4stocking'outlets'with'injectable'artesunate'in'stock'on'the'day'of'the'survey,'Kinshasa'and'Katanga,'200942015!Among&all&antimalarial,stocking&outlets,&across&survey&rounds&

.

..

Injectable.artesunate. is. the. first:line. treatment. for. severe.malaria. in. the.DRC.. In.2015,.public.health. facility. availability.of. injectable.artesunate.was.18%.in.Kinshasa.and.14%.in.Katanga..Availability.was.somewhat. lower. in.private.for:profit.health.facilities. (Kinshasa,.15%;.Katanga,.5%)......Figure'25.' Percentage'of'antimalarial4stocking'outlets'with'injectable'artesunate'in'stock'on'the'day'of'the'

survey,'Kinshasa'and'Katanga,'2015!Among&antimalarial,stocking&outlets,&across&urban/rural&location&

.

..

There.was.a.trend.for.higher.levels.of.availability.of.injectable.artesunate.among.outlets.in.urban.versus.rural.areas.for.all.outlet.types..This.was.the.case.for.public.health.facilities.in.Kinshasa.(urban,.21%;.rural.6%).and.Katanga.(urban,.25%;.rural.12%)...

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Kinshasa Katanga

Percen

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Urban RuralKINSHASA'

KINSHASA' KATANGA'

KATANGA'


z..

.Figure'27.' Antimalarial'market'share'within'sector,'Kinshasa'and'Katanga,'200942015!

Relative&market&volume&(sale/distribution)&of&antimalarial&AETDs,&by&antimalarial&class&within&sector,&across&survey&round&

.

.

.

Within.the.public.sector.in.Kinshasa,.QA.ACT.market.share.increased.from.29%.in.2009.to.52%.in.2013.and.then.decreased.to.33%.in.2015..Within. the. private. sector. in. Kinshasa,.QA.ACT.market. share. remained. low.over. time. (2009,. 2%;. 2013,. 3%;. 2015,. 2%).. In. the.private. sector. in.Kinshasa,.oral. artemisinin.monotherapy.accounted. for.11%.of. the.private:sector.market. share. in.2009,.but.market.share.was.nearly.0%.in.2013.and.2015..Within.the.public.sector.in.Katanga,.QA.ACT.market.share.increased.from.49%.in.2013.to.57%.in.2015..QA.ACT.market.share.in.the.private.sector.remained.low.at.21%.in.2013.and.22%.in.2015...

Figure'26.' Antimalarial'market'share,'Kinshasa'and'Katanga,'200942015!Relative&market&volume&(sale/distribution)&of&antimalarial&AETDs,&by&antimalarial&class&and&sector,&across&survey&round& & &

.

.

.

.

The.private.sector.distributed.the.majority.of.antimalarials.in.Kinshasa.(2009,.96%;.2013,.97%;.2015,.86%).and.Katanga.provinces.(2013,.86%;.2015,.74%)..The.most.commonly.distributed.antimalarials.over.time.were.non:artemisinin.therapies,.including.SP..In.2015,.non:artemisinin.therapy.accounted.for.46%.market.share.in.Kinshasa.and.45%.in.Katanga..QA.ACT.market.share.remained.relatively.low.over.time,.and.accounted.for.7%.of.the.market.share.in.Kinshasa.in.2015.compared.with.31%.in.Katanga..Non:QA.ACT.market.share.remained.high.between.2013.and.2015.in.Kinshasa,.at.39%..In.Katanga,.non:QA.ACTs.accounted.for.20%.of.the.market.share.in.2015..'

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Public. Private Public. Private Public Private Public Private Public Private

2009 2013 2015 2013 2015

Kinshasa Katanga

Percen

tage.of.sector.m

arket.share

QA.ACT Non.QA.ACT SP

Other.non:artemisinin.therapy Oral.artemisin.monotherapy Non:oral.artemisinin.monotherapy

KINSHASA KATANGA

0102030405060708090

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Public. Private Public Private Public Private Public Private Public Private

2009 2013 2015 2013 2015

Kinshasa Katanga

Percen

tage.of.total.m

arket.share

QA.ACT Non.QA.ACT SPOther.non:artemisinin.therapy Oral.artemisinin.monotherapy Non:oral.artemisinin.monotherapy

KINSHASA KATANGA


Figure'28.' Antimalarial'market'share,'Kinshasa,'2015!Relative&market&volume&(sale/distribution)&of&antimalarial&AETDs,&by&antimalarial&class&and&outlet&type

.

.

.

In.2015,.the.private.sector.accounted.for.86%.of.the.antimalarial.distribution.in.Kinshasa..This.market.share.was.captured.primarily.by.drug.stores.(80%)....Figure'29.' Antimalarial'market'share,'Katanga,'2015!

Relative&market&volume&(sale/distribution)&of&antimalarial&AETDs,&by&antimalarial&class&and&outlet&type .

In.2015,.the.private.sector.accounted.for.74%.of.the.antimalarial.distribution.in.Katanga..This.market.share.was.captured.primarily.by.drug.stores.(61%).&.

0

10

20

30

40

50

60

70

80

90

100

Public Private Private.for:profit.Health.Facility

Pharmacy Drug.Store

Percen

tage.of.total.m

arket.share


Other.non:artemisinin.therapy Oral.artemisinin.monotherapy Non:oral.artemisinin.monotherapy

0

10

20

30

40

50

60

70

80

90

100


Pharmacy Drug.Store

Percen

tage.of.total.m

arket.share


Other.non:artemisinin.therapy Oral.artemisinin.monotherapy Non:oral.artemisinin.monotherapy


.

.

Figure'30.' Antimalarial'market'share,'Kinshasa'and'Katanga,'2015'!Relative&market&volume&(sale/distribution)&of&antimalarial&AETDs,&by&antimalarial&class&and&sector,&across&urban/rural&location&

.

.

.

Private:sector.antimalarial.market.share.was.higher.in.urban.compared.to.rural.areas.in.Kinshasa.(88%,.75%).and.Katanga.(90%,.59%)..In.rural.areas,.QA.ACT.market.share.was.16%.in.Kinshasa.and.47%.in.Katanga,.as.compared.with.lower.QA.ACT.market.share.in.urban.areas.of.Kinshasa.(5%).and.Katanga.(14%)..Non:quality.assured.ACT.market.share.was.higher.in.urban.versus.rural.areas.of.Kinshasa.(40%,.26%).and.Katanga.(37%,.6%)......

Figure'31.' Percentage'of'antimalarial4stocking'outlets'with'malaria'blood'testing'available,'Kinshasa'and'Katanga,'200942015!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&

.

..

The.percentage.of. antimalarial:stocking.public.health. facilities.with.malaria.blood. testing.available. (RDT.or.microscopy). increased. in.Kinshasa.from.83%.in.2009.to.97%.in.2015..In.Katanga,.testing.availability.was.76%.in.2013.and.87%.in.2015..Among.private.not:for:profit. and. for:profit. facilities,.more. than. 90%. in. Kinshasa. had. testing. available. in. 2015.. Availability.was. lower. in. Katanga. for:profit.facilities. (57%)..Malaria. blood. testing. was. not. commonly. available. in. drug. stores. in. 2015. (Kinshasa. 2%;. Katanga. 10%),. and. overall.private:sector.availability.in.2015.was.very.low.(Kinshasa,.22%;.Katanga,.19%)....

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Kinshasa Kinshasa

Percen

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2009 2013 2015KINSHASA' KATANGA'

0102030405060708090

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Public. Private Public. Private Public. Private Public. Private

Urban Rural Urban Rural

Percen

tage.of.sector.m

arket.share

QA.ACT Non.QA.ACT SPOther.non:artemisinin.therapy Oral.artemisinin.therapy Non:oral.artemisinin.monotherapy

KINSHASA KATANGA


Figure'32.' Percentage'of'antimalarial4stocking'outlets'with'malaria'blood'testing'available,'Kinshasa'and'Katanga,'2015!Among&all&outlets&with&at&least&one&antimalarial&in&stock&on&the&day&of&the&survey&or&within&the&past&three&months,&across&urban/rural&location&

.

..

Among. antimalarial:stocking. outlets,. malaria. blood. testing. (RDT. or.microscopy). availability. was. similar. in. urban. versus. rural. areas..Exceptions.include.higher.availability.among.urban.(78%).versus.rural.(46%).private.for:profit.health.facilities.in.Katanga.......

Figure'33.' Percentage'of'antimalarial4stocking'outlets'with'malaria'microscopy'available,'Kinshasa'and'Katanga,'200942015!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&

.

..

The. percentage. of. antimalarial:stocking. outlets. with. malaria. microscopy. available. remained. high. over. time. among. public. health.facilities.(2009.83%;.2013.89%;.2015.89%).and.private.for:profit.health.facilities.(2009,.85%;.2013,.89%;.2015,.89%). in.Kinshasa..The.availability.of.malaria.microscopy.in.Katanga.was.much.lower,.including.among.public.facilities.(2013.45%;.2015.28%).and.private.for:profit.health.facilities.(2013,.49%;.2015,.23%).........

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Facility.


Kinshasa Katanga

Percen

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Urban Rural

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Kinshasa Kinshasa

Percen

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2009 2013 2015

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.

.Figure'34.' Percentage'of'antimalarial4stocking'outlets'with'malaria'microscopy'available,'Kinshasa'and'

Katanga,'2015!Among&all&outlets&with&at&least&one&antimalarial&in&stock&on&the&day&of&the&survey&or&within&the&past&three&months,&across&urban/rural&location&

.

..

Availability. of. malaria. microscopy. was. similar. in. urban. versus. rural. public. and. private. health. facilities. in. Kinshasa.. In. Katanga,.microscopy.availability.was.higher. in.urban.versus. rural.public.health. facilities. (urban,.58%;. rural,. 23%);.private.not:for:profit.health.facilities.(urban,.72%;.rural,.40%);.and.private.for:profit.health.facilities.(urban,.47%;.rural,.13%).......

Figure'35.' Percentage'of'antimalarial4stocking'outlets'with'malaria'RDTs'available,'Kinshasa'and'Katanga,'200942015!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&

.

..

RDT.availability.increased.among.antimalarial:stocking.outlets.within.most.outlet.types.over.time..This.includes.RDT.scale.up.in.public.health. facilities. within. Kinshasa. (2009,. 4%;. 2013,. 29%;. 2015,. 69%). and. Katanga. (2013,. 54%;. 2015,. 84%).. In. the. private. sector,.availability.increased.among.private.for:profit.facilities.in.Kinshasa.(2009,.5%;.2013,.18%;.2015,.31%)..Drug.store.availability.remained.very.low.in.Kinshasa.and.Katanga,.and.in.2015.was.only.1%.in.Kinshasa.and.10%.in.Katanga......

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Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

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Urban Rural

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Kinshasa Kinshasa

Percen

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2009 2013 2015

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.

.

.

.Figure'36.' Percentage'of'antimalarial4stocking'outlets'with'malaria'RDTs'available,'Kinshasa'and'Katanga,'

2015!Among&all&outlets&with&at&least&one&antimalarial&in&stock&on&the&day&of&the&survey&or&within&the&past&three&months,&across&urban/rural&location&

.

..

Data.trends.suggest.higher.RDT.availability.in.rural.(86%).versus.urban.(75%).public.health.facilities.in.Katanga,.but.no.such.difference.in.Kinshasa..Data.trends.also.suggest.higher.availability.in.urban.versus.rural.private.for:profit.health.facilities.in.Katanga.(urban,.61%;.rural,.39%),.with.no.difference.in.Kinshasa......'

Figure'37.' Malaria'blood'testing'market'share,'Kinshasa,'2015!Relative&market&volume&(sale/distribution)&of&malaria&blood&testing&using&RDTs&and&microscopy,&by&type&of&test&and&outlet&type&&

.

.

In.2015,.the.private.sector.was.responsible.for.just.under.half.of.all.malaria.blood.testing.in.Kinshasa.(48%),.with.private:for:profit.health.facilities.accounting.for.47%.of.the.market.share..The.majority.of.blood.tests.were.performed.using.malaria.microscopy.(64%). '

0102030405060708090

100



Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets

Urban Rural

0

10

20

30

40

50

60

70

80

90

100


Pharmacy Drug.Store

Percen

tage.of.total.m

arket.share

Microscopy RDT

KINSHASA' KATANGA'


'''''Figure'38.' Malaria'blood'testing'market'share,'Katanga,'2015!

Relative&market&volume&(sale/distribution)&of&malaria&blood&testing&using&RDTs&and&microscopy,&by&type&of&test&and&outlet&type

.

.

In.2015,.the.public.sector.was.responsible.for.more.than.half.of.all.malaria.blood.testing.in.Katanga.(74%)..The.majority.of.blood.tests.were.performed.using.malaria.RDTs.(82%)..'''

Figure'39.' Malaria'RDT'market'share'by'manufacturer,'within'sector,'Kinshasa'and'Katanga,'2015!Relative&market&volume&(sale/distribution)&of&malaria&RDTs&by&manufacturer&and&within&sector

.

.

.

The.vast.majority.of.RDT.testing.in.the.public.and.private.sectors.of.Kinshasa.and.Katanga.was.performed.using.Standard.Diagnostics.RDTs..

0

10

20

30

40

50

60

70

80

90

100


Pharmacy Drug.Store

Percen

tage.of.total.m

arket.share

Microscopy RDT

0

10

20

30

40

50

60

70

80

90

100

Public Private Public Private

Kinshasa Katanga

Percen

tage.of.w

ithin.se

ctor.market.share.

Standard.Diagnostics Access.Bio Other.RDT.manufacturer Manufacturer.not.specified

KINSHASA KATANGA


.

.Figure'41.' Private4sector'median'price'of'SP'and'QA'ACT'adult'equivalent'treatment'dosages'(AETD)'and'

pre4packaged'pediatric'quality4assured'ACT'(PP'ped'QA'ASAQ),'Kinshasa'and'Katanga,'2015!Among&all&tablet&formulation&SP,&QA&ACT,&and&PP&ped&QA&ASAQ&(treatment&for&a&two,year,old&child),&available&in&the&private&sector,&by&outlet&type,&in&2015&US&dollars&

.

.

The.private:sector.median.price.for.QA.ACT.was.$0.00.(free.of.charge).in.private.for:profit.health.facilities.within.Kinshasa.and.Katanga,.as.compared.with.drug.stores.where.QA.ACT.was.generally.not.free.of.charge...

Figure'40.' Private4sector'median'price'of'antimalarial'adult'equivalent'treatment'dosages'(AETD),'Kinshasa'and'Katanga,'200942015!Among&all&tablet&formulation&non,quality&assured&ACT&(Non,QA&ACT),&quality,assured&ACT&(QA&ACT),&and&sulfadoxine&pyrimethamine&available&in&the&private&sector,&across&survey&round,&in&2009&US&dollars&to&account&for&inflation

.

!.

The.2015.private.sector.median.price.for.one.adult.equivalent.treatment.dose.of.QA.ACT.was.12.times.more.expensive.than.one.AETD.of.SP. in.Kinshasa.($3.96.QA.ACT;.$0.34.SP).. In.Katanga,.one.AETD.of.QA.ACT.in.2015.($1.20).was.four.times.more.expensive.than.SP.($0.30)..QA.ACT.was.more.expensive.than.non:QA.ACT.in.2015.in.Kinshasa.($3.96.versus.$3.01),.and.QA.ACT.was.less.expensive.than.non:QA.ACT.in.Katanga.($1.20.versus.$3.44)..While.the.price.of.QA.ACT.remained.similar.over.time.in.Katanga,.the.2015.price.was.three.times.higher.than.the.2013.price.in.Kinshasa..

$3.50

$2.28

$0.40

$3.01

$1.27$0.34

$3.39

$1.27$0.34

$3.01

$3.96

$0.34

$3.44

$1.20

$0.30

$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

$7.00

Non:QA.ACT QA.ACT SP Non:QA.ACT QA.ACT SP

Kinshasa Katanga

2009.USD

2009 2013 2015

$0.33$0.00 $0.00

$0.33

$0.00 $0.00$0.44

$6.47

$1.64

$0.33

$1.64

$0.55$0.44

$5.04

$0.00$0.38

$1.53

$0.44

$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

$7.00

$8.00

$9.00

$10.00

SP.AETD QA.ACT.AETD PP.ped.QA.ASAQ SP.AETD QA.ACT.AETD PP.ped.QA.ASAQ

Kinshasa Katanga

2015.USD

Private.for:profit.Health.Facility Drug.Store All.Private

KATANGAKINSHASA'

KINSHASA' KATANGA'


.

.

Figure'42.' Private4sector'median'price'of'SP'and'QA'ACT'adult'equivalent'treatment'dosages'(AETD)'and'pre4packaged'pediatric'quality4assured'artesunate'amodiaquine'(PP'ped'QA'ASAQ),'Kinshasa'and'Katanga,'2015'Among&all&tablet&formulation&SP,&QA&ACT,&and&PP&ped&QA&ASAQ&(treatment&for&a&two,year,old,child)&available&in&the&private&sector,&across&urban/rural&location,&in&2015&US&Dollars

.

.

In.Kinshasa,.the.private:sector.price.for.SP.was.similar.in.urban.and.rural.areas.($0.44).and.similar.between.urban.and.rural.areas.for.pre:packaged.therapy.for.a.two:year:old.child.($0.00)..QA.ACT.was.generally.more.expensive.in.urban.($5.45).versus.rural.areas.($0.77)..The.price.of.SP.and.QA.ACT.was.slightly.higher.in.urban.versus.rural.areas.of.Katanga.(SP:.urban,.$0.55;.rural,.$0.33;.QA.ACT.AETD:.urban,.$1.64;.rural,.$1.32).....Figure'43.' Median'private4sector'consumer'prices'or'malaria'RDT'testing'for'adults'and'children,'Kinshasa'

and'Katanga,'2015' 'Among&all&malaria&RDTs&available&within&private&for,profit&health&facilities&and&drug&stores,&in&2015&US&dollars'

.

..

Malaria.RDT.testing.was.the.same.price.in.private.for:profit.facilities.and.drug.stores.in.Kinshasa.and.Katanga.($1.10).'

$1.10 $1.10 $1.10 $1.10$1.10 $1.10 $1.10 $1.10

$0.00

$0.25

$0.50

$0.75

$1.00

$1.25

$1.50

$1.75

Child Adult Child Adult

Kinshasa Katanga

2015.USD

Private:For:Profit.Health.Facility Drug.Store.

$0.44

$5.45

$0.00$0.55

$1.64

$0.55$0.44

$0.77

$0.00$0.33

$1.32

$0.44

$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

$7.00

$8.00

SP.AETD QA.ACT.AETD PP.ped.QA.ASAQ SP.AETD QA.ACT.AETD PP.ped.QA.ASAQ

Kinshasa Katanga

2015.USD

Urban Rural

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.'

Figure'44.' Median'private4sector'prices'of'pre4packaged'quality4assured'artesunate'amodiaquine'(PP'QA'ASAQ)'and'malaria'RDT'testing'for'children'and'adults,'Kinshasa'and'Katanga,'2015' !Among&all&tablet&formulation&pediatric&(treatment&for&a&two,year,old,child)&and&adult&PP&QA&ASAQ&and&malaria&RDTs&available&in&the&private&sector,&in&2015&US&dollars'

.

..

For.both.children.and.adults,.the.price.of.a.pre:packaged.QA.ASAQ.treatment.was.more.than.RDT.testing..The.price.difference.between.treatment.and.testing.was.greater.in.Kinshasa.(child,.$1.10;.adult,.$1.10).compared.to.Katanga.(child,.$0.66;.adult,.$0.55).. .

Figure'45.' Percentage'of'providers'who'correctly'state'the'first4line'treatment'for'uncomplicated'malaria,'Kinshasa'and'Katanga,'201342015!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&

.

..

According.to.national.policy.in.the.DRC,.first:line.treatments.for.uncomplicated.malaria.are.ASAQ.and.AL..Across.nearly.all.outlet.types,.data. trends. suggest. an. increase. in. the.percentage.of. providers.who. correctly. stated. a. first:line. treatment. for. uncomplicated.malaria.between.2013.and.2015..Notable. improvements. included.providers. in.public.health. facilities. in.Kinshasa,. from.42%. in.2013.to.65%. in.2015.. Provider. knowledge.within. public. health. facilities.was.higher. in. Katanga. (83%). versus. Kinshasa. (65%).. Provider. knowledge.was.lowest.among.drug.stores.in.Kinshasa.(14%).and.Katanga.(29%).....

$0.00 $0.00

$0.55$0.44

$1.10 $1.10 $1.10 $1.10

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

Adult Child Adult Child

Kinshasa Katanga

2015.USD

PP.QA.ASAQ RDT

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Health.Facility

All.public Private.for:profit.Heath.

Facility



Health.Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets

2013 2015

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.

.

Figure'47.' Percentage'of'providers'who'correctly'state'the'first4line'dosing'regimen'for'uncomplicated'malaria'for'a'two4year4old'child,'Kinshasa'and'Katanga,'201342015!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&

.

..

Provider.knowledge.of.the.correct.first:line.dosing.regimen.for.uncomplicated.malaria.for.a.two:year:old.child.(using.either.ASAQ.or.AL).was.generally. low..However,. there.was.a. trend. for. improvement.across.most.outlet. types.between.2013.and.2015,. including.public.health.facilities.in.Katanga.(2013,.38%;.2015,.55%).and.Kinshasa.(2013,.20%;.2015,.29%).........

0102030405060708090100



Health.Facility


Facility

Pharmacy Drug.Store All.private Public.Health.Facility.


Health.Facility.


Facility.

Drug.Store All.private

Kinshasa Katanga

Percen

tage.of.o

utlets

2013 2015

Figure'46.' Percentage'of'providers'who'correctly'state'the'first4line'treatment'for'uncomplicated'malaria,'Kinshasa'and'Katanga,'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&urban/rural&location&

.

..

Provider.knowledge.about. the. first:line. treatment. for.uncomplicated.malaria.was. similar. in.urban.versus. rural.areas,.with.a.notable.exception.among.public.health.facilities.in.Kinshasa,.where.knowledge.was.higher.in.rural.(83%).versus.urban.areas.(61%)..

0102030405060708090100



Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets

Urban Rural

KINSHASA' KATANGA'

KINSHASA' KATANGA'


.

.

.Figure'48.' Percentage'of'providers'who'correctly'state'the'first4line'dosing'regimen'for'uncomplicated'malaria'

for'a'two4year4old'child,'Kinshasa'and'Katanga,'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&urban/rural&location&

.

..

Provider.knowledge.of.the.first:line.dosing.regimen.for.a.two:year:old.child.was.similar.in.urban.versus.rural.areas..Data.trends.suggest.higher. knowledge. in. rural. versus. urban. public. health. facilities. in. Kinshasa. (rural,. 37%;. urban,. 27%). and. Katanga. (rural,. 57%;. urban,.40%)..

0102030405060708090100



Facility


Facility



Facility.


Facility.


Kinshasa Katanga

Percen

tage.of.o

utlets

Urban Rural

KINSHASA' KATANGA'

www.ACTwatch.info....................Page.46

Results'Section'A:'Core'Indicators,'Katanga'Province'..

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


Community.Health.Worker.

[email protected]'


[email protected].

Drug.Store. ALL'Private.

ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:. N=266. N=35. N=23. N=324. N=152. N=568. N=728. N=1,052.

Any.antimalarial.at.the.time.of.survey.visit.98.0. 98.3. 88.7. 97.3. 72.1. 96.0. 90.8. 92.5.

(94.6,.99.3). (87.1,.99.8). (68.1,.96.6). (93.9,.98.8). (59.4,.82.0). (92.1,.98.0). (85.9,.94.1). (89.0,.94.9).

Any.ACT.91.8. 89.6. 58.7. 88.6. 41.1. 71.9. 65.7. 71.5.

(83.8,.96.0). (58.4,.98.1). (34.5,.79.2). (80.4,.93.6). (31.5,.51.4). (62.3,.79.8). (56.7,.73.6). (65.4,.77.0).

[email protected].!.91.7. 89.6. 58.7. 88.5. 41.1. 71.6. 65.5. 71.4.

(83.7,.96.0). (58.4,.98.1). (34.5,.79.2). (80.4,.93.5). (31.5,.51.4). (62.3,.79.4). (56.7,.73.3). (65.3,.76.8).

Artesunate.amodiaquine.89.7. 89.6. 49.1. 86.4. 32.1. 60.8. 52.7. 42.0.

(82.3,.94.2). (58.4,.98.1). (26.1,.72.5). (78.1,.91.9). (23.2,.42.5). (50.7,.70.0). (43.2,.62.1). (33.0,.51.6).

Artemether.lumefantrine. 15.2. 0.0. 13.4. 11.1. 20.2. 33.0. 32.2. 46.1.(10.8,.20.9). @. (4.0,.36.6). (7.0,.17.0). (13.4,.29.4). (26.5,.40.3). (26.4,.38.5). (40.4,.51.8).

Artesunate.sulfadoxine.pyrimethamine.1.1. 0.0. 3.1. 1.0. 0.4. 9.4. 8.6. 6.6.

(0.5,.2.3). @. (0.5,.17.6). (0.4,.2.0). (0.1,.2.7). (4.0,.20.8). (3.2,.20.9). (2.5,.16.1).

Dihydroartemisinin.piperaquine.0.6. 0.0. 0.0. 0.4. 1.6. 9.5. 8.1. 6.1.

(0.2,.1.4). @. @. (0.1,.0.9). (0.3,.8.3). (5.1,.17.0). (4.0,.15.8). (2.9,.12.4).Dihydroartemisinin.sulfadoxine.pyrimethamine..

0.2. 0.0. 7.3. 0.7. 1.8. 16.8. 14.3. 10.8.(0.1,.0.7). @. (1.1,.36.6). (0.1,.3.6). (0.6,.5.4). (11.3,.24.2). (8.9,.22.0). (6.6,.17.2).

Other.ACT.β.0.2. 0.0. 2.3. 0.3. 0.2. 2.9. 3.0. 2.3.

(0.0,.1.0). @. (0.3,.14.3). (0.1,.1.1). (0.0,.1.2). (0.9,.8.8). (0.9,.10.2). (0.7,.7.8).

[email protected].(QA.ACT).89.8. 89.6. 54.4. 86.9. 34.7. 50.3. 47.2. 57.4.

(82.3,.94.4). (58.4,.98.1). (31.4,.75.8). (78.7,.92.3). (25.7,.44.9). (43.3,.57.2). (41.1,.53.5). (52.8,.61.9).

QA.artesunate.amodiaquine' 89.3. 89.6. 49.1. 86.2. 31.9. 27.9. 28.2. 43.1.(82.0,.93.9). (58.4,.98.1). (26.1,.72.5). (77.8,.91.7). (23.1,.42.2). (20.9,.36.2). (21.9,.35.5). (36.5,.49.9).

QA.artemether.lumefantrine.4.6. 0.0. 9.2. 3.7. 6.5. 33.5. 28.4. 22.1.

(2.6,.7.9). @. (3.0,.24.6). (2.1,.6.5). (3.3,.12.6). (27.5,.40.2). (22.7,.34.9). (16.9,.28.3).

[email protected].([email protected])'13.3. 4.0. 15.7. 11.0. 17.1. 55.2. 47.8. 38.4.

(9.4,.18.4). (1.5,.10.0). (5.0,.39.9). (7.8,.15.3). (11.0,.25.5). (45.3,.64.7). (37.9,.57.9). (29.6,.47.9).

Nationally.registered.ACT. 90.5. 89.6. 58.7. 87.7. 38.5. 62.7. 58.1. 65.7.(82.9,.94.9). (58.4,.98.1). (34.5,.79.2). (79.5,.92.9). (28.6,.49.5). (54.1,.70.5). (49.5,.66.1). (59.7,.71.1).


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



[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


[email protected]. 81.3. 8.6. 88.7. 62.8. 64.3. 92.9. 86.7. 80.6.(74.0,.86.9). (1.5,.37.3). (68.1,.96.6). (41.6,.80.0). (53.1,.74.1). (89.0,.95.4). (81.9,.90.4). (71.6,.87.2).

Sulfadoxine.pyrimethamine. 44.7. 5.4. 33.6. 33.5. 25.4. 60.2. 52.6. 47.7.(35.2,.54.7). (0.6,.36.9). (16.1,.57.2). (21.9,.47.5). (17.4,.35.5). (53.1,.66.8). (46.8,.58.3). (41.1,.54.4).

Oral.quinine. 63.2. 3.2. 50.8. 46.4. 38.8. 84.3. 74.7. 67.5.(53.9,.71.5). (0.4,.22.1). (26.4,.74.8). (31.2,.62.3). (27.5,.51.5). (78.6,.88.6). (67.9,.80.5). (58.9,.75.0).

[email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.8. 0.6. 0.4.@. @. @. @. @. (0.3,.2.3). (0.2,.1.8). (0.1,.1.3).

Oral.artemisinin.monotherapy. 0.2. 0.0. 0.0. 0.1. 0.0. 0.2. 0.2. 0.1.(0.0,.1.0). @. @. (0.0,.0.7). @. (0.0,.1.3). (0.0,.1.0). (0.0,.0.7).

[email protected]. 25.4. 18.4. 30.7. 24.0. 21.6. 46.5. 41.5. 37.0.(18.2,.34.2). (9.9,.31.4). (12.4,.58.3). (18.2,.30.9). (15.8,.28.9). (38.2,.54.9). (33.7,.49.8). (30.3,.44.3).

Any.treatment.for.severe.malaria. 65.7. 18.4. 86.4. 54.9. 53.4. 63.2. 61.6. 59.9.(56.7,.73.6). (9.9,.31.4). (66.7,.95.2). (41.6,.67.6). (41.9,.64.4). (56.7,.69.3). (55.2,.67.7). (53.1,.66.3).

....Artesunate.IV/IM.#' 14.0. 0.0. 8.8. 9.9. 3.9. 4.2. 4.1. 5.6.(8.5,.22.1). @. (3.0,.23.0). (5.6,.17.0). (1.5,.9.8). (2.6,.6.8). (2.6,.6.4). (3.9,.7.9).

Artemether.IV/IM. 2.0. 0.0. 9.1. 2.0. 6.3. 18.8. 15.8. 12.3.(1.0,.4.0). @. (1.3,.43.0). (0.9,.4.8). (2.9,.13.2). (13.1,.26.3). (11.2,.21.8). (8.5,.17.3).

Arteether.IV/IM'7.4. 0.0. 19.3. 6.4. 13.8. 33.7. 30.1. 24.0.

(4.7,.11.4). @. (5.8,.48.2). (3.8,.10.7). (9.1,.20.3). (25.2,.43.4). (22.1,.39.5). (17.2,.32.5).

Quinine.IV/IM.55.3. 0.0. 72.4. 42.2. 46.6. 38.8. 40.7. 41.1.

(46.7,.63.7). @. (48.0,.88.2). (28.1,.57.6). (35.4,.58.2). (32.8,.45.3). (35.8,.45.8). (35.4,.47.0).

*. The.denominator.includes.5.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..β. Other.types.of.ACT.include.artemisinin.piperaquine,.artesunate.mefloquine,.and.dihydroartemisinin.piperaquine.trimethoprim..^. [email protected],.atovaquone@proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015.... .


.

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



[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:. N=258. N=34. N=19. N=311. N=121. N=554. N=682. N=993.

Any.ACT.93.7. 91.2. 66.1. 91.0. 57.0. 74.9. 72.3. 77.4.

(84.9,.97.5). (61.6,.98.5). (38.7,.85.8). (83.1,.95.4). (45.8,.67.4). (66.5,.81.7). (64.5,.79.0). (72.1,.81.9).

[email protected].!.93.6. 91.2. 66.1. 91.0. 57.0. 74.6. 72.1. 77.2.

(84.9,.97.5). (61.6,.98.5). (38.7,.85.8). (83.1,.95.4). (45.8,.67.4). (66.5,.81.3). (64.5,.78.6). (72.1,.81.7).


(11.0,.21.4). @. (4.5,.40.3). (7.2,.17.6). (18.5,.40.1). (53.8,.71.9). (48.6,.67.0). (36.1,.55.1).

Artemether.lumefantrine.91.6. 91.2. 55.3. 88.8. 44.5. 34.4. 35.4. 49.9.

(83.8,.95.8). (61.6,.98.5). (29.1,.78.9). (80.8,.93.7). (34.6,.55.0). (27.9,.41.5). (29.7,.41.6). (43.9,.55.9).Artesunate.sulfadoxine.pyrimethamine.

1.1. 0.0. 3.5. 1.0. 0.6. 9.8. 9.4. 7.2.(0.5,.2.3). @. (0.5,.19.4). (0.5,.2.1). (0.1,.3.7). (4.1,.21.5). (3.6,.22.7). (2.8,.17.3).


(0.2,.1.4). @. @. (0.1,.1.0). (0.4,.11.2). (5.3,.17.6). (4.4,.17.3). (3.2,.13.3).Dihydroartemisinin.sulfadoxine.pyrimethamine.

0.2. 0.0. 8.2. 0.8. 2.5. 17.5. 15.7. 11.7.(0.1,.0.7). @. (1.2,.39.9). (0.2,.3.7). (0.8,.7.6). (11.8,.25.0). (9.9,.23.9). (7.2,.18.5).

Other.ACT.β.0.2. 0.0. 2.6. 0.3. 0.3. 3.0. 3.3. 2.5.

(0.0,.1.0). @. (0.4,.15.9). (0.1,.1.1). (0.0,.1.7). (1.0,.9.1). (0.9,.11.1). (0.7,.8.4).


(83.8,.95.9). (61.6,.98.5). (35.2,.82.3). (81.4,.94.2). (38.3,.58.0). (46.0,.58.7). (46.6,.57.4). (57.8,.66.3).

QA.artesunate.amodiaquine'91.2. 91.2. 55.3. 88.6. 44.2. 29.1. 31.1. 46.6.

(83.5,.95.5). (61.6,.98.5). (29.1,.78.9). (80.5,.93.6). (34.4,.54.5). (22.0,.37.4). (24.4,.38.6). (39.5,.53.8).


(2.7,.8.0). @. (3.4,.27.3). (2.2,.6.7). (4.5,.17.5). (29.0,.41.4). (25.4,.37.8). (18.5,.30.2)[email protected].([email protected])'

13.5. 4.1. 17.7. 11.3. 23.7. 57.5. 52.7. 41.5.(9.6,.18.8). (1.6,.9.9). (5.6,.43.9). (8.1,.15.7). (15.3,.34.8). (47.9,.66.6). (42.5,.62.6). (32.4,.51.3).


[email protected]. 83.0. 8.8. 100.0. 64.6. 89.1. 96.7. 95.5. 87.1.(75.7,.88.4). (1.5,.38.4). @. (42.0,.82.1). (79.5,.94.5). (94.1,.98.2). (93.0,.97.2). (77.3,.93.1).

Sulfadoxine.pyrimethamine. 45.7. 5.5. 37.9. 34.5. 35.2. 62.7. 57.9. 51.6.(35.9,.55.7). (0.6,.37.6). (18.0,.63.0). (22.4,.48.9). (24.4,.47.7). (55.7,.69.2). (52.0,.63.6). (44.5,.58.7).


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



[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:. N=258. N=34. N=19. N=311. N=121. N=554. N=682. N=993.

Oral.quinine. 64.5. 3.3. 57.3. 47.7. 53.9. 87.8. 82.3. 73.0.(55.1,.72.9). (0.4,.23.1). (31.1,.80.0). (31.8,.64.2). (39.0,.68.1). (83.5,.91.0). (76.7,.86.8). (64.4,.80.1).

[email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.8. 0.7. 0.5.@. @. @. @. @. (0.3,.2.4). (0.2,.1.9). (0.2,.1.4).

Oral.artemisinin.monotherapy. 0.2. 0.0. 0.0. 0.1. 0.0. 0.2. 0.2. 0.1.(0.0,.1.0). @. @. (0.0,.0.7). @. (0.0,.1.4). (0.0,.1.1). (0.0,.0.7).

[email protected]. 25.9. 18.7. 34.7. 24.6. 30.0. 48.4. 45.8. 40.1.(18.6,.34.8). (10.3,.31.6). (13.8,.63.8). (18.7,.31.7). (22.3,.39.0). (40.0,.56.9). (37.5,.54.3). (32.9,.47.7).

Any.treatment.for.severe.malaria. 67.0. 18.7. 97.4. 56.4. 74.0. 65.8. 67.9. 64.8.(58.2,.74.8). (10.3,.31.6). (84.1,.99.6). (42.4,.69.5). (63.0,.82.6). (59.4,.71.7). (61.4,.73.7). (57.7,.71.2).

..Artesunate.IV/IM.#' 14.3. 0.0. 9.9. 10.2. 5.4. 4.4. 4.5. 6.0.(8.7,.22.5). @. (3.3,.26.4). (5.7,.17.5). (2.0,.13.5). (2.8,.7.0). (2.9,.7.0). (4.2,.8.5).

Artemether.IV/IM. 2.0. 0.0. 10.3. 2.1. 8.8. 19.6. 17.4. 13.3.(1.0,.4.1). @. (1.5,.46.6). (0.9,.5.0). (4.0,.18.2). (13.6,.27.3). (12.3,.24.0). (9.3,.18.6).

Arteether.IV/IM' 7.6. 0.0. 21.7. 6.6. 19.1. 35.1. 33.1. 26.0.(4.8,.11.7). @. (6.4,.53.0). (3.8,.11.1). (12.9,.27.2). (26.4,.45.0). (24.5,.43.0). (18.7,.34.8).

Quinine.IV/IM.56.5. 0.0. 81.7. 43.3. 64.7. 40.5. 44.8. 44.4.

(47.8,.64.7). @. (52.1,.94.8). (28.7,.59.3). (52.6,.75.1). (34.1,.47.2). (39.2,.50.6). (38.3,.50.8).

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

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..β. Other.types.of.ACT.include.artemisinin.piperaquine,.artesunate.mefloquine,.and.dihydroartemisinin.piperaquine.trimethoprim..^. [email protected],.atovaquone@proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015.... .


.

Table'A3:'Types'of'qualityCassured'and'nonCquality'assured'ACTs'audited'in'the'public'and'private'sector,'Katanga'

ACT'generic'name'and'formulation''QualityCassured'ACT' NonCquality'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=801. N.audited=706. N.audited=148. N.audited=1,877.Tablet.formulation:. . . . .

Artemether.lumefantrine.1.6. 42.2. 48.4. 44.5.

(0.9,.2.8). (33.0,.52.0). (37.0,.59.9). (37.8,.51.4).

Artemisinin.piperaquine.0.0. 0.0. 1.6. 1.5.

@. @. (0.5,.4.9). (0.6,.3.5).

Artesunate.amodiaquine.98.4. 57.8. 10.4. 3.7.

(97.2,.99.1). (48.0,.67.0). (3.9,.25.3). (2.9,.4.9).

Artesunate.mefloquine.0.0. 0.0. 0.0. 0.0.

@. @. @. @.

Artesunate.sulfadoxine.pyrimethamine.

0.0. 0.0. 5.5. 7.3.@. @. (2.9,.10.3). (4.0,.13.0).

Dihydroartemisinin.piperaquine.0.0. 0.0. 0.5. 1.8.@. @. (0.1,.3.1). (1.1,.2.9).

Dihydroartesmisinin.sulfadoxine.pyrimethamine.

0.0. 0.0. 3.5. 7.2.@. @. (0.9,.12.3). (6.3,.8.2).

[email protected]*:. . . . .

Artemether.lumefantrine.0.0. 0.0. 28.4. 30.6.@. @. (20.9,.37.4). (28.7,.32.7).

Artesunate.mefloquine.0.0. 0.0. 0.0. 0.0.@. @. @. (0.0,.0.2).


*.Non@tablet.ACTs.were.most.common.suspensions.along.with.granules.and.suppositories...

Source:.ACTwatch.Outlet.Survey,.DRC,.2015.... .


.

Table'A4:'Antimalarial'market'composition,'Katanga.Outlet'type,'among'outlets'with'at'least'1'antimalarial'in'stock'on'the'day'of'the'survey:*'.

Public.Health.Facility.


[email protected]'

ALL'Public'/'NotC'ForC

Profit'

[email protected].


%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

N=843.outlets.19.6. 7.1. 1.9. 28.6. 12.1. 0.7. 58.5. 71.4.

(15.7,.24.3). (2.9,.16.3). (1.2,.3.3). (22.4,.35.8). (8.9,.16.3). (0.1,.4.1). (51.7,.65.1). (64.2,.77.6).

*.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..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015... .


!

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

'Private.

[email protected].


Median'price'of'a'tablet'AETD*:' Median.[IQR].(N.of.Antimalarials).

Median.[IQR].(N.of.Antimalarials).


Any.ACT.$0.88. $2.74. $2.19.

[[email protected]].(198). [[email protected]].(1,605). [[email protected]].(1,831).

[email protected].!.$0.66. $2.19. $2.19.


Artesunate.amodiaquine..$0.00. $1.32. $1.10.


Artemether.lumefantrine.$1.75. $3.29. $3.07.


[email protected].(QA.ACT).$0.00. $1.64. $1.53.


QA.artesunate.amodiaquine.$0.00. $1.10. $1.10.


QA.artemether.lumefantrine.$1.64. $1.75. $1.75.


[email protected].([email protected]).$2.19. $4.38. $4.38.


Sulfadoxine.pyrimethamine.$0.33. $0.33. $0.38.


Oral.quinine..$4.60. $4.60. $4.60.


*. [email protected][email protected].(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.DRC.ACTwatch.outlet.survey,.artemether.lumefantrine.and.artesunate.amodiaquine.were.the.first@line.treatments.for.uncomplicated.malaria........Figures.in.this.table.are.derived.using.audited.products.with.price.information..The.numbers.of.tablet.antimalarials.captured.in.audit.sheets.with.missing.price.and/.or.product.information.are.as.follows:.

57.any.ACT,.5.artesunate.amodiaquine,.40.artemether.lumefantrine,.3.QA.artesunate.amodiaquine,.11.QA.artemether.lumefantrine,[email protected],.9.sulfadoxine.pyrimethamine,.22.oral.quinine..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015..!

! !


!!!!

Table'A5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'Katanga'

'Private.

[email protected].


Median'price'of'one'preCpackaged'therapy:' Median.[IQR].(N.of.Antimalarials).



[email protected]@assured.ACT.(QA.ACT).!.$0.00. $1.43. $1.10.


Adult.Quality@assured.(QA).artesunate.amodiaquine.'$0.00. $0.66. $0.55.


Adult.Quality@assured.(QA).artemether.lumefantrine'$1.64. $1.64. $1.64.


[email protected]@assured.ACT.(QA.ACT).!!$0.00. $0.55. $0.55.


Pediatric.Quality@assured.(QA).artesunate.amodiaquine..$0.00. $0.55. $0.44.


Pediatric.Quality@assured.(QA).artemether.lumefantrine.$1.10. $1.10. $1.10.


!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artemether.lumefantrine.and.artesunate.amodiaquine.were.the.first@line.treatments.for.uncomplicated.malaria..Adult.pre@packaged.therapy.is.the.package.size.intended.for.a.60kg.adult..Pediatric.pre@packaged.therapy.is.the.package.size.intended.for.a.10kg.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:.7.adult.QA.artemether.lumefantrine..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015...

! !


!

Table'A6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'Katanga.

'Public.Health.Facility..


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking.

N=261. N=35. N=19. N=315. N=141. N=558. N=706. N=1,021.

Any.malaria.blood.testing.

86.8. 89.6. 100.0. 88.5. 55.6. 9.8. 19.0. 37.1.(79.5,.91.7). (58.4,.98.1). @. (80.4,.93.5). (45.8,.65.1). (6.4,.14.8). (14.9,.24.0). (30.7,.43.9).

. N=261. N=35. N=19. N=315. N=141. N=558. N=706. N=1,021.

Malaria.microscopy.

28.0. 3.1. 55.2. 23.3. 23.4. 0.8. 5.4. 10.1.(21.3,.35.8). (1.2,.7.7). (30.3,.77.7). (16.8,.31.4). (15.6,.33.4). (0.4,.1.8). (4.0,.7.4). (8.2,.12.3).

. N=260. N=35. N=20. N=315. N=141. N=558. N=706. N=1,021.Rapid.diagnostic.tests.(RDTs).

84.1. 86.5. 89.1. 85.1. 45.9. 9.6. 16.9. 34.5.

(76.2,.89.7). (64.2,.95.8). (63.2,.97.5). (77.5,.90.4). (36.5,.55.5). (6.2,.14.7). (12.7,.22.1). (28.2,.41.5).

. N=260. N=35. N=20. N=315. N=141. N=558. N=706. N=1,[email protected].(QARDTs)***.

83.1. 84.6. 86.6. 83.8. 42.9. 9.1. 15.9. 33.5.

(75.3,.88.8). (62.0,.94.9). (63.4,.96.0). (76.2,.89.3). (34.9,.51.2). (5.8,.14.1). (12.1,.20.6). (27.3,.40.3).

*. 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..Six.antimalarial@stocking.outlets.were.missing.information.about.both.availability.of.microscopy.and.

availability.of.RDTs..Seven.antimalarial@stocking.outlets.had.partial.information.about.blood.testing.availability.and.are.included.in.the.denominator.of.the.indicator.“any.blood.testing.available.”.***.QA.RDT.status.could.not.be.determined.for.9.RDTs.because.of.missing.product.information..


! !


!

Table'A7:'Malaria'blood'testing'market'composition,'Katanga.Outlet'type,'among'outlets'with'malaria'blood'testing'available'on'the'day'of'the'survey:*'.



[email protected]'


Profit'

[email protected].


%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

N=307.outlets.42.4. 15.6. 4.9. 62.9. 22.9. 0.0. 14.2. 37.1.

(33.0,.52.3). (6.1,.34.1). (3.0,.8.0). (53.2,.71.5). (16.9,.30.3). @. (9.2,.21.4). (28.5,.46.8).

*. Outlets.with.malaria.blood.testing.available.on.the.day.of.the.survey,.verified.by.presence.of.at.least.one.RDT.recorded.in.the.RDT.audit.sheet.and/or.reported.availability.of.malaria.microscopy..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015..

!! !


!

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

'Private.

[email protected].


Total'median'price'to'consumers:*'Median.[IQR].(N.of.Antimalarials).



Malaria.microscopy. . . .

Adult.$1.10. $1.64. $1.10.


Child.under.5.years.$1.10. $1.10. $1.10.


Rapid.diagnostic.tests.(RDTs). . . .

Adult.$1.10. $1.10. $1.10.


Child.under.5.years.$1.10. $1.10. $1.10.


*. 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:.. 22.adult.RDTs,.22.child.RDTs,.2.adult.microscopy.tests,.2.child.microscopy.tests..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!

Table'A9:'Antimalarial'market'share,'Katanga!AETDs'sold'or'distributed'in'the'previous'week'by'outlet'type'and'antimalarial'type'as'a'percentage'of'all'AETDs'sold'/'distributed:*'

Public.Health.Facility..


[email protected]'

TOTAL'Public'/'NotCForC

Profit'

[email protected].

Pharmacy. Drug.Store. TOTAL'Private.

ANTICMALARIAL'TOTAL**'

%. %. %. %. %. %. %. %. %.1.'Any'ACT' 14.5. 0.6. 0.9. 16.0. 5.1. 1.0. 29.5. 35.6. 51.6.

First.line.ACT.!. 14.5. 0.6. 0.9. 15.9. 4.8. 0.6. 25.2. 30.6. 46.6.Artesunate.amodiaquine. 13.6. 0.6. 0.7. 14.9. 2.6. 0.0. 7.1. 9.7. 24.7.Artemether.lumefantrine. 0.9. 0.0. 0.2. 1.0. 2.2. 0.6. 18.1. 20.9. 21.9.

Artesunate.sulfadoxine.pyrimethamine. 0.1. 0.0. 0.0. 0.1. 0.0. 0.2. 1.5. 1.7. 1.8.

Dihydroartemisinin.piperaquine. 0.0. 0.0. 0.0. 0.0. 0.2. 0.1. 0.3. 0.6. 0.6.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 2.3. 2.4. 2.4.

[email protected].(QA.ACT). 13.8. 0.6. 0.8. 15.2. 3.2. 0.3. 12.5. 16.0. 31.2.QA.artesunate.amodiaquine. 13.5. 0.6. 0.7. 14.8. 2.6. 0.0. 6.6. 9.2. 24.0.QA.artemether.lumefantrine. 0.3. 0.0. 0.1. 0.4. 0.6. 0.3. 5.9. 6.8. 7.2.

[email protected].([email protected]). 0.8. 0.0. 0.1. 0.8. 1.9. 0.7. 17.0. 19.6. 20.4.

Nationally.registered.ACT. 13.8. 0.6. 0.9. 15.3. 3.9. 0.7. 19.2. 23.8. 39.1.2.'Any'nonCartemisinin'therapy. 8.3. 0.0. 2.0. 10.3. 5.6. 0.5. 28.8. 34.9. 45.2.

Sulfadoxine.pyrimethamine. 6.4. 0.0. 1.2. 7.6. 4.3. 0.2. 19.3. 23.9. 31.5.Oral.quinine. 1.5. 0.0. 0.7. 2.2. 1.1. 0.3. 8.8. 10.2. 12.4.Quinine.IV/IM. 0.4. 0.0. 0.1. 0.4. 0.2. 0.0. 0.6. 0.8. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.4.'NonCoral'artemisinin'monotherapy' 0.1. 0.0. 0.1. 0.2. 0.4. 0.1. 2.6. 3.0. 3.1.

Artesunate.IV/IM.#. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1.Artemether.IV/IM.. 0.0. 0.0. 0.0. 0.1. 0.2. 0.0. 0.6. 0.8. 0.8.Arteether/Artemotil.IV/IM. 0.0. 0.0. 0.0. 0.0. 0.2. 0.1. 1.8. 2.0. 2.1.

Any.severe.malaria.treatment. 0.5. 0.0. 0.1. 0.6. 0.6. 0.1. 3.1. 3.7. 4.3.OUTLET'TYPE'TOTAL***' 22.9' 0.6' 3.0' 26.5' 11.1' 1.6' 60.9' 73.5' 100.0'

*. A.total.of.16,798.8.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...


Table'A9:'Antimalarial'market'share,'Katanga!AETDs'sold'or'distributed'in'the'previous'week'by'outlet'type'and'antimalarial'type'as'a'percentage'of'all'AETDs'sold'/'distributed:*'



[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %. %.A.total.of.7,016.antimalarials.(in.the.census.sample).were.audited..Of.these,.1,172.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information..



Table'A10:'Antimalarial'market'share'within'outlet'type,'Katanga!

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



[email protected]'


Profit'

[email protected].


ANTICMALARIAL'TOTAL'

%. %. %. %. %. %. %. %. %.1.'Any'ACT' 63.5' 94.7' 30.5' 60.5' 45.9' 63.8' 48.4' 48.4' 51.6'

[email protected].!. 63.2. 94.7. 29.2. 60.1. 43.5. 36.2. 41.5. 41.7. 46.6.Artesunate.amodiaquine. 59.5. 94.7. 23.2. 56.2. 23.8. 0.0. 11.7. 13.3. 24.7.Artemether.lumefantrine. 3.7. 0.0. 5.9. 3.9. 19.7. 36.2. 29.8. 28.4. 21.9.

Artesunate.sulfadoxine.pyrimethamine. 0.3. 0.0. 0.0. 0.2. 0.1. 14.9. 2.4. 2.3. 1.8.Dihydroartemisinin.piperaquine. 0.0. 0.0. 0.0. 0.0. 2.2. 5.1. 0.5. 0.8. 0.6.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0. 0.0. 1.4. 0.2. 0.1. 6.2. 3.7. 3.2. 2.4.

Quality.Assured.ACT.(QA.ACT). 60.2. 94.7. 27.4. 57.3. 29.1. 17.2. 20.5. 21.7. 31.2.QA.artesunate.amodiaquine. 59.1. 94.7. 23.2. 55.9. 23.8. 0.0. 10.8. 12.5. 24.0.QA.artemether.lumefantrine. 1.1. 0.0. 4.1. 1.4. 5.3. 17.2. 9.7. 9.2. 7.2.

[email protected].([email protected]). 3.3. 0.0. 3.1. 3.2. 16.7. 46.6. 27.9. 26.7. 20.4.Nationally.Registered.ACT. 60.4. 94.7. 28.7. 57.7. 35.0. 45.5. 31.6. 32.4. 39.1.

2.'Any'nonCartemisinin'therapy. 36.2' 3.5' 67.5' 38.9' 50.8' 32.7' 47.3' 47.5' 45.2'Sulfadoxine.pyrimethamine. 27.8. 3.5. 42.0. 28.8. 38.9. 14.0. 31.8. 32.5. 31.5.Oral.quinine. 6.6. 0.0. 23.3. 8.3. 9.9. 17.3. 14.5. 13.9. 12.4.Quinine.IV/IM. 1.6. 0.0. 2.1. 1.7. 2.0. 1.1. 0.9. 1.1. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.0. 0.0.

3.'Oral'artemisinin'monotherapy' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 0.4' 1.7' 2.0' 0.6' 3.3' 3.5' 4.2' 4.1' 3.1'

Artesunate.IV/IM.#. 0.0' 0.0' 0.0' 0.0' 0.3' 0.0' 0.0' 0.1' 0.1'Artemether.IV/IM.. 0.1' 0.0' 1.5' 0.2' 1.4' 0.0' 1.0' 1.1' 0.8'Arteether/Artemotil.IV/IM. 0.1' 0.0' 0.5' 0.2' 1.6' 3.5' 3.0' 2.8' 2.1'

Any.severe.malaria.treatment. 2.0' 1.7' 4.2' 2.2' 5.3' 4.5' 5.0' 5.1' 4.3'*. A.total.of.16,798.8.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.days:.2,355.4.public.health.facilities,.51.1.community.health.workers,[email protected],.1989.1.private.

[email protected],.235.6..pharmacies,.11,494.0..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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.7,016.antimalarials.were.audited..Of.these,.1,172.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.68.public.health.facilities,.5.community.health.workers,[email protected],[email protected],.1.pharmacy,.908.drug.stores..



!

Table'A11:'Malaria'blood'testing'market'share,'Katanga.!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:*'



[email protected]'

TOTAL'Public'/'Not'ForC

Profit'

[email protected].


BLOOD'TEST'TOTAL**'

%. %. %. %. %. %. %. %. %.

1..Malaria.microscopy. 6.9. 0.0. 1.7. 8.5. 8.3. 0.0. 1.3. 9.6. 18.1.2..RDT. 56.8. 4.4. 4.6. 65.8. 11.8. 0.0. 4.4. 16.1. 81.9.OUTLET'TYPE'TOTAL***' 63.7' 4.4' 6.3' 74.3' 20.0' 0.0' 5.6' 25.7' 100.0'

*. A.total.of.6,295.malaria.blood.tests.were.reportedly.administered.in.the.previous.7.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%[email protected].–.malaria.blood.testing.total.column...A.total.of.1,169.malaria.blood.tests.were.audited..Of.these,.65.audited.tests.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information..



!

Table'A12:'Malaria'blood'testing'market'share,'within'outlet'type,'Katanga!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:*'



[email protected]'


Profit'

[email protected].


BLOOD'TEST'TOTAL**'

%. %. %. %. %. %. %. %. %.

Total'blood'testing'market'' . . . . . . . . .1..Malaria.microscopy. 10.8. 0.0. 26.6. 11.5. 41.4. 0.0. 22.5. 37.2. 18.1.2..RDT. 89.2. 100.0. 73.4. 88.5. 58.6. 0.0. 77.5. 62.8. 81.9.Malaria'RDT'market'' . . . . . . . . .

Manufacturer.!. . . . . . . . . .Standard.Diagnostics.

Inc.. 98.5. 100.0. 99.7. 98.7. 79.6. 0.0. 96.1. 84.1. 95.8.

Access.Bio.Inc.. 1.5. 0.0. 0.0. 1.3. 6.6. 0.0. 0.0. 4.8. 2.0.Other.. 0.0. 0.0. 0.3. 0.0. 12.6. 0.0. 3.9. 10.3. 2.0.Unknown. 0.0. 0.0. 0.0. 0.0. 1.1. 0.0. 0.0. 0.8. 0.2.

[email protected].(QA.RDT).**. 97.5. 98.2. 100.0. 97.7. 83.4. 0.0. 86.6. 84.3. 95.1.

*. 6,295.malaria.blood.tests.reportedly.administered.in.the.previous.7.days:.3,353.public.health.facilities;.182.community.health.workers;[email protected];.1,[email protected];.0.pharmacies;.513.drug.stores..

Categories.1.through.2.sum.to.100%.within.each.column...A.total.of.1,169.malaria.blood.tests.were.audited..Of.these,.65.audited.tests.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information..!. Manufacturer.was.not.captured.for.45.RDTs.audited...**. QA.RDT.status.could.not.be.determined.for.9.RDTs.because.of.missing.product.information..


! !


!

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



[email protected]'


Profit'

[email protected].


ALL'Outlets'

Proportion'of'providers'who:.

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

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

N=249. N=34. N=19. N=302. N=130. N=375. N=512. N=814.

Yes.–.sometimes. 40.4. 9.3. 28.2. 31.1. 49.5. 28.1. 33.4. 32.6.

(32.9,.48.5). (1.7,.37.6). (8.7,.61.7). (21.0,.43.5). (35.9,.63.2). (22.1,.35.0). (26.5,.41.0). (26.5,.39.5).

Yes.–.always.. 6.7. 0.0. 13.9. 5.4. 9.9. 5.8. 6.7. 6.3.(3.7,.11.8). @. (4.6,.35.0). (3.0,.9.8). (5.9,.16.1). (2.5,.12.7). (3.9,.11.3). (3.9,.10.0).

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

N=140. N=5. N=9. N=154. N=86. N=131. N=218. N=372.

Patient.has.signs.and.symptoms.of.malaria..

92.3. 100.0. 89.8. 92.6. 88.0. 85.1. 86.4. 88.3.(86.3,.95.8). @. (50.5,.98.7). (87.3,.95.8). (77.3,.94.1). (76.4,.91.0). (79.1,.91.4). (83.0,.92.1).

When.the.patient.asks.for.antimalarial.treatment..

7.3. 19.9. 0.0. 7.5. 2.5. 24.0. 15.4. 13.0.

(3.4,.14.9). (6.9,.45.5). @. (3.4,.15.9). (0.9,.7.1). (17.1,.32.4). (10.5,.22.2). (9.2,.18.2).

When.the.patient.has.visited.a.malaria.endemic.area..

10.0. 19.9. 10.2. 10.7. 18.3. 6.1. 10.7. 10.7.

(4.7,.20.0). (6.9,.45.5). (1.3,.49.5). (5.7,.19.3). (10.1,.30.8). (2.9,.12.4). (6.8,.16.6). (7.1,.15.9).

Other.(all.other.reasons). 11.0. 0.0. 6.3. 9.9. 6.8. 6.7. 6.6. 7.6.(6.4,.18.3). @. (0.9,.33.4). (5.9,.16.1). (3.0,.14.4). (2.9,.14.7). (3.4,.12.7). (4.9,.11.7).

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,'Katanga.



[email protected]'


Profit'

[email protected].


ALL'Outlets'

. %.(95%.CI).

%.(95%.CI).

.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'providers'who:' N=261. N=35. N=20. N=316. N=141. N=563. N=711. N=1,027.Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria.!.

82.5. 58.0. 76.3. 75.6. 45.4. 28.6. 32.0. 43.3.

(74.1,.88.6).

(37.0,.76.5). (54.1,.89.8). (63.5,.84.6). (37.5,.53.6). (23.2,.34.7). (27.6,.36.8). (39.6,.47.1).

[email protected]:..

. . . . . . . .

An.adult. 39.4. 0.0. 19.0. 27.5. 12.5. 5.8. 7.1. 12.4.(31.1,.48.4). @. (3.9,.57.4). (18.6,.38.8). (6.9,.21.6). (3.9,.8.6). (5.0,.9.9). (9.7,.15.6).

A.two@[email protected]. 54.6. 21.1. 5.4. 42.1. 17.0. 5.0. 7.4. 16.4.(45.9,.63.1). (7.7,.46.2). (0.8,.28.5). (31.1,.54.0). (11.1,.25.2). (3.2,.7.6). (5.2,.10.3). (13.3,.19.9).

Report.an.ACT.as.the.most.effective.antimalarial.medicine.for:.

. . . . . . . .

An.adult. 79.7. 37.1. 71.3. 67.7. 39.6. 28.8. 31.2. 40.7.(72.7,.85.2). (27.4,.47.9). (45.3,.88.2). (58.0,.76.2). (31.3,.48.6). (21.7,.37.0). (25.3,.37.9). (36.5,.45.1).

A.child'78.6. 56.2. 61.3. 71.4. 40.1. 22.6. 27.0. 38.5.

(71.2,.84.5). (40.4,.70.9). (36.8,.81.1). (61.2,.79.7). (31.0,.50.0). (17.1,.29.2). (21.6,.33.3). (34.0,.43.3).

!.At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.both.artesunate.amodiaquine.and.artemether.lumefantrine.were.DRC’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:.4.providers.were.missing.information.on.the.national.first@line.treatmen;,.5.and.3.were.missing.information.about.the.first@line.dosing.regimen.for.adults.and.children,.respectively;.and.7.providers.were.missing.information.on.the.most.effective.antimalarial.medicine.for.adults.and.children..


! !


Results'Section'B:'Core'Indicators,'Kinshasa'Province'!!

!

Table'B1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'Kinshasa.



[email protected]'


[email protected].


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=205. N=12. N=79. N=296. N=327. N=61. N=574. N=872. N=1,168.

Any.antimalarial.at.the.time.of.survey.visit. 98.5. 33.6. 72.8. 77.5. 63.4. 100.0. 97.8. 88.3. 87.0.(95.8,.99.4). (11.6,.66.0). (60.2,.82.6). (68.2,.84.6). (52.7,.73.0). @. (94.5,.99.1). (82.4,.92.4). (82.2,.90.7).

Any.ACT. 93.4. 22.7. 53.4. 64.5. 42.1. 99.3. 89.6. 76.6. 75.2.(86.5,.96.9). (4.9,.62.7). (42.1,.64.4). (55.5,.72.6). (33.9,.50.7). (94.2,.99.9). (83.4,.93.7). (69.4,.82.5). (68.8,.80.6).

First.line.ACT.!.92.9. 22.7. 53.4. 64.3. 39.8. 99.3. 88.4. 75.1. 73.8.

(86.3,.96.5). (4.9,.62.7). (42.1,.64.4). (55.3,.72.4). (30.9,.49.4). (94.2,.99.9). (82.1,.92.6). (68.3,.80.8). (67.8,.79.1).

Artesunate.amodiaquine. 87.0. 0.0. 32.1. 51.4. 21.4. 27.2. 32.1. 29.0. 31.6.(80.3,.91.7). @. (22.9,.43.0). (43.0,.59.8). (13.6,.32.2). (15.2,.43.7). (25.9,.38.9). (24.2,.34.4). (27.4,.36.2).

Artemether.lumefantrine. 38.0. 22.7. 28.0. 28.2. 25.4. 96.1. 87.2. 70.2. 65.4.(31.9,.44.5). (4.9,.62.7). (14.4,.47.5). (19.8,.38.6). (19.6,.32.2). (83.1,.99.2). (80.9,.91.7). (63.7,.76.0). (59.0,.71.3).

Artemisinin.piperaquine. 2.4. 0.0. 0.3. 1.1. 0.0. 46.9. 15.4. 11.7. 10.5.(0.5,.10.7). @. (0.1,.2.0). (0.3,.4.2). @. (34.6,.59.5). (9.7,.23.7). (7.2,.18.4). (6.5,.16.4).

Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 37.2. 4.1. 3.5. 3.1.@. @. @. @. @. (19.4,.59.3). (2.0,.8.2). (1.8,.6.7). (1.6,.6.0).

Artesunate.sulfadoxine.pyrimethamine.. 5.7. 0.0. 2.5. 3.4. 3.6. 89.8. 51.6. 38.9. 34.8.(2.1,.14.3). @. (1.2,.5.3). (1.8,.6.3). (1.3,.9.5). (81.3,.94.7). (43.8,.59.3). (31.7,.46.6). (28.2,.42.1).

Dihydroartemisinin.piperaquine. 10.3. 0.0. 6.5. 7.1. 12.8. 70.5. 57.0. 45.0. 40.6.(6.2,.16.7). @. (2.4,.16.4). (4.0,.12.3). (8.0,.20.0). (54.2,.82.8). (49.7,.64.0). (37.9,.52.2). (34.1,.47.5).

Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0. 0.0. 0.0. 25.7. 2.0. 1.9. 1.7.@. @. @. @. @. (16.0,.38.6). (0.8,.5.2). (0.8,.4.3). (0.7,.3.8).

Dihydroartemisinin.sulfadoxine.pyrimethamine. 2.1. 0.0. 0.0. 0.8. 0.2. 59.9. 33.3. 24.5. 21.8.(0.9,.4.6). @. @. (0.4,.1.6). (0.1,.0.7). (44.8,.73.4). (27.4,.39.7). (19.2,.30.8). (17.1,.27.4).

Other.ACT.β. 2.3. 0.0. 0.0. 0.8. 0.0. 0.0. 0.0. 0.0. 0.1.(0.4,.12.2). @. @. (0.1,.5.1). @. @. @. @. (0.0,.0.6).

[email protected].(QA.ACT). 85.4. 22.7. 29.3. 49.4. 20.2. 64.3. 18.6. 19.8. 23.2.(78.3,.90.4). (4.9,.62.7). (19.5,.41.4). (40.2,.58.6). (12.4,.31.2). (46.1,.79.1). (14.7,.23.1). (15.9,.24.4). (19.6,.27.1).

QA.artesunate.amodiaquine' 85.2. 22.7. 29.3. 49.3. 20.2. 5.4. 4.0. 8.6. 13.2.(78.2,.90.2). (4.9,.62.7). (19.5,.41.4). (40.1,.58.5). (12.4,.31.2). (1.4,.18.0). (2.6,.6.2). (5.8,.12.4). (10.5,.16.5).

QA.artemether.lumefantrine. 1.9. 0.0. 0.6. 1.0. 0.0. 63.0. 15.4. 11.9. 10.7.(0.7,.5.1). @. (0.1,.4.0). (0.3,.2.9). @. (44.0,.78.7). (11.4,.20.4). (8.7,.16.1). (7.8,.14.4).


Table'B1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'Kinshasa.



[email protected]'


[email protected].


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=205. N=12. N=79. N=296. N=327. N=61. N=574. N=872. N=1,168.

[email protected].([email protected])' 43.5. 0.0. 28.3. 30.4. 30.3. 98.1. 89.3. 73.1. 68.2.(37.4,.49.7). @. (14.6,.47.7). (22.0,.40.4). (24.6,.36.6). (89.5,.99.7). (83.1,.93.4). (66.0,.79.1). (61.4,.74.3).

Nationally.registered.ACT. 91.1. 22.7. 43.9. 58.9. 33.6. 99.3. 85.6. 71.4. 69.9.(84.0,.95.2). (4.9,.62.7). (32.3,.56.2). (49.9,.67.3). (24.1,.44.6). (94.2,.99.9). (79.7,.90.0). (64.5,.77.3). (63.7,.75.5).

[email protected]. 81.5. 10.9. 61.1. 62.4. 45.1. 100.0. 94.3. 80.7. 78.6.(70.8,.88.9). (1.6,.47.0). (46.8,.73.6). (51.2,.72.4). (35.3,.55.3). @. (91.0,.96.4). (75.2,.85.2). (73.8,.82.8).

Sulfadoxine.pyrimethamine. 45.6. 10.9. 31.0. 33.9. 13.3. 72.4. 69.8. 54.1. 51.8.(35.3,.56.2). (1.6,.47.0). (19.9,.44.7). (24.9,.44.2). (8.6,.19.9). (60.4,.81.8). (62.8,.76.0). (47.7,.60.4). (46.0,.57.6).

Oral.quinine. 63.1. 0.0. 42.5. 44.9. 28.4. 96.6. 88.4. 71.9. 68.8.(52.7,.72.3). @. (27.6,.59.0). (34.5,.55.7). (22.6,.35.0). (89.9,.98.9). (84.8,.91.2). (67.3,.76.1). (64.6,.72.6).

[email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 20.1. 0.4. 0.6. 0.6.@. @. @. @. @. (8.4,.40.8). (0.1,.3.1). (0.2,.2.3). (0.1,.2.1).

Oral.artemisinin.monotherapy. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.4. 0.4.@. @. @. @. @. @. (0.2,.2.0). (0.1,.1.4). (0.1,.1.3).

[email protected]. 43.8. 0.0. 41.8. 37.3. 32.6. 86.8. 81.6. 68.1. 64.6.(33.9,.54.2). @. (24.9,.61.0). (27.0,.48.9). (24.9,.41.3). (80.5,.91.4). (77.7,.85.0). (63.5,.72.3). (60.3,.68.6).

Any.treatment.for.severe.malaria. 65.6. 0.0. 52.9. 51.0. 44.7. 88.2. 84.3. 73.4. 70.8.(55.3,.74.6). @. (32.9,.72.1). (39.4,.62.6). (33.5,.56.4). (80.9,.93.0). (80.4,.87.6). (68.2,.78.0). (66.1,.75.1).

Artesunate.IV/IM.#' 17.9. 0.0. 12.8. 13.1. 9.6. 37.4. 17.8. 15.8. 15.5.(10.4,.29.1). @. (5.1,.28.3). (7.1,.22.9). (6.1,.14.9). (27.1,.48.9). (15.0,.21.1). (12.9,.19.3). (12.6,.19.0).

Artemether.IV/IM. 9.4. 0.0. 6.2. 6.6. 5.5. 43.3. 30.7. 23.9. 22.0.(4.9,.17.2). @. (2.6,.13.9). (3.3,.13.0). (3.1,.9.8). (32.1,.55.3). (26.3,.35.6). (20.9,.27.3). (19.5,.24.7).

Arteether.IV/IM' 31.9. 0.0. 34.1. 29.0. 28.0. 86.8. 79.8. 65.5. 61.3.(23.9,.41.2). @. (20.2,.51.4). (21.0,.38.6). (21.6,.35.5). (80.5,.91.4). (75.3,.83.6). (61.0,.69.8). (57.0,.65.5).

Quinine.IV/IM. 45.4. 0.0. 25.2. 29.6. 26.2. 27.4. 23.2. 24.1. 24.7.(35.6,.55.5). @. (13.9,.41.3). (22.3,.38.1). (17.7,.37.0). (17.2,.40.7). (16.3,.31.9). (17.9,.31.6). (19.0,.31.6).

*. The.denominator.includes.24.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated!malaria..β. Other.types.of.ACT.include.artemisinin.napthoquine..^[email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015.. .! !


Table'B2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'Kinshasa'

'Public.Health.Facility'

[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


Any.ACT. 94.8. 73.4. 83.2. 66.4. 99.3. 91.6. 86.7. 86.4.(86.9,.98.1). (60.5,.83.2). (73.9,.89.7). (55.3,.75.9). (94.2,.99.9). (85.3,.95.4). (79.8,.91.5). (79.8,.91.0).

[email protected].!.94.4. 73.4. 83.0. 62.7. 99.3. 90.4. 85.0. 84.8.

(86.8,.97.7). (60.5,.83.2). (73.7,.89.5). (51.0,.73.2). (94.2,.99.9). (83.9,.94.4). (78.5,.89.8). (78.6,.89.5).


(80.8,.93.2). (29.4,.59.9). (54.3,.76.6). (24.0,.45.2). (15.2,.43.7). (26.3,.40.1). (27.4,.39.0). (31.4,.41.6).

Artemether.lumefantrine.38.6. 38.5. 36.4. 40.1. 96.1. 89.2. 79.5. 75.1.

(32.3,.45.3). (20.8,.59.8). (26.8,.47.4). (29.7,.51.4). (83.1,.99.2). (82.6,.93.5). (72.7,.85.0). (68.2,.81.0).

Artemisin.piperaquine. 2.5. 0.4. 1.4. 0.0. 46.9. 15.8. 13.2. 12.0.(0.5,.10.8). (0.1,.2.8). (0.4,.5.2). @. (34.6,.59.5). (9.9,.24.2). (8.2,.20.5). (7.5,.18.7).

Artesunate.mefloquine.0.0. 0.0. 0.0. 0.0. 37.2. 4.2. 4.0. 3.6.@. @. @. @. (19.4,.59.3). (2.1,.8.3). (2.1,.7.5). (1.9,.6.7).

Artesunate.sulfadoxine.pyrimethamine..5.8. 3.5. 4.4. 5.6. 89.8. 52.8. 44.0. 40.0.

(2.2,.14.5). (1.7,.7.2). (2.4,.8.0). (1.9,.15.5). (81.3,.94.7). (45.1,.60.3). (36.7,.51.6). (33.0,.47.4).


(6.3,.16.9). (3.5,.21.3). (5.2,.15.7). (11.9,.32.3). (54.2,.82.8). (51.5,.64.8). (44.3,.57.6). (40.2,.53.3).

Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0. 0.0. 25.7. 2.1. 2.1. 1.9.@. @. @. @. (16.0,.38.6). (0.8,.5.3). (0.9,.4.8). (0.8,.4.3).

Dihydroartemisinin.sulfadoxine.pyrimethamine.2.1. 0.0. 1.0. 0.3. 59.9. 34.0. 27.8. 25.1.

(0.9,.4.7). @. (0.5,.2.1). (0.1,.1.2). (44.8,.73.4). (28.3,.40.2). (22.6,.33.7). (20.3,.30.5).

Other.ACT.β.2.3. 0.0. 1.1. 0.0. 0.0. 0.0. 0.0. 0.1.

(0.4,.12.3). @. (0.2,.6.5). @. @. @. @. (0.0,.0.7).


(78.7,.92.0). (24.9,.57.6). (50.1,.75.4). (22.0,.43.8). (46.1,.79.1). (15.0,.23.7). (18.2,.27.2). (22.8,.30.8).

QA.aresunate.amodiaquine' 86.5. 40.2. 63.6. 31.9. 5.4. 4.1. 9.7. 15.2.(78.6,.91.8). (24.9,.57.6). (50.1,.75.3). (22.0,.43.8). (1.4,.18.0). (2.7,.6.4). (6.7,.13.9). (12.2,.18.8).


(0.7,.5.2). (0.1,.5.6). (0.4,.3.7). @. (44.0,.78.7). (11.7,.20.9). (9.9,.18.0). (9.0,.16.4).

[email protected].([email protected])'44.1. 38.9. 39.3. 47.7. 98.1. 91.3. 82.8. 78.3.

(38.0,.50.5). (21.2,.60.1). (29.7,.49.8). (37.3,.58.3). (89.5,.99.7). (85.0,.95.1). (75.6,.88.1). (71.0,.84.2).' . . . . . . . .


Table'B2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'Kinshasa'

'Public.Health.Facility'

[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'



[email protected]. 83.8. 80.5. 71.1. 100.0. 96.4. 91.4. 90.3.

(71.9,.90.0). (67.2,.92.9). (70.4,.87.8). (60.5,.79.8). @. (93.7,.98.0). (88.9,.93.4). (87.8,.92.3).

Sulfadoxine.pyrimethamine.46.3. 42.5. 43.7. 20.9. 72.4. 71.4. 61.3. 59.5.

(36.0,.56.9). (27.0,.59.6). (32.3,.55.9). (14.6,.29.1). (60.4,.81.8). (64.8,.77.1). (56.1,.66.3). (54.5,.64.4).

Oral.quinine.64.1. 58.4. 57.9. 44.7. 96.6. 90.4. 81.4. 79.0.

(53.6,.73.3). (39.8,.74.9). (47.1,.68.0). (37.8,.51.9). (89.9,.98.9). (86.7,.93.1). (78.1,.84.3). (75.6,.82.1).

[email protected].^. 0.0. 0.0. 0.0. 0.0. 20.1. 0.4. 0.7. 0.6.@. @. @. @. (8.4,.40.8). (0.1,.3.1). (0.2,.2.6). (0.2,.2.3).

Oral.artemisinin.monotherapy.0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.5. 0.4.@. @. @. @. @. (0.2,.2.0). (0.1,.1.6). (0.1,.1.5).

[email protected]. 57.4. 48.2. 51.4. 86.8. 83.5. 77.1. 74.2.

(34.4,.55.0). (34.8,.77.4). (35.5,.61.2). (42.8,.59.8). (80.5,.91.4). (79.6,.86.8). (73.8,.80.1). (70.7,.77.4).

Any.treatment.for.severe.malaria.66.6. 72.6. 65.9. 70.4. 88.2. 86.2. 83.1. 81.4.

(56.2,.75.7). (44.1,.89.9). (52.2,.77.4). (57.2,.80.9). (80.9,.93.0). (82.4,.89.3). (80.0,.85.8). (78.2,.84.1).

..Artesunate.IV/IM.#' 18.2. 17.5. 16.9. 15.2. 37.4. 18.2. 18.0. 17.8.(10.6,.29.4). (7.1,.37.1). (9.2,.29.1). (9.5,.23.4). (27.1,.48.9). (15.4,.21.4). (15.0,.21.3). (14.8,.21.3).

Artemether.IV/IM.9.5. 8.5. 8.5. 8.7. 43.3. 31.4. 27.1. 25.2.

(5.0,.17.4). (3.7,.18.2). (4.4,.16.0). (4.9,.15.1). (32.1,.55.3). (26.8,.36.5). (23.7,.30.9). (22.3,.28.4).

Arteether.IV/IM'32.4. 46.8. 37.4. 44.2. 86.8. 81.6. 74.2. 70.5.

(24.1,.42.1). (28.6,.65.9). (27.9,.48.1). (36.2,.52.5). (80.5,.91.4). (77.0,.85.4). (70.4,.77.7). (66.4,.74.2).

Quinine.IV/IM.46.1. 34.6. 38.2. 41.3. 27.4. 23.7. 27.3. 28.4.

(36.2,.56.3). (19.7,.53.5). (30.2,.46.8). (28.8,.55.1). (17.2,.40.7). (16.8,.32.4). (20.7,.35.2). (22.2,.35.7).

*. Antimalarial@stocking.outlets.have.at.least.one.antimalarial.in.stock.on.the.day.of.the.survey,.verified.by.the.presence.of.at.least.one.antimalarial.recorded.in.the.antimalarial.audit.sheet..The.denominator.includes.19.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated!malaria..β. Other.types.of.ACT.include.artemisinin.napthoquine..^[email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015.. .!! !


!

Table'B3:'Types'of'qualityCassured'and'nonCquality'assured'ACTs'audited'in'the'public'and'private'sector,'Kinshasa'

ACT'generic'name'and'formulation''QualityCassured'ACT' NonCquality'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=562. N.audited=291. N.audited=390. N.audited=6,999.Tablet.formulation:. . . . .

Artemether.lumefantrine.1.2. 53.4. 38.7. 34.6.

(0.4,.3.5). (38.1,.68.1). (31.9,.46.0). (33.2,.36.1).

Artimisinin.napthoquine.0.0. 0.0. 0.9. 0.0.@. @. (0.1,.6.1). @.

Artemisinin.piperaquine.0.0. 0.0. 1.2. 1.4.@. @. (0.3,.4.5). (0.9,.2.1).

Artesunate.amodiaquine.98.8. 46.6. 4.9. 3.8.

(96.5,.99.6). (31.9,.61.9). (3.1,.7.9). (3.1,.4.6).


Artesunate.sulfadoxine.pyrimethamine.0.0. 0.0. 5.1. 9.7.@. @. (3.3,.7.9). (8.6,.10.8).


Dihydroartemisinin.piperaquine.trimethoprim.

0.0. 0.0. 0.0. 0.2.@. @. @. (0.1,.0.5).

Dihydroartemisinin.sulfadoxine.pyrimethamine.

0.0. 0.0. 0.8. 2.9.@. @. (0.4,.1.8). (2.5,.3.3).

[email protected]*:. . . . .

Artemether.lumefantrine.0.0. 0.0. 36.2. 32.4.@. @. (28.7,.44.5). (30.0,.35.0).



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



!!

!

Table'B4:'Antimalarial'market'composition,'Kinshasa'

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



[email protected]'


[email protected].


%.(95%.CI).

%.(95%.CI)'

%.(95%.CI)'

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

N=852.outlets.8.4. 0.5. 4.7. 13.6. 17.5. 0.4. 68.5. 86.4.

(5.2,.13.2). (0.2,.1.6). (2.9,.7.5). (9.6,.19.0). (13.6,.22.2). (0.1,.1.9). (62.7,.73.7). (81.0,.90.4).*....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..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..!! !


!!

Table'B5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'Kinshasa''

'Private.

[email protected].






Any'ACT' $0.00. $4.93. $3.84. $3.84.[[email protected]].(175). [[email protected]].(781). [[email protected]].(3,386). [[email protected]].(4,342).

[email protected].!.$0.00. $4.93. $3.95. $3.95.

[[email protected]].(152). [[email protected]].(474). [[email protected]].(2,266). [[email protected]].(2,892).

Artesunate.amodiaquine.. $0.00. $3.29. $2.19. $1.75.[[email protected]].(100). [[email protected]].(24). [[email protected]].(253). [[email protected]].(377).

Artemether.lumefantrine. $3.29. $4.93. $4.06. $4.06.[[email protected]].(52). [[email protected]].(450). [[email protected]].(2,013). [[email protected]].(2,515).

[email protected].(QA.ACT). $0.00. $7.67. $6.47. $5.04.[[email protected]].(92). [[email protected]].(53). [[email protected]].(134). [[email protected]].(279).

QA.artesunate.amodiaquine. $0.00. $0.00. $3.07. $0.00.[[email protected]].(92). [[email protected]].(6). [[email protected]].(44). [[email protected]].(142).

QA.artemether.lumefantrine. @. $8.33. $6.58. $6.58.@. [[email protected]].(47). [[email protected]].(90). [[email protected]].(137).

[email protected].([email protected]). $3.07. $4.82. $3.84. $3.84.[[email protected]].(83). [[email protected]].(728). [[email protected]].(3,252). [[email protected]].(4,063).

Artesunate.sulfadoxine.pyrimethamine. $3.29. $4.38. $3.51. $3.51.[[email protected]].(13). [[email protected]].(127). [[email protected]].(519). [[email protected]].(659).

Dihydroartemisinin.piperaquine. $1.85. $4.49. $3.95. $3.84.[[email protected]].(8). [[email protected]].(92). [[email protected]].(354). [[email protected]].(454).

Sulfodoxine.pyrimethamine. $0.33. $1.64. $0.44. $0.44.[[email protected]].(44). [[email protected]].(68). [[email protected]].(761). [[email protected]].(873).

Oral.quinine. $3.31. $4.42. $3.31. $3.31.[[email protected]].(96). [[email protected]].(122). [[email protected]].(971). [[email protected]].(1,189).


!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artemether.lumefantrine.and.artesunate.amodiaquine.were.the.first@line.treatments.for.uncomplicated.malaria..Figures.in.this.table.are.derived.using.audited.products.with.price.information..The.numbers.of.tablet.antimalarials.captured.in.audit.sheets.with.missing.price.and/.or.product.information.are.as.follows:.

130.any.ACT,.10.artesunate.amodiaquine,.73.artemether.lumefantrine,.4.QA.artesunate.amodiaquine,.8.QA.artemether.lumefantrine,[email protected],.17.artesunate.sulfadoxine.pyrimethamine,.17.dihydroartemisinin.piperaquine,.13.sulfadoxine.pyrimethamine,.22.oral.quinine..


! !


!

Table'B5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'Kinshasa'

'Private.

[email protected].






[email protected]@assured.ACT.(QA.ACT).!.$0.00. $6.25. $6.03. $5.48.

[[email protected]].(26). [[email protected]].(30). [[email protected]].(67). [[email protected]].(123).

Adult.Quality@assured.(QA).artesunate.amodiaquine.'$0.00. $3.29. $2.19. $0.00.


Adult.Quality@assured.(QA).artemether.lumefantrine'@. $6.36. $6.03. $6.03.@. [[email protected]].(27). [[email protected]].(56). [[email protected]].(83).

[email protected].(QA.ACT).!!$0.00. $3.12. $2.52. $1.75.


Pediatric.Quality@assured.(QA).artesunate.amodiaquine..$0.00. $0.00. $1.64. $0.00.


Pediatric.Quality@assured.(QA).artemether.lumefantrine.@. $3.12. $2.74. $2.74.@. [[email protected]].(10). [[email protected]].(19). [[email protected]].(29).


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:.4.adult.QA.artemether.lumefantrine,.1.pediatric.QA.artesunate.amodiaquine,.4.pediatric.QA.artemether.lumefantrine.


!!

! !


!

Table'B6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'Kinshasa'


[email protected].


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking. N=201. N=64. N=270. N=176. N=60. N=560. N=796. N=1,066.

Any.malaria.blood.testing. 97.2. 97.5. 95.3. 94.0. 14.8. 1.5. 21.7. 29.3.(87.5,.99.4). (83.7,.99.7). (87.8,.98.3). (88.1,.97.1). (5.3,.35.1). (0.7,.3.1). (17.5,.26.6). (24.7,.34.3).

. N=201. N=64. N=270. N=176. N=60. N=560. N=796. N=1,066.

Malaria.microscopy. 88.7. 92.2. 85.7. 88.7. 1.2. 0.9. 19.9. 26.6.(77.9,.94.6). (77.5,.97.6). (75.6,.92.0). (83.2,.92.5). (0.1,.11.1). (0.4,.2.0). (16.1,.24.2). (22.4,.31.2).

. N=203. N=64. N=272. N=176. N=59. N=553. N=788. N=1,060.

Rapid.diagnostic.tests.(RDTs). 68.6. 43.6. 56.2. 31.1. 15.0. 1.0. 7.8. 12.8.(58.7,.77.0). (28.3,.60.2). (44.2,.67.5). (21.8,.42.2). (5.4,.35.1). (0.3,.2.7). (5.3,.11.3). (9.7,.16.5).

. N=203. N=64. N=272. N=176. N=59. N=553. N=788. N=1,[email protected].(QARDTs)***.

68.6. 40.5. 54.7. 30.1. 15.0. 0.4. 7.1. 12.0.(58.7,.77.0). (27.1,.55.5). (43.5,.65.5). (20.9,.41.3). (5.4,.35.1). (0.1,.1.5). (4.8,.10.5). (9.2,.15.6).

*. 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..12.antimalarial@stocking.outlets.were.missing.information.about.both.availability.of.

microscopy.and.availability.of.RDTs..22.antimalarial@stocking.outlets.had.partial.information.about.blood.testing.availability.and.are.included.in.the.denominator.of.the.indicator.“any.blood.testing.available.”.

***.QA.RDT.status.could.not.be.determined.for.2.RDTs.because.of.missing.product.information..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!

Table'B7:'Malaria'blood'testing'market'composition,'Kinshasa'Outlet'type,'among'outlets'with'malaria'blood'testing'available'on'the'day'of'the'survey:*'.



[email protected]'


Profit'

[email protected].


%.(95%.CI).

%.(95%.CI)'

%.(95%.CI)'

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

N=356.outlets.20.4. 0.8. 14.6. 35.8. 61.7. 0.0. 2.5. 64.2.

(13.5,.29.6). (0.2,.3.7). (9.4,.21.9). (27.1,.45.5). (52.4,.70.1). @. (1.2,.5.5). (54.5,.72.9).*. Outlets.with.malaria.blood.testing.available.on.the.day.of.the.survey,.verified.by.presence.of.at.least.one.RDT.recorded.in.the.RDT.audit.sheet.and/or.reported.availability.of.malaria.microscopy..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..

!! !


!

Table'B8:'Price'of'malaria'blood'testing'for'adults,'by'outlet'type,'Kinshasa''

'Private.

[email protected].


Total'median'price'to'consumers:*' Median.[IQR].(N.of.Antimalarials).




Malaria.microscopy. . . . .

Adult.$1.10. $1.64. $1.10. $1.10.


Child.under.five.years.$1.10. $1.64. $1.10. $1.10.


Rapid.diagnostic.tests.(RDTs). . . . .

Adult.$1.10. $0.00. $1.10. $1.10.


Child.under.five.years.$1.10. $0.00. $1.10. $1.10.


*. 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:.

12.adult.RDTs,.12.child.RDTs,.5.adult.microscopy.tests,.5.child.microscopy.tests..


!!

!

!! !


!

Table'B9:'Antimalarial'market'share,'Kinshasa'



Community.Health..Worker'

[email protected].


Profit'

[email protected].



%. %.%.

%. %. %. %. %. %.

1.'Any'ACT' 6.0. 0.1. 1.0. 7.1. 2.4. 0.0. 35.6. 38.1. 45.1.First.line.ACT.!. 5.5. 0.1. 0.9. 6.5. 2.0. 0.0. 25.0. 27.0. 33.6.

Artesunate.amodiaquine. 4.7. 0.1. 0.5. 5.3. 0.9. 0.0. 1.3. 2.2. 7.5.

Artemether.lumefantrine. 0.7. 0.0. 0.5. 1.2. 1.2. 0.0. 23.6. 24.8. 26.1.

Artesunate.piperaquine. 0.1. 0.0. 0.0. 0.1. 0.0. 0.0. 0.4. 0.4. 0.4.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.0. 0.0! 0.0. 0.0! 0.1! 0.0! 5.1! 5.2! 5.2!Dihydroartemisinin.piperaquine. 0.4. 0.0! 0.0. 0.4! 0.3! 0.0! 3.0! 3.3! 3.7!Dihydroartemisinin.piperaquine.trimethoprim.

0.0. 0.0! 0.0. 0.0! 0.0! 0.0! 0.1! 0.1! 0.1!


0.0. 0.0! 0.0. 0.0! 0.0! 0.0! 2.1! 2.1! 2.1!

[email protected].(QA.ACT). 3.9. 0.1! 0.5. 4.6! 0.8! 0.0! 1.1! 1.9! 6.5!QA.artesunate.amodiaquine. 3.9. 0.1! 0.5. 4.5! 0.8! 0.0! 0.2! 1.0! 5.6!QA.artemether.lumefantrine. 0.0. 0.0! 0.0. 0.1! 0.0! 0.0! 0.9! 0.9! 0.9!

[email protected]. 2.0. 0.0! 0.5. 2.5! 1.6! 0.0! 34.5! 36.1! 38.7!Nationally.registered.ACT. 4.9. 0.1! 0.8. 5.9! 1.5! 0.0! 19.6! 21.2! 27.0!

2.'Any'nonCartemisinin'therapy. 5.2' 0.1! 0.8. 6.1! 1.9! 0.3! 37.6! 39.7! 45.8!

Sulfadoxine.pyrimethamine. 3.6. 0.1! 0.6. 4.2! 1.0! 0.2! 25.7! 27.0! 31.1!Oral.quinine. 1.6. 0.0! 0.2. 1.8! 0.8! 0.0! 11.6! 12.4! 14.2!Quinine.IV/IM. 0.1. 0.0. 0.0. 0.1. 0.1. 0.0. 0.3. 0.4. 0.5.. . . . . . . . . .


Table'B9:'Antimalarial'market'share,'Kinshasa'




[email protected].


Profit'

[email protected].



%. %.%.

%. %. %. %. %. %.

[email protected].^. 0.0. 0.0! 0.0. 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!

3.'Oral'artemisinin'monotherapy' 0.0. 0.0! 0.0. 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!4.'NonCoral'artemisinin'monotherapy' 0.4. 0.0! 0.3. 0.7! 0.9! 0.0! 7.4! 8.3! 9.0!

Artesunate.IV/IM.#. 0.1. 0.0! 0.1. 0.1! 0.0! 0.0! 0.1! 0.1! 0.2!Artemether.IV/IM.. 0.1. 0.0! 0.0. 0.1! 0.1! 0.0! 0.3! 0.4! 0.4!Arteether/Artemotil.IV/IM. 0.3. 0.0! 0.2. 0.6! 0.8! 0.0! 6.9! 7.7! 8.3!

Any.severe.antimalarial.treatment. 0.5. 0.0! 0.3. 0.9! 0.9! 0.0! 7.7! 8.7! 9.5!OUTLET'TYPE'TOTAL***' 11.6' 0.2! 2.1' 13.9! 5.1! 0.3! 80.6! 86.1! 100.0!*. A.total.of.13,447.5.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine,.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...A.total.of.12,900.antimalarials.(in.the.census.sample).were.audited..Of.these,.942.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.'Source:.ACTwatch.Outlet.Survey,.DRC,.2015.'!


Table'B10:'Antimalarial'market'share'within'outlet'type,'Kinshasa'AETDs'sold'or'distributed'in'the'previous'week'by'antimalarial'type'as'a'percentage'of'all'AETDs'sold'/'distributed'within'each'outlet'type:*'



[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %. %.

1.'Any'ACT' 51.3. 72.7. 47.2' 51.0' 46.8' 15.0' 44.2' 44.2' 45.1'[email protected].!. 46.9. 72.7. 44.9. 47.0. 39.3. 14.2. 31.0. 31.4. 33.6.

Artesunate.amodiaquine. 40.5. 72.7. 22.3. 38.2. 16.8. 0.0. 1.7. 2.6. 7.5.Artemether.lumefantrine. 6.4. 0.0. 22.6. 8.8. 22.5. 14.2. 29.3. 28.8. 26.1.

Artesunate.piperaquine. 0.6. 0.0. 0.1. 0.6. 0.0. 0.0. 0.4. 0.4. 0.4.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.0. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.2. 0.0. 0.5. 0.3. 1.7. 0.8. 6.3. 6.0. 5.2.Dihydroartemisinin.piperaquine. 3.3. 0.0. 1.7. 3.0. 5.8. 0.0. 3.7. 3.9. 3.7.Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1. 0.1.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.1. 0.0. 0.0. 0.1. 0.0. 0.0. 2.5. 2.4. [email protected].(QA.ACT). 33.9. 72.7. 24.3. 32.9. 16.2. 0.0. 1.3. 2.2. 6.5.QA.artesunate.amodiaquine. 33.8. 72.7. 22.3. 32.6. 16.2. 0.0. 0.2. 1.2. 5.6.QA.artemether.lumefantrine. 0.1. 0.0. 2.1. 0.4. 0.0. 0.0. 1.1. 1.0. 0.9.

[email protected]. 17.4. 0.0. 22.9. 18.0. 30.7. 15.0. 42.8. 42.0. 38.7.Nationally.registered.ACT. 42.6. 72.7. 36.6. 42.1. 29.9. 6.0. 24.4. 24.6. 27.0.

2.'Any'nonCartemisinin'therapy. 45.0. 27.3. 38.9' 43.8' 36.5' 82.3' 46.6' 46.2' 45.8'

Sulfadoxine.pyrimethamine. 30.6. 27.3. 27.0. 30.0. 19.8. 69.9. 31.9. 31.3. 31.1.Oral.quinine. 13.4. 0.0. 10.2. 12.8. 14.8. 12.3. 14.4. 14.4. 14.2.Quinine.IV/IM. 0.9. 0.0. 1.7. 1.0. 1.7. 0.0. 0.3. 0.4. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.


Table'B10:'Antimalarial'market'share'within'outlet'type,'Kinshasa'AETDs'sold'or'distributed'in'the'previous'week'by'antimalarial'type'as'a'percentage'of'all'AETDs'sold'/'distributed'within'each'outlet'type:*'



[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %. %.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 3.7. 0.0. 13.9' 5.2' 16.7' 2.7' 9.2' 9.6' 9.0'

Artesunate.IV/IM.#. 0.5. 0.0. 2.4' 0.7' 0.2' 0.0' 0.2' 0.2' 0.2'Artemether.IV/IM.. 0.4. 0.0. 0.4' 0.4' 1.3' 0.0' 0.4' 0.5' 0.4'Arteether/Artemotil.IV/IM. 2.8. 0.0. 11.0' 4.0' 15.2' 2.7' 8.6' 9.0' 8.3'

Any.severe.antimalarial.treatment. 4.7. 0.0. 15.6' 6.2' 18.4' 2.7' 9.6' 10.1' 9.5'*. A.total.of.13,447.5.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.days:.1,202.1.public.health.facilities,.45.1.community.health.workers,[email protected],[email protected],.

45.0..pharmacies,.10,707.4..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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.12,900.antimalarials.were.audited..Of.these,.942.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.44.public.health.facilities,.0.community.health.workers,[email protected],[email protected],.12.pharmacies,.744.drug.stores..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..

!


Table'B11:'Malaria'blood'testing'market'share,'Kinshasa'

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:*'



[email protected]'

TOTAL'Public'/'Not'ForCProfit'

[email protected].


BLOOD'TEST'TOTAL**'

%. %. %. %. %. %. %. %. %.1..Malaria.microscopy. 14.6. 0.0. 12.3. 26.9. 36.4. 0.0. 0.5. 36.8. 63.7.2..RDT. 16.2. 0.3. 8.5. 25.0. 10.9. 0.0. 0.4. 11.3. 36.3.OUTLET'TYPE'TOTAL***' 30.8' 0.3' 20.8' 51.9' 47.3' 0.0' 0.9' 48.1' 100.0'

*. A.total.of.7,086.malaria.blood.tests.were.reportedly.administered.in.the.previous.7.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%[email protected].–.malaria.blood.testing.total.column...A.total.of.1,074.malaria.blood.tests.were.audited..Of.these,.48.audited.tests.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!

Table'B12:'Malaria'blood'testing'market'share,'within'outlet'type,'Kinshasa'

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:*'



[email protected]'

TOTAL'Public'/'NotCForCProfit'

[email protected].


BLOOD'TEST'TOTAL**'

%. %. %. %. %. %. %. %. %.Total'blood'testing'market'' . . . . . . . . .1..Malaria.microscopy. 47.4. 0.0. 58.9. 51.8. 76.9. 0.0. 54.1. 76.5. 63.7.2..RDT. 52.6. 100.0. 41.1. 48.2. 23.1. 0.0. 45.9. 23.5. 36.3.Malaria'RDT'market'' . . . . . . . . .

Manufacturer.!. . . . . . . . . .Standard.Diagnostics.Inc.. 100.0. 100.0. 100.0. 100.0. 93.9. 0.0. 100.0. 94.1. 98.2.Other.. 0.0. 0.0. 0.0. 0.0. 4.9. 0.0. 0.0. 4.8. 1.5.Unknown. 0.0. 0.0. 0.0. 0.0. 1.1. 0.0. 0.0. 1.1. 0.3.

[email protected].(QA.RDT).**. 100.0. 100.0. 100.0. 100.0. 93.9. 0.0. 100.0. 94.1. 98.2.

*. 7,086.malaria.blood.tests.reportedly.administered.in.the.previous.7.days:.1,615.public.health.facilities;.10.community.health.worker;.2,[email protected];.3,[email protected];.0.pharmacies;.101.drug.stores..

Categories.1.through.2.sum.to.100%.in.within.each.column...A.total.of.1,074.malaria.blood.tests.were.audited..Of.these,.48.audited.tests.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information..!. Manufacturer.was.not.captured.for.45.RDTs.audited...**. QA.RDT.status.could.not.be.determined.for.15.RDTs.because.of.missing.product.information..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!!

Table'B13:'Provider'case'management'knowledge'and'practices,'by'outlet'type,'Kinshasa'


[email protected]'


[email protected].


ALL'Outlets'

Proportion'of'providers'who:. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Would.recommend.that.a.client.with.a.negative.malaria.blood.test.take.an.antimalarial. N=195. N=63. N=261. N=170. N=44. N=344. N=558. N=819.

Yes.–.sometimes.52.2. 66.0. 59.7. 54.6. 41.6. 37.0. 42.7. 45.0.

(43.5,.60.7). (41.3,.84.2). (46.4,.71.8). (45.5,.63.4). (31.2,.52.9). (31.8,.42.6). (37.2,.48.4). (39.1,.51.0).

Yes.–.always..23.5. 13.5. 17.8. 20.9. 11.1. 11.8. 14.7. 15.1.

(14.1,.36.3). (6.8,.24.9). (11.3,.27.0). (14.2,.29.6). (5.1,.22.3). (7.7,.17.6). (10.8,.19.6). (11.3,.19.8).

Circumstances.cited.for.recommending.antimalarial.treatment.to.a.client.who.tested.negative.for.malaria:*. N=147. N=52. N=200. N=135. N=21. N=178. N=334. N=534.

Patient.has.signs.and.symptoms.of.malaria..86.7. 84.8. 86.3. 77.0. 89.0. 82.2. 80.2. 81.2.

(80.4,.91.3). (72.1,.92.3). (79.2,.91.3). (66.2,.85.2). (80.5,.94.1). (72.2,.89.1). (73.3,.85.6). (75.2,.86.1).

When.the.patient.has.visited.a.malaria.endemic.area.

21.3. 21.3. 20.5. 26.9. 8.2. 18.1. 21.6. 21.4.

(14.4,.30.4). (10.1,.39.4). (13.2,.30.3). (20.0,.35.0). (1.1,.41.5). (10.8,.28.8). (16.1,.28.2). (16.4,.27.4).

Provider.doesn't.trust.the.test.results.. 11.7. 5.6. 8.3. 10.8. 8.6. 7.6. 9.0. 8.8.(6.1,.21.5). (1.0,.25.3). (4.1,.15.9). (5.5,.20.1). (3.5,.19.4). (4.4,.12.8). (6.1,.12.9). (6.3,.12.3).

Other.(all.other.reasons). 6.9. 13.9. 10.0. 8.5. 1.9. 9.9. 9.1. 9.3.(2.3,.19.1). (6.1,.28.7). (4.6,.20.3). (3.7,.18.1). (0.2,.17.8). (4.2,.21.4). (5.1,.15.7). (5.7,.14.9).

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...Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!

Table'B14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'Kinshasa'


[email protected]'


[email protected].


ALL'Outlets'

. %.(95%.CI).

.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'providers'who:' N=209. N=66. N=275. N=177. N=61. N=565. N=803. N=1,078.Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria.!.

64.9. 40.2. 53.2. 46.6. 44.6. 14.0. 21.6. 24.9.(56.1,.72.8). (26.0,.56.3). (43.2,.62.8). (38.2,.55.2). (31.2,.58.9). (11.3,.17.1). (18.2,.25.5). (21.8,.28.2).

[email protected]:.. . . . . . . . .

An.adult. 21.4. 4.2. 12.2. 4.1. 3.4. 0.6. 1.4. 2.5.(15.3,.29.2). (1.2,.13.1). (8.3,.17.6). (1.8,.9.1). (1.1,.10.1). (0.1,.2.7). (0.7,.2.9). (1.6,.4.0).

A.two@[email protected]. 28.5. 3.3. 15.0. 8.6. 5.6. 1.1. 2.8. 4.0.(20.4,.38.3). (1.1,.9.6). (10.4,.21.2). (4.0,.17.5). (2.8,.10.8). (0.4,.2.9). (1.6,.4.9). (2.6,.6.2).

Report.an.ACT.as.the.most.effective.antimalarial.medicine.for:. . . . . . . . .

An.adult. 62.5. 37.3. 50.6. 36.4. 52.0. 16.0. 21.1. 24.2.(48.1,.74.9). (21.6,.56.4). (38.7,.62.5). (28.4,.45.3). (31.6,.71.7). (13.1,.19.5). (17.9,.24.8). (21.0,.27.7).

A.child' 68.9. 34.7. 52.8. 51.0. 58.7. 31.1. 35.9. 37.7.(58.3,.77.9). (20.5,.52.2). (42.3,.63.1). (43.5,.58.4). (35.8,.78.4). (25.8,.36.8). (30.9,.41.2). (33.3,.42.2).

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.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:.. 6.providers.were.missing.information.on.the.national.first@line.treatment,.21.providers.were.missing.information.on.the.first@line.dosing.regimen.for.adults.and.children,.and.10.providers.were.missing.information.on.the.most.effective.antimalarial.medicine.for.adults.and.children..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..

!


Results'Section'C:'Results'by'urban/rural'location,'Katanga'Province'!

Table'C1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:. Urban.N=95.Rural.N=171.

Urban.N=0.Rural.N=35.







Any.antimalarial.at.the.time.of.survey.visit.. . . . . . . .. . . . . . . .

Urban.96.1. @. 87.6. 93.7. 84.1. 99.2. 96.0. 95.7.

(89.5,.98.6). @. (58.9,.97.2). (82.6,.97.9). (72.6,.91.4). (98.0,.99.7). (93.1,.97.7). (93.3,.97.3).

Rural.98.3. 98.3. 89.7. 97.9. 66.4. 93.9. 87.5. 90.9.

(93.5,.99.6). (87.1,.99.8). (49.7,.98.7). (93.8,.99.3). (48.2,.80.7). (87.4,.97.2). (79.4,.92.6). (85.9,.94.2).Any.ACT. . . . . . . . .

Urban.83.9. @. 70.8. 80.3. 55.8. 89.7. 83.6. 83.3.

(69.3,.92.4). @. (44.5,.88.1). (66.6,.89.3). (38.8,.71.5). (82.5,.94.2). (73.2,.90.5). (73.4,.90.0).

Rural. 93.2. 89.6. 47.3. 89.9. 34.0. 60.3. 54.1. 65.9.(82.8,.97.5). (58.4,.98.1). (13.6,.83.7). (80.3,.95.1). (23.0,.47.0). (46.6,.72.5). (42.8,.65.1). (58.6,.72.4).

First.line.ACT.!. . . . . . . . .

Urban.83.5. @. 70.8. 80.0. 55.8. 89.1. 83.1. 82.8.

(69.0,.92.0). @. (44.5,.88.1). (66.5,.89.0). (38.8,.71.5). (82.9,.93.2). (73.4,.89.8). (73.6,.89.3).

Rural.93.2. 89.6. 47.3. 89.9. 34.0. 60.3. 54.1. 65.9.

(82.8,.97.5). (58.4,.98.1). (13.6,.83.7). (80.3,.95.1). (23.0,.47.0). (46.6,.72.5). (42.8,.65.1). (58.6,.72.4).Artemether.lumefantrine. . . . . . . . .

Urban.39.4. @. 27.7. 36.1. 29.6. 87.0. 77.0. 72.5.

(25.0,.55.9). @. (7.4,.64.7). (23.7,.50.8). (16.6,.47.0). (81.0,.91.3). (65.4,.85.5). (60.7,.81.9).

Rural.10.8. 0.0. 0.0. 7.0. 15.7. 43.7. 37.2. 27.3.

(6.6,.17.3). @. @. (3.7,.12.9). (8.3,.27.7). (30.5,.57.9). (26.4,.49.4). (18.5,.38.2).

Artesunate.amodiaquine. . . . . . . . .

Urban. 73.3. @. 51.0. 67.0. 41.6. 26.7. 27.9. 32.2.(60.2,.83.2). @. (26.4,.75.1). (54.6,.77.5). (26.7,.58.1). (21.3,.32.8). (23.8,.32.4). (27.5,.37.2).

Rural.92.6. 89.6. 47.3. 89.5. 27.6. 37.1. 34.9. 52.8.

(82.6,.97.1). (58.4,.98.1). (13.6,.83.7). (79.8,.94.9). (17.1,.41.2). (27.3,.48.2). (26.2,.44.7). (45.6,.59.9).. . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Artesunate.sulfadoxine.pyrimethamine. . . . . . . . .

Urban.4.1. @. 6.3. 4.8. 1.2. 23.9. 21.9. 20.0.

(1.7,.9.8). @. (0.9,.33.8). (2.0,.10.9). (0.2,.9.2). (10.9,.44.7). (9.0,.44.4). (8.4,.40.8).

Rural.0.5. 0.0. 0.0. 0.3. 0.0. 0.0. 0.0. 0.1.

(0.1,.2.3). @. @. (0.1,.1.6). @. @. @. (0.0,.0.5).DHA.PPQ.. . . . . . . . .

Urban'3.7. @. 0.0. 2.7. 5.0. 21.9. 19.1. 17.3.

(1.4,.9.4). @. @. (1.0,.6.9). (0.8,.25.7). (12.7,.35.0). (10.1,.33.0). (9.0,.30.6).

Rural.0.0. 0.0. 0.0. 0.0. 0.0. 1.4. 1.1. 0.7.@. @. @. @. @. (0.4,.4.5). (0.3,.3.4). (0.2,.2.4).

Dihydroartemisinin.sulfadoxine.pyrimethamine. . . . . . . . .

Urban'1.5. @. 15.0. 5.3. 4.2. 35.2. 30.5. 27.7.

(0.5,.5.0). @. (1.9,.62.2). (1.0,.24.7). (0.9,.17.0). (25.8,.45.8). (20.6,.42.5). (18.4,.39.5).

Rural. 0.0. 0.0. 0.0. 0.0. 0.6. 4.8. 3.8. 2.6.@. @. @. @. (0.1,.4.3). (2.0,.11.0). (1.6,.8.8). (1.0,.6.3).

Other.ACT.β. . . . . . . . .

Urban' 1.4. @. 4.8. 2.4. 0.6. 7.4. 7.8. 7.2.(0.3,.7.1). @. (0.6,.29.5). (0.6,.8.3). (0.1,.4.1). (2.6,.19.4). (2.4,.22.3). (2.3,.20.3).

Rural. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.

[email protected].(QA.ACT)' . . . . . . . .

Urban.76.0. @. 62.1. 72.1. 46.5. 53.6. 52.8. 54.9.

(62.4,.85.7). @. (39.2,.80.7). (60.1,.81.6). (31.8,.61.7). (47.8,.59.3). (47.7,.57.8). (50.4,.59.3).

Rural' 92.3. 89.6. 47.3. 89.3. 29.0. 48.2. 43.7. 58.7.(82.4,.96.9). (58.4,.98.1). (13.6,.83.7). (79.6,.94.7). (18.5,.42.5). (37.2,.59.3). (34.3,.53.6). (52.0,.65.0).

. . . . . . . . .

. . . . . . . . .

. . . . . . . . .

. . . . . . . . .

. . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









QA.artesunate.amodiaquine. . . . . . . . .

Urban.72.7. @. 51.0. 66.6. 40.8. 15.5. 19.2. 24.3.

(59.7,.82.7). @. (26.4,.75.1). (53.8,.77.4). (26.4,.57.0). (10.8,.21.7). (13.1,.27.1). (17.5,.32.8).

Rural.92.3. 89.6. 47.3. 89.3. 27.6. 36.0. 34.0. 52.2.

(82.4,.96.9). (58.4,.98.1). (13.6,.83.7). (79.6,.94.7). (17.1,.41.2). (26.2,.47.1). (25.5,.43.7). (45.0,.59.3).QA.artemether.lumefantrine. . . . . . . . .

Urban.6.9. @. 19.0. 10.3. 11.0. 48.1. 42.4. 38.9.

(2.9,.15.7). @. (5.9,.46.7). (5.6,.18.2). (4.4,.25.2). (42.3,.54.0). (35.1,.50.0). (32.1,.46.1).

Rural.4.2. 0.0. 0.0. 2.7. 4.4. 24.1. 19.5. 14.0.

(2.1,.8.1). @. @. (1.2,.5.8). (1.5,.12.4). (16.0,.34.6). (13.0,.28.1). (8.8,.21.4)[email protected].([email protected])' . . . . . . . .

Urban.38.8. @. 32.5. 37.1. 29.0. 85.0. 75.3. 71.1.

(23.9,.56.3). @. (9.2,.69.7). (22.9,.53.8). (16.2,.46.3). (75.5,.91.3). (61.3,.85.4). (57.2,.82.0).

Rural. 8.7. 4.0. 0.0. 6.8. 11.3. 35.9. 30.1. 22.5.(5.2,.14.2). (1.5,.10.0). @. (4.3,.10.6). (5.3,.22.6). (24.6,.48.9). (20.8,.41.4). (15.3,.31.7).

Nationally.registered.ACT' . . . . . . . .

Urban.78.6. @. 70.8. 76.4. 53.1. 78.7. 74.6. 74.8.

(64.5,.88.1). @. (44.5,.88.1). (64.1,.85.5). (35.5,.69.9). (69.6,.85.6). (63.3,.83.4). (64.6,.82.9).

Rural. 92.6. 89.6. 47.3. 89.5. 31.5. 52.3. 47.4. 61.2.(82.6,.97.1). (58.4,.98.1). (13.6,.83.7). (79.8,.94.9). (20.2,.45.6). (41.0,.63.3). (37.5,.57.5). (54.5,.67.6).

[email protected]. . . . . . . . .

Urban' 87.2. @. 87.6. 87.3. 81.1. 96.6. 93.4. 92.7.(77.3,.93.1). @. (58.9,.97.2). (75.9,.93.7). (70.5,.88.5). (94.5,.97.9). (90.4,.95.5). (90.2,.94.6).

Rural'80.2. 8.6. 89.7. 58.9. 56.2. 90.4. 82.4. 74.7.

(71.6,.86.7). (1.5,.37.3). (49.7,.98.7). (36.3,.78.3). (40.6,.70.6). (83.9,.94.5). (74.6,.88.2). (62.4,.84.0).Sulfadoxine.pyrimethamine' . . . . . . . .

Urban' 41.5. @. 49.4. 43.7. 29.1. 67.2. 59.6. 57.9.(30.9,.53.0). @. (27.4,.71.7). (34.7,.53.3). (20.8,.39.1). (59.1,.74.4). (53.7,.65.2). (52.7,.63.0).

Rural'45.3. 5.4. 18.8. 31.9. 23.6. 55.6. 48.1. 42.8.

(34.2,.56.9). (0.6,.36.9). (2.5,.67.4). (19.2,.48.0). (13.1,.38.7). (44.9,.65.7). (39.2,.57.1). (33.8,.52.3).' . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Oral.quinine' . . . . . . . .

Urban'72.7. @. 47.0. 65.5. 54.8. 92.5. 85.6. 83.4.

(57.4,.84.1). @. (17.2,.79.2). (48.2,.79.5). (42.5,.66.5). (89.8,.94.6). (81.1,.89.2). (78.5,.87.4).

Rural.61.4. 3.2. 54.4. 43.4. 31.2. 78.9. 67.7. 59.7.

(50.8,.71.1). (0.4,.22.1). (19.6,.85.3). (27.1,.61.2). (17.3,.49.6). (70.0,.85.7). (57.8,.76.2). (48.7,.69.8)[email protected].^' . . . . . . . .

Urban'0.0. @. 0.0. 0.0. 0.0. 1.0. 0.8. 0.7.@. @. @. @. @. (0.2,.5.4). (0.1,.4.0). (0.1,.3.7).

Rural'0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.5. 0.3.@. @. @. @. @. (0.2,.2.7). (0.1,.2.0). (0.1,.1.3).

Oral.artemisinin.monotherapy. . . . . . . . .

Urban.1.0. @. 0.0. 0.7. 0.0. 0.0. 0.0. 0.1.

(0.1,.7.4). @. @. (0.1,.5.6). @. @. @. (0.0,.0.6).

Rural. 0.0. 0.0. 0.0. 0.0. 0.0. 0.3. 0.2. 0.2.@. @. @. @. @. (0.0,.2.1). (0.0,.1.6). (0.0,.1.1).


Urban.52.1. @. 24.6. 44.4. 35.7. 64.7. 59.5. 57.8.

(34.3,.69.3). @. (6.9,.58.8). (30.6,.59.0). (21.0,.53.7). (53.5,.74.5). (47.0,.70.8). (45.5,.69.3).

Rural. 20.6. 18.4. 36.5. 20.7. 14.9. 34.6. 30.0. 26.9.(13.0,.31.1). (9.9,.31.4). (9.0,.77.1). (14.6,.28.5). (9.4,.22.7). (25.5,.45.0). (22.6,.38.6). (21.3,.33.4).

Any.treatment.for.severe.malaria. . . . . . . . .

Urban. 83.4. @. 82.8. 83.2. 61.4. 72.5. 71.4. 72.6.(69.7,.91.7). @. (57.3,.94.5). (71.9,.90.6). (46.5,.74.4). (63.4,.80.1). (60.7,.80.1). (63.0,.80.6).

Rural.62.5. 18.4. 89.7. 50.3. 49.5. 57.1. 55.3. 53.7.

(52.1,.71.8). (9.9,.31.4). (49.7,.98.7). (36.5,.64.2). (33.9,.65.2). (49.2,.64.7). (48.3,.62.2). (45.9,.61.3).Artesunate.IV/IM.#. . . . . . . . .

Urban. 23.9. @. 18.2. 22.3. 11.9. 8.1. 8.4. 9.9.(13.3,.39.3). @. (6.6,.41.3). (13.4,.34.9). (4.1,.30.2). (6.2,.10.7). (6.2,.11.3). (7.4,.13.2).

Rural.12.2. 0.0. 0.0. 7.9. 0.0. 1.7. 1.3. 3.5.

(6.4,.22.2). @. @. (3.7,.16.3). @. (0.4,.7.2). (0.3,.5.6). (1.8,.6.6).. . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Artemether.IV/IM. . . . . . . . .

Urban.6.8. @. 0.0. 4.9. 2.3. 11.0. 8.9. 8.5.

(2.6,.16.6). @. @. (1.9,.11.9). (0.4,.11.1). (8.0,.14.9). (6.6,.11.9). (6.1,.11.6).

Rural.1.1. 0.0. 17.7. 1.6. 8.3. 23.8. 20.2. 14.1.

(0.4,.3.5). @. (2.4,.65.7). (0.5,.5.2). (3.6,.18.0). (15.1,.35.6). (13.1,.29.7). (8.9,.21.7).Arteether.IV/IM. . . . . . . . .

.37.0. @. 19.8. 32.2. 30.1. 62.7. 57.0. 54.3.

(21.1,.56.5). @. (4.2,.58.3). (19.4,.48.4). (18.0,.45.7). (51.6,.72.6). (44.9,.68.2). (42.0,.66.0).

.2.1. 0.0. 18.8. 2.3. 5.9. 14.9. 12.8. 9.3.

(0.7,.5.8). @. (2.5,.67.4). (0.8,.6.3). (2.4,.13.9). (9.0,.23.6). (8.0,.19.7). (5.7,.14.8).Quinine.IV/IM' . . . . . . . .

Urban.64.5. @. 74.1. 67.2. 50.7. 26.8. 32.2. 36.0.

(45.2,.80.0). @. (50.3,.89.0). (51.9,.79.5). (37.8,.63.4). (20.5,.34.3). (27.2,.37.7). (30.6,.41.8).

Rural. 53.7. 0.0. 70.9. 38.2. 44.7. 46.6. 46.2. 43.5.(44.0,.63.1). @. (28.9,.93.6). (23.5,.55.3). (29.3,.61.1). (38.9,.54.6). (39.8,.52.7). (35.6,.51.9).

*. The.denominator.includes.5.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..β. Other.types.of.ACT.include.artemisinin.piperaquine,.artesunate.mefloquine,.and.dihydroartemisinin.piperaquine.trimethoprim..^. [email protected],.atovaquone@proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015..!! !


!

Table'C2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Any.ACT. . . . . . . . .

Urban.87.3. @. 80.9. 85.6. 66.3. 90.4. 87.2. 87.0.

(70.1,.95.3). @. (51.0,.94.5). (71.6,.93.4). (50.7,.79.1). (83.4,.94.7). (77.3,.93.1). (77.8,.92.8).

Rural.94.8. 91.2. 52.7. 91.8. 51.2. 64.2. 61.9. 72.5.

(83.0,.98.5). (61.6,.98.5). (15.1,.87.4). (82.4,.96.4). (37.2,.65.0). (51.8,.74.9). (51.8,.71.0). (66.4,.77.8).First.line.ACT.!. . . . . . . . .

Urban.86.9. @. 80.9. 85.3. 66.3. 89.8. 86.6. 86.5.

(69.9,.95.0). @. (51.0,.94.5). (71.5,.93.1). (50.7,.79.1). (83.8,.93.7). (77.6,.92.4). (78.0,.92.0).

Rural.94.8. 91.2. 52.7. 91.8. 51.2. 64.2. 61.9. 72.5.


Urban.41.0. @. 31.6. 38.6. 35.2. 87.7. 80.2. 75.8.

(26.1,.57.8). @. (8.8,.68.8). (25.8,.53.1). (20.7,.53.0). (81.9,.91.9). (69.0,.88.1). (64.1,.84.6).

Rural.11.0. 0.0. 0.0. 7.2. 23.7. 46.6. 42.5. 30.0.

(6.7,.17.6). @. @. (3.8,.13.2). (12.3,.40.7). (33.5,.60.1). (31.4,.54.4). (20.7,.41.3).


Urban. 76.2. @. 58.2. 71.5. 49.4. 26.9. 29.1. 33.6.(61.8,.86.4). @. (27.8,.83.4). (57.7,.82.2). (34.0,.64.9). (21.5,.33.1). (24.9,.33.7). (28.7,.39.0).

Rural.94.2. 91.2. 52.7. 91.5. 41.6. 39.5. 39.9. 58.1.

(83.2,.98.2). (61.6,.98.5). (15.1,.87.4). (82.0,.96.2). (28.9,.55.5). (29.8,.50.1). (31.3,.49.2). (50.8,.65.1).Artesunate.sulfadoxine.pyrimethamine. . . . . . . . .

Urban.

4.3. @. 7.2. 5.1. 1.5. 24.1. 22.8. 20.9.

(1.7,.10.5). @. (1.1,.36.3). (2.1,.11.7). (0.2,.10.6). (11.0,.44.9). (9.4,.45.9)..

(8.8,.42.2)..





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









.

Rural.0.5. 0.0. 0.0. 0.4. 0.0. 0.0. 0.0. 0.1.

(0.1,.2.3). @. @. (0.1,.1.6). @. @. @. (0.0,.0.5).DHA.PPQ.. . . . . . . . .

Urban' 3.9. @. 0.0. 2.9. 5.9. 22.0. 19.9. 18.1.(1.5,.9.7). @. @. (1.1,.7.3). (0.9,.29.1). (12.9,.35.1). (10.6,.34.1). (9.5,.31.7).

Rural.0.0. 0.0. 0.0. 0.0. 0.0. 1.5. 1.3. 0.8.@. @. @. @. @. (0.5,.4.7). (0.4,.3.9). (0.2,.2.6).

Dihydroartemisinin.sulfadoxine.pyrimethamine. . . . . . . . .

Urban' 1.6. @. 17.2. 5.7. 5.0. 35.4. 31.8. 29.0.(0.5,.5.3). @. (2.2,.65.8). (1.0,.25.9). (1.1,.19.9). (26.1,.46.0). (21.7,.43.9). (19.5,.40.8).

Rural. 0.0. 0.0. 0.0. 0.0. 0.9. 5.1. 4.4. 2.8.@. @. @. @. (0.1,.6.4). (2.2,.11.5). (1.9,.9.8). (1.1,.6.8).

Other.ACT. . . . . . . . .

Urban' 1.5. @. 5.5. 2.5. 0.7. 7.5. 8.1. 7.5.(0.3,.7.5). @. (0.7,.32.2). (0.7,.8.9). (0.1,.4.8). (2.6,.19.5). (2.5,.23.1). (2.4,.21.0).

Rural. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.


Urban. 79.0. @. 70.9. 76.9. 55.2. 54.0. 55.0. 57.3.(64.0,.88.9). @. (43.6,.88.5). (64.0,.86.2). (41.2,.68.5). (48.0,.59.9). (50.0,.60.0). (52.8,.61.8).

Rural'93.9. 91.2. 52.7. 91.3. 43.7. 51.3. 49.9. 64.5.

(83.1,.98.0). (61.6,.98.5). (15.1,.87.4). (81.8,.96.1). (31.2,.57.1). (41.1,.61.3). (41.2,.58.7). (58.4,.70.2).QA.ACT.artesunate.amodiaquine. . . . . . . . .

Urban. 75.6. @. 58.2. 71.1. 48.6. 15.6. 20.0. 25.4.(61.3,.85.9). @. (27.8,.83.4). (56.7,.82.2). (33.7,.63.7). (10.8,.22.0). (13.6,.28.3). (18.1,.34.4).

Rural.93.9. 91.2. 52.7. 91.3. 41.6. 38.3. 38.9. 57.4.

(83.1,.98.0). (61.6,.98.5). (15.1,.87.4). (81.8,.96.1). (28.9,.55.5). (28.6,.49.0). (30.3,.48.2). (50.0,.64.5).QA.ACT.artemether.lumefantrine. . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Urban.7.2. @. 21.7. 11.0. 13.1. 48.5. 44.1. 40.6.

(3.0,.16.2). @. (7.1,.50.1). (6.1,.19.0). (5.3,.29.0). (42.6,.54.4). (36.7,.51.8). (33.7,.47.9).

Rural. 4.2. 0.0. 0.0. 2.7. 6.6. 25.6. 22.2. 15.4.(2.1,.8.2). @. @. (1.3,.5.9). (2.1,.18.7). (17.4,.36.0). (15.3,.31.1). (9.8,.23.2).

[email protected].([email protected])' . . . . . . . .

Urban. 40.4. @. 37.1. 39.6. 34.5. 85.7. 78.5. 74.3.(24.7,.58.3). @. (10.9,.74.0). (24.9,.56.4). (20.2,.52.2). (76.2,.91.8). (64.4,.88.1). (60.3,.84.7).

Rural. 8.8. 4.1. 0.0. 7.0. 17.1. 38.2. 34.4. 24.7.(5.3,.14.4). (1.6,.9.9). @. (4.4,.10.8). (8.0,.32.9). (27.0,.50.8). (24.7,.45.7). (17.1,.34.3).


Urban. 81.7. @. 80.9. 81.5. 63.1. 79.3. 77.8. 78.2.(65.7,.91.3). @. (51.0,.94.5). (68.7,.89.9). (46.4,.77.2). (70.3,.86.2). (66.6,.86.0). (68.4,.85.6).

Rural.94.2. 91.2. 52.7. 91.5. 47.5. 55.6. 54.2. 67.4.

(83.2,.98.2). (61.6,.98.5). (15.1,.87.4). (82.0,.96.2). (34.3,.61.1). (45.5,.65.4). (45.4,.62.7). (61.5,.72.7)[email protected]. . . . . . . . .

Urban' 90.7. @. 100.0. 93.1. 96.4. 97.3. 97.3. 96.9.(83.5,.95.0). @. @. (88.0,.96.1). (88.4,.99.0). (95.1,.98.6). (95.6,.98.4). (95.5,.97.8).

Rural' 81.6. 8.8. 100.0. 60.2. 84.6. 96.3. 94.2. 82.2.(73.1,.87.9). (1.5,.38.4). @. (36.5,.79.8). (70.1,.92.8). (91.5,.98.4). (89.8,.96.8). (68.3,.90.8).

Sulfadoxine.pyrimethamine' . . . . . . . .

Urban'43.2. @. 56.4. 46.7. 34.6. 67.7. 62.1. 60.5.

(32.0,.55.1). @. (34.1,.76.4). (37.6,.56.0). (25.2,.45.3). (59.2,.75.2). (56.1,.67.8). (54.8,.65.9).

Rural' 46.1. 5.5. 21.0. 32.6. 35.6. 59.2. 55.0. 47.1.(34.8,.57.7). (0.6,.37.6). (2.8,.71.2). (19.5,.49.1). (19.8,.55.2). (48.5,.69.1). (45.5,.64.1). (37.1,.57.3).

Oral.quinine' . . . . . . . .

Urban' 75.6. @. 53.7. 69.9. 65.1. 93.3. 89.2. 87.2.(59.7,.86.7). @. (21.4,.83.1). (53.4,.82.5). (54.0,.74.7). (90.2,.95.4). (85.8,.91.9). (83.2,.90.3).

Rural. 62.5. 3.3. 60.6. 44.3. 47.0. 84.0. 77.4. 65.7.(51.7,.72.2). (0.4,.23.1). (22.1,.89.3). (27.5,.62.6). (26.4,.68.6). (77.2,.89.1). (68.7,.84.2). (54.2,.75.6).

[email protected].^' . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Urban'0.0. @. 0.0. 0.0. 0.0. 1.0. 0.8. 0.7.@. @. @. @. @. (0.2,.5.4). (0.1,.4.2). (0.1,.3.8).

Rural' 0.0. 0.0. 0.0. 0.0. 0.0. 0.7. 0.6. 0.4.@. @. @. @. @. (0.2,.2.9). (0.1,.2.3). (0.1,.1.5).


Urban' 1.1. @. 0.0. 0.8. 0.0. 0.0. 0.0. 0.1.(0.1,.8.0). @. @. (0.1,.6.0). @. @. @. (0.0,.0.7).

Rural' 0.0. 0.0. 0.0. 0.0. 0.0. 0.3. 0.3. 0.2.@. @. @. @. @. (0.1,.2.3). (0.0,.1.9). (0.0,.1.2).


Urban' 54.2. @. 28.0. 47.3. 42.5. 65.2. 62.0. 60.4.(35.8,.71.5). @. (7.6,.64.8). (32.8,.62.4). (26.5,.60.1). (54.1,.74.9). (49.4,.73.1). (48.0,.71.7).

Rural'21.0. 18.7. 40.7. 21.1. 22.4. 36.9. 34.3. 29.7.

(13.2,.31.6). (10.3,.31.6). (9.6,.81.6). (15.0,.29.0). (14.8,.32.4). (27.4,.47.5). (26.1,.43.6). (23.5,.36.7).Any.treatment.for.severe.malaria. . . . . . . . .

Urban. 86.8. @. 94.5. 88.8. 73.0. 73.1. 74.4. 75.9.(75.6,.93.3). @. (67.8,.99.3). (80.7,.93.8). (57.8,.84.2). (64.0,.80.6). (63.5,.82.9). (66.2,.83.5).

Rural. 63.6. 18.7. 100.0. 51.4. 74.6. 60.8. 63.3. 59.1.(53.3,.72.7). (10.3,.31.6). @. (37.1,.65.5). (58.4,.86.0). (52.7,.68.4). (55.9,.70.1). (50.7,.67.0).

Artesunate.IV/IM.#. . . . . . . . .

Urban.24.9. @. 20.8. 23.8. 14.2. 8.2. 8.7. 10.4.

(13.9,.40.5). @. (7.1,.47.4). (14.0,.37.5). (5.0,.34.4). (6.2,.10.7). (6.5,.11.7). (7.8,.13.6).

Rural. 12.4. 0.0. 0.0. 8.1. 0.0. 1.8. 1.5. 3.8.(6.5,.22.5). @. @. (3.7,.16.6). @. (0.4,.7.6). (0.3,.6.3). (2.0,.7.3).


Urban. 7.1. @. 0.0. 5.2. 2.7. 11.1. 9.3. 8.8.(2.7,.17.3). @. @. (2.1,.12.7). (0.5,.12.9). (8.1,.15.0). (7.0,.12.3). (6.5,.12.0).

Rural. 1.2. 0.0. 19.7. 1.6. 12.5. 25.4. 23.1. 15.5.(0.4,.3.6). @. (2.6,.69.6). (0.5,.5.3). (5.2,.27.1). (16.1,.37.6). (15.1,.33.7). (9.8,.23.7).

Arteether.IV/IM. . . . . . . . .





[email protected]'


[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'









Urban.38.5. @. 22.6. 34.4. 35.7. 63.2. 59.4. 56.7.

(21.8,.58.5). @. (4.5,.64.1). (20.6,.51.4). (22.6,.51.5). (52.2,.73.0). (47.2,.70.5). (44.3,.68.3).

Rural. 2.1. 0.0. 21.0. 2.3. 8.9. 15.8. 14.6. 10.3.(0.8,.5.9). @. (2.8,.71.2). (0.8,.6.5). (3.9,.19.1). (9.6,.24.9). (9.3,.22.1). (6.4,.16.1).

Quinine.IV/IM' . . . . . . . .

Urban.67.1. @. 84.6. 71.7. 60.2. 27.1. 33.6. 37.6.

(47.8,.82.0). @. (54.9,.96.1). (57.1,.82.8). (44.9,.73.8). (20.6,.34.7). (28.2,.39.4). (31.7,.43.9).

Rural.54.6. 0.0. 79.0. 39.0. 67.3. 49.6. 52.8. 47.9.

(44.9,.64.0). @. (28.8,.97.2). (23.9,.56.6). (49.8,.81.1). (41.4,.57.9). (45.5,.60.0). (39.2,.56.7).

*. The.denominator.includes.3.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..β. Other.types.of.ACT.include.artemisinin.piperaquine.and.artesunate.mefloquine..^. [email protected],.atovaquone@proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015..!! !


!

Table'C4:'Antimalarial'market'composition,'across'urban/rural'location,'Katanga'




[email protected]'


[email protected].


%.(95%.CI).

%.(95%.CI)'

%.(95%.CI)'

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).


. . . . . . . .

Urban,.N=.458.outlets.8.4. 0.0. 2.8. 11.2. 14.0. 2.2. 72.6. 88.8.

(5.1,.13.4). @. (1.5,.5.4). (7.3,.16.8). (9.7,.19.7). (0.4,.10.8). (66.9,.77.7). (83.2,.92.7).

Rural,.N=.385.outlets'25.1. 10.5. 1.5. 37.1. 11.2. 0.0. 51.7. 62.9.

(19.3,.32.0). (4.3,.23.3). (0.6,.3.5). (28.6,.46.6). (7.0,.17.4). @. (42.7,.60.6). (53.4,.71.4).*....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..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..! !


!

Table'C5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'urban/rural'location,'Katanga''

'Private.

[email protected].





Any.ACT. . . .

Urban' $1.10. $3.84. $3.84.[[email protected]].(137). [[email protected]].(1,225). [[email protected]].(1,390).

Rural' $0.55. $1.75. $1.64.[[email protected]].(61). [[email protected]].(380). [[email protected]].(441).

[email protected].!. . . .

Urban.$1.10. $3.84. $3.29.

[[email protected]].(131). [[email protected]].(958). [[email protected]].(1,104).

Rural.$0.55. $1.64. $1.64.

[[email protected]].(59). [[email protected]].(369). [[email protected]].(428).Artesunate.amodiaquine' . . .

Urban'$0.00. $2.19. $1.64.



Artemether.lumefantrine.' . . .

Urban'$2.19. $4.38. $4.06.



[email protected].(QA.ACT)' . . .

Urban' $0.00. $1.64. $1.64.[[email protected]].(97). [[email protected]].(288). [[email protected]].(390).


QA.artesunate.amodiaquine. . . .

Urban'$0.00. $1.64. $1.10.


Rural'$0.00. $1.10. $1.10.

[[email protected]].(43). [[email protected]].(165). [[email protected]].(208).' . . .


Table'C5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'urban/rural'location,'Katanga''

'Private.

[email protected].





QA.artemether.lumefantrine. . . .

Urban'$1.75. $1.64. $1.64.


Rural'$1.64. $2.19. $2.19.

[[email protected]].(4). [[email protected]].(90). [[email protected]].(90)[email protected].([email protected]). . . .

Urban'$3.33. $4.38. $4.38.



Sulfadoxine.pyrimethamine. . . .

Urban'$0.55. $0.55. $0.55.



Oral.quinine. . . .

Urban. $5.52. $5.52. $5.52.[[email protected]].(55). [[email protected]].(569). [[email protected]].(569).

Rural. $4.60. $4.60. $4.60.[[email protected]].(36). [[email protected]].(252). [[email protected]].(252).


!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artemether.lumefantrine.and.artesunate.amodiaquine.were.the.first@line.treatments.for.uncomplicated.malaria..Figures.in.this.table.are.derived.using.audited.products.with.price.information..The.numbers.of.tablet.antimalarials.captured.in.audit.sheets.with.missing.price.and/.or.product.information.are.as.follows:.

57.any.ACT,.5.artesunate.amodiaquine,.40.artemether.lumefantrine,.3.QA.artesunate.amodiaquine,.11.QA.artemether.lumefantrine,[email protected],.9.sulfadoxine.pyrimethamine,.22.oral.quinine..

Source:.ACTwatch.Outlet.Survey,.DRC,.2015...!! !


!

Table'C5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'across'urban/rural'location,'Katanga''

'Private.

[email protected].





[email protected]@assured.ACT.(QA.ACT).!. . . .

Urban.$0.00. $1.64. $1.64.


Rural.$0.00. $1.10. $0.99.


Adult.Quality@assured.(QA).artesunate.amodiaquine.' . . .

Urban'$0.00. $1.10. $1.10.


Rural'$0.00. $0.55. $0.55.


Adult.Quality@assured.(QA).artemether.lumefantrine. . . .

Urban'$1.64. $1.64. $1.64.


Rural'$1.64. $1.64. $1.64.


[email protected]@assured.ACT.(QA.ACT).!' . . .

Urban'$0.00. $0.77. $0.55.


Rural'$0.00. $0.55. $0.55.


Adult.Quality@assured.(QA).artesunate.amodiaquine.' . . .

Urban'$0.00. $0.55. $0.55.


Rural'$0.00. $0.55. $0.44.



Table'C5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'across'urban/rural'location,'Katanga''

'Private.

[email protected].


Adult.Quality@assured.(QA).artemether.lumefantrine' . . .

Urban'$1.10. $1.10. $1.10.


Rural'@. $0.99. $0.99.@. [[email protected]].(15). [[email protected]].(15).


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:.7.adult.QA.artemether.lumefantrine..


!!!! !


!

Table'C6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected].


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking. Urban.N=91.Rural.N=170.








Any.malaria.blood.testing. . . . . . . . .

Urban. 89.2. @. 100.0. 92.1. 78.0. 13.5. 23.5. 30.9.(72.4,.96.3). @. @. (79.0,.97.3). (62.2,.88.4). (8.1,.21.6). (16.1,.33.0). (22.2,.41.1).

Rural. 86.3. 89.6. 100.0. 87.9. 45.5. 7.5. 16.2. 40.0.(78.0,.91.9). (58.4,.98.1). @. (78.4,.93.6). (33.6,.57.9). (3.3,.16.2). (10.9,.23.5). (32.2,.48.4).

. Urban.N=91.Rural.N=170.








Malaria.microscopy. . . . . . . . .

Urban. 58.1. @. 72.2. 61.8. 46.7. 2.1. 9.4. 14.9.(44.8,.70.3). @. (41.2,.90.6). (51.2,.71.3). (31.8,.62.3). (0.8,.5.2). (6.4,.13.5). (10.9,.20.2).

Rural. 22.7. 3.1. 39.6. 17.4. 12.8. 0.0. 2.9. 7.7.(15.7,.31.8). (1.2,.7.7). (9.1,.81.1). (11.5,.25.6). (5.8,.25.7). @. (1.4,.6.2). (5.6,.10.6).









Rapid.diagnostic.tests.(RDTs). . . . . . . . .

Urban. 75.2. @. 77.8. 75.9. 61.1. 12.9. 20.2. 26.2.(54.4,.88.5). @. (38.6,.95.1). (56.9,.88.2). (46.1,.74.2). (7.5,.21.2). (12.7,.30.6). (17.3,.37.7).

Rural. 85.6. 86.5. 100.0. 86.5. 39.0. 7.5. 14.7. 38.5.(76.6,.91.5). (64.2,.95.8). @. (78.1,.92.0). (27.7,.51.6). (3.3,.16.2). (9.5,.22.1). (31.0,.46.6).









[email protected].(QARDTs)***.

. . . . . . . .

Urban. 75.2. @. 72.7. 74.5. 59.4. 11.7. 19.0. 25.0.(54.4,.88.5). @. (39.2,.91.7). (56.2,.86.9). (44.4,.72.8). (7.0,.19.0). (12.0,.28.8). (16.5,.35.9).

Rural. 84.5. 84.6. 100.0. 85.2. 35.4. 7.5. 13.9. 37.5.(75.6,.90.5). (62.0,.94.9). @. (76.8,.90.9). (26.8,.45.0). (3.3,.16.2). (9.3,.20.3). (30.1,.45.6).

*. 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..Six.antimalarial@stocking.outlets.were.missing.information.about.both.availability.of.microscopy.and.

availability.of.RDTs..Seven.antimalarial@stocking.outlets.had.partial.information.about.blood.testing.availability.and.are.included.in.the.denominator.of.the.indicator.“any.blood.testing.available.”.***.QA.RDT.status.could.not.be.determined.for.6.RDTs.in.urban.locations.and.3.RDTs.in.rural.locations.because.of.missing.product.information...Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'C8:'Price'of'malaria'blood'testing,'by'outlet'type,'across'urban/rural'location,'Katanga'.

'Private.

[email protected].





Malaria.microscopy. . . .

Adult. . . .


Rural. $0.55. @. $0.55.[[email protected]].(14). @. [[email protected]].(14).

Child.under.five.years. . . .


Rural. $0.55. @. $0.55.[[email protected]].(14). @. [[email protected]].(14).

Rapid.diagnostic.tests.(RDTs). . . .Adult. . . .



Child.under.five.years. . . .



*. 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:.

22.adult.RDTs,.22.child.RDTs,.2.adult.microscopy.tests,.2.child.microscopy.tests..



Table'C9.1:'Antimalarial'market'share,'within'urban'location,'Katanga'



[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 3.0. 1.1. 4.1. 5.8. 2.1. 38.7. 46.6. 50.7.

[email protected].!. 3.0. 1.0. 4.0. 5.3. 1.2. 30.2. 36.6. 40.6.Artesunate.amodiaquine. 2.1. 0.6. 2.7. 1.3. 0.0. 2.8. 4.1. 6.9.Artemether.lumefantrine. 0.9. 0.4. 1.2. 4.0. 1.2. 27.3. 32.5. 33.7.

Artesunate.sulfadoxine.pyrimethamine. 0.0. 0.0. 0.0. 0.0. 0.5. 3.1. 3.6. 3.6.Dihydroartemisinin.piperaquine. 0.0. 0.0. 0.0. 0.5. 0.2. 0.6. 1.3. 1.3.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0. 0.1. 0.1. 0.0. 0.2. 4.4. 4.6. [email protected].(QA.ACT). 2.2. 0.9. 3.1. 2.3. 0.6. 8.3. 11.2. 14.2.QA.artesunate.amodiaquine. 2.1. 0.6. 2.7. 1.3. 0.0. 1.8. 3.1. 5.8.QA.artemether.lumefantrine. 0.1. 0.3. 0.4. 1.0. 0.6. 6.5. 8.0. 8.4.

[email protected].([email protected]). 0.8. 0.2. 1.0. 3.6. 1.6. 30.4. 35.5. 36.5.Nationally.registered.ACT. 2.2. 1.0. 3.2. 3.6. 1.5. 22.0. 27.1. 30.3.

2.'Any'nonCartemisinin'therapy. 1.7. 4.1. 5.8. 4.5. 1.1. 33.0. 38.6. 44.5.Sulfadoxine.pyrimethamine. 1.1. 2.6. 3.7. 2.8. 0.5. 19.8. 23.1. 26.8.Oral.quinine. 0.4. 1.3. 1.8. 1.5. 0.6. 12.5. 14.6. 16.3.Quinine.IV/IM. 0.3. 0.1. 0.4. 0.2. 0.0. 0.6. 0.8. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.4.'NonCoral'artemisinin'monotherapy' 0.1. 0.0. 0.1. 0.4. 0.1. 4.3. 4.8. 4.8.

Artesunate.IV/IM.#. 0.0. 0.0. 0.0. 0.1. 0.0. 0.0. 0.1. 0.1.Artemether.IV/IM.. 0.0. 0.0. 0.0. 0.0. 0.0. 0.7. 0.7. 0.7.Arteether/Artemotil.IV/IM. 0.1. 0.0. 0.1. 0.3. 0.1. 3.3. 3.7. 3.8.

Any.severe.malaria.treatment. 0.3. 0.1. 0.4. 0.6. 0.2. 4.7. 5.5. 6.0.OUTLET'TYPE'TOTAL***' 4.8' 5.1' 10.0' 10.7' 3.3' 76.0' 90.0' 100.0'

*. A.total.of.10,835.0.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine,.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...A.total.of.5,003.antimalarials.(in.the.census.sample).were.audited..Of.these,.855.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.'Source:.ACTwatch.Outlet.Survey,.DRC,.2015.'


Table'C9.2:'Antimalarial'market'share,'within'rural'location,'Katanga'




[email protected]'


Profit'

[email protected].

Drug.Store. TOTAL'Private.


%. %. %. %. %. %. %. %.1.'Any'ACT' 25.0. 1.1. 0.8. 26.9. 4.4. 21.1. 25.5. 52.4.



[email protected].([email protected]). 0.7. 0.0. 0.0. 0.7. 0.3. 4.9. 5.2. 5.9.Nationally.registered.ACT. 24.4. 1.1. 0.8. 26.3. 4.1. 16.7. 20.8. 47.1.

2.'Any'nonCartemisinin'therapy. 14.2. 0.0. 0.1. 14.4. 6.6. 25.0. 31.6. 46.0.Sulfadoxine.pyrimethamine. 11.2. 0.0. 0.0. 11.2. 5.7. 18.9. 24.6. 35.8.Oral.quinine. 2.5. 0.0. 0.1. 2.6. 0.7. 5.4. 6.2. 8.8.Quinine.IV/IM. 0.5. 0.0. 0.0. 0.5. 0.2. 0.5. 0.8. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1. 0.1.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.4.'NonCoral'artemisinin'monotherapy' 0.1. 0.0. 0.1. 0.2. 0.3. 1.0. 1.4. 1.6.

Artesunate.IV/IM.#. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artemether.IV/IM.. 0.0. 0.0. 0.1. 0.1. 0.3. 0.6. 0.8. 1.0.Arteether/Artemotil.IV/IM. 0.0. 0.0. 0.0. 0.0. 0.1. 0.4. 0.5. 0.5.

Any.severe.malaria.treatment. 0.6. 0.0. 0.1. 0.7. 0.5. 1.6. 2.1. 2.8.OUTLET'TYPE'TOTAL***' 39.3' 1.2' 1.0' 41.5' 11.3' 47.1' 58.5' 100.0'

*. A.total.of.5,963.9.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...A.total.of.2,013.antimalarials.(in.the.census.sample).were.audited..Of.these,.317.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.'


Table'C9.2:'Antimalarial'market'share,'within'rural'location,'Katanga'




[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %.Source:.ACTwatch.Outlet.Survey,.DRC,.2015.'


Table'C10.1:'Antimalarial'market'share'within'outlet'type,'within'urban'location,'Katanga'



[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 62.1' 20.8' 40.8' 54.2' 63.8' 50.9' 51.8' 50.7'



[email protected].([email protected]). 16.2. 3.8. 9.8. 33.3. 46.6. 40.0. 39.4. 36.5.Nationally.Registered.ACT. 46.0. 18.7. 31.9. 33.5. 45.5. 29.0. 30.1. 30.3.

2.'Any'nonCartemisinin'therapy. 36.3' 79.1' 58.4' 42.0' 32.7' 43.5' 42.9' 44.5'Sulfadoxine.pyrimethamine. 21.9. 51.0. 37.0. 26.0. 14.0. 26.1. 25.7. 26.8.Oral.quinine. 8.7. 26.0. 17.7. 13.9. 17.3. 16.5. 16.2. 16.3.Quinine.IV/IM. 5.2. 2.0. 3.6. 2.2. 1.1. 0.7. 0.9. [email protected].^. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.

3.'Oral'artemisinin'monotherapy' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 1.6' 0.1' 0.8' 3.7' 3.5' 5.6' 5.3' 4.8'

Artesunate.IV/IM.#. 0.0' 0.0' 0.0' 0.7' 0.0' 0.0' 0.1' 0.1'Artemether.IV/IM.. 0.3' 0.0' 0.1' 0.0' 0.0' 0.9' 0.8' 0.7'Arteether/Artemotil.IV/IM. 1.2' 0.0' 0.6' 3.0' 3.5' 4.3' 4.1' 3.8'

Any.severe.malaria.treatment. 6.8' 2.1' 4.4' 5.9' 4.5' 6.2' 6.1' 6.0'*. A.total.of.10,835.0.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.days:.400.1.public.health.facilities,.0.0.community.health.workers,[email protected],.1087.9.private.

[email protected],.235.6.pharmacies,.8,484.0.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.5,003.antimalarials.were.audited..Of.these,.855.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.34.public.health.facilities,.0.community.health.workers,[email protected],[email protected],.one.pharmacy,.663.drug.stores..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'C10.2:'Antimalarial'market'share'within'outlet'type,'within'rural'location,'Katanga'




[email protected]'


Profit'

[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 63.6' 94.7' 75.8' 64.8' 38.7' 44.8' 43.6' 52.4'



[email protected].([email protected]). 1.9. 0.0. 0.0. 1.8. 2.6. 10.4. 8.9. 5.9.Nationally.Registered.ACT. 62.0. 94.7. 75.8. 63.3. 36.2. 35.5. 35.6. 47.1.




Any.severe.malaria.treatment. 1.5' 1.7' 13.8' 1.8' 4.8' 3.3' 3.6' 2.8'*. A.total.of.5,963.9.AETDs.reportedly.sold.or.distributed.in.the.previous.7.days:.1,955.2.public.health.facilities,.51.1.community.health.workers,[email protected],.901.2.private.for@profit.

health.facilities,.0.pharmacies,.3,010.0.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine,.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected]:.amodiaquine,.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.2,013.antimalarials.were.audited..Of.these,.317.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.34.public.health.facilities,.5.community.health.workers,[email protected],[email protected],.0.pharmacies,.245.drug.stores..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'C13:'Provider'case'management'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


Profit'

[email protected].


ALL'Outlets'


%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).










Yes.–.sometimes. . . . . . . . .

Urban.51.4. @. 24.3. 44.3. 54.9. 28.1. 32.5. 34.1.

(40.0,.62.7). @. (6.3,.60.6). (32.9,.56.4). (41.6,.67.5). (23.4,.33.4). (24.8,.41.4). (27.2,.41.7).

Rural.38.4. 9.3. 31.7. 29.0. 47.0. 28.2. 34.0. 31.9.

(29.9,.47.8). (1.7,.37.6). (4.8,.80.9). (18.2,.43.0). (28.5,.66.3). (18.5,.40.4). (23.8,.45.9). (23.4,.41.8).

Yes.–.always' . . . . . . . .

Urban'10.3. @. 20.5. 12.9. 16.6. 5.6. 7.4. 8.1.

(4.8,.20.7). @. (5.0,.55.8). (6.0,.25.7). (10.5,.25.3). (2.9,.10.5). (4.8,.11.3). (5.8,.11.3).

Rural.6.1. 0.0. 7.9. 4.3. 6.6. 6.0. 6.2. 5.4.

(2.9,.12.2). @. (1.1,.39.7). (1.9,.9.1). (2.6,.15.7). (1.5,.21.0). (2.3,.15.5). (2.4,.11.8).Circumstances.cited.for.recommending.antimalarial.treatment.to.a.client.who.tested.negative.for.malaria:*.









Patient.has.signs.and.symptoms.of.malaria.. . . . . . . . .

Urban'91.2. @. 79.8. 88.9. 93.6. 83.3. 87.3. 87.6.

(80.4,.96.3). @. (27.6,.97.6). (76.4,.95.2). (85.7,.97.3). (70.7,.91.2). (78.3,.92.9). (80.4,.92.4).

Rural'92.6. 100.0. 100.0. 93.6. 84.5. 86.6. 85.7. 88.7.

(84.9,.96.5). @. @. (87.1,.97.0). (65.8,.93.9). (72.7,.94.0). (73.3,.92.9). (80.6,.93.7).

When.the.patient.asks.for.antimalarial.treatment.' . . . . . . . .

Urban'3.2. @. 0.0. 2.6. 5.4. 14.3. 10.8. 9.3.

(0.5,.16.6). @. @. (0.4,.13.5). (1.7,.15.9). (8.4,.23.3). (6.6,.17.3). (5.4,.15.5).

Rural'8.3. 19.9. 0.0. 8.9. 0.7. 31.6. 18.9. 15.1.

(3.6,.18.0). (6.9,.45.5). @. (3.8,.19.5). (0.1,.4.6). (21.5,.43.8). (11.1,.30.1). (9.6,.22.9).


Table'C13:'Provider'case'management'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


Profit'

[email protected].


ALL'Outlets'


%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

When.the.patient.has.visited.a.malaria.endemic.area.. . . . . . . . .

Urban'12.5. @. 20.2. 14.0. 19.3. 6.5. 10.9. 11.5.

(5.9,.24.3). @. (2.4,.72.4). (5.9,.30.0). (9.3,.35.9). (2.6,.15.6). (6.8,.16.9). (7.7,.16.8).

Rural'9.4. 19.9. 0.0. 9.8. 17.6. 5.7. 10.6. 10.3.

(3.5,.22.9). (6.9,.45.5). @. (4.2,.21.1). (7.1,.37.3). (1.7,.17.4). (5.0,.21.2). (5.5,.18.7).

Other.(all.other.reasons)' . . . . . . . .

Urban'18.7. @. 12.3. 17.4. 10.7. 8.0. 8.8. 10.3.

(9.2,.34.5). @. (1.9,.51.3). (9.1,.30.8). (4.9,.21.9). (2.9,.19.9). (3.7,.19.3). (5.8,.17.8).

Rural'9.1. 0.0. 0.0. 7.8. 4.3. 5.6. 5.1. 6.1.

(4.4,.17.8). @. @. (3.8,.15.3). (0.9,.17.5). (1.3,.20.7). (1.7,.14.4). (3.1,.11.6).

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....Source:.ACTwatch.Outlet.Survey,.DRC,.2015..

. .


Table'C14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


[email protected].


ALL'Outlets'

. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'providers'who:' Urban.N=91.Rural.N=170.








Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria.!.

. . . . . . . .

Urban.77.6. @. 72.1. 76.1. 53.1. 30.7. 34.3. 38.8.

(65.9,.86.2). @. (42.1,.90.2). (63.5,.85.4). (39.4,.66.4). (22.9,.39.8). (28.5,.40.5). (33.7,.44.2).

Rural.83.4. 58.0. 80.3. 75.5. 41.9. 27.2. 30.6. 45.5.

(73.3,.90.2). (37.0,.76.5). (43.1,.95.7). (61.4,.85.6). (32.5,.52.1). (20.0,.35.9). (24.4,.37.6). (40.5,.50.6)[email protected]:. . . . . . . . .

An.adult. . . . . . . . .

Urban.13.3. @. 5.9. 11.2. 4.1. 4.8. 4.5. 5.2.

(6.1,.26.5). @. (0.9,.30.9). (5.6,.21.3). (1.1,.14.3). (3.0,.7.5). (3.0,.6.7). (3.7,.7.2).

Rural.43.8. 0.0. 31.7. 30.0. 16.3. 6.4. 8.7. 15.8.

(34.1,.54.0). @. (4.8,.80.9). (19.2,.43.6). (8.5,.29.0). (3.6,.11.1). (5.6,.13.3). (11.8,.20.7).A.two@[email protected].. . . . . . . . .

Urban.39.6. @. 11.0. 31.6. 11.5. 2.3. 3.7. 6.7.

(24.4,.57.1). @. (1.5,.49.7). (18.5,.48.5). (4.0,.28.7). (0.9,.5.5). (1.7,.7.9). (3.9,.11.2).

Rural.57.2. 21.1. 0.0. 43.7. 19.5. 6.7. 9.7. 21.0.

(47.1,.66.6). (7.7,.46.2). @. (30.8,.57.6). (12.3,.29.6). (4.3,.10.4). (7.0,.13.4). (17.2,.25.4).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for:. . . . . . . . .

An.adult. . . . . . . . .

Urban.51.6. @. 71.5. 57.0. 42.4. 28.0. 31.1. 33.9.

(39.6,.63.4). @. (40.7,.90.2). (43.4,.69.6). (32.0,.53.5). (16.0,.44.4). (20.5,.44.1). (24.7,.44.5).

Rural.84.5. 37.1. 71.1. 69.4. 38.3. 29.3. 31.4. 44.0.

(76.6,.90.1). (27.4,.47.9). (28.4,.93.8). (57.6,.79.1). (27.4,.50.6). (20.9,.39.3). (24.3,.39.4). (38.9,.49.1).


Table'C14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Katanga'



[email protected]'


[email protected].


ALL'Outlets'

. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).









A.child. . . . . . . . .

Urban.60.1. @. 51.2. 57.7. 46.1. 24.1. 29.8. 32.8.

(48.5,.70.6). @. (25.0,.76.7). (46.1,.68.5). (33.8,.58.8). (16.2,.34.2). (20.9,.40.7). (24.7,.42.2).

Rural.81.8. 56.2. 71.1. 73.5. 37.5. 21.6. 25.3. 41.2.

(72.9,.88.2). (40.4,.70.9). (28.4,.93.8). (60.9,.83.1). (25.9,.50.8). (14.4,.31.1). (18.8,.33.1). (35.4,.47.4).

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.both.artemether.lumefantrine.and.artesunate.amodiaquine.were.DRC’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:.

4.providers.were.missing.information.on.the.national.first@line.treatment,.5.and.3.were.missing.information.on.the.first@line.dosing.regimen.for.adults.and.children,.respectively,.while.7.providers.were.missing.information.on.the.most.effective.antimalarial.medicine.for.adults.and.children..


.

. .


Results'Section'D:'Results'by'urban/rural'location,'Kinshasa'Province'

Table'D1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'across'urban/rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:.









Any.antimalarial.at.the.time.of.survey.visit.

. . . . . . . .

. . . . . . . .

Urban. 98.6. 67.2. 73.7. 61.4. 100.0. 97.9. 88.1. 86.7.(94.8,.99.6). (49.4,.81.2). (61.3,.83.1). (49.6,.72.0). @. (93.9,.99.3). (81.5,.92.5). (81.1,.90.9).

Rural. 97.9. 84.1. 86.9. 78.0. @. 96.8. 90.2. 89.3.(89.5,.99.6). (75.0,.90.4). (78.2,.92.5). (60.0,.89.4). @. (92.9,.98.6). (84.5,.94.0). (85.0,.92.5).

Any.ACT. . . . . . . . .

Urban. 93.4. 55.4. 65.9. 43.0. 99.3. 90.3. 77.7. 76.6.(84.5,.97.4). (39.8,.70.0). (55.0,.75.3). (33.6,.52.9). (94.2,.99.9). (83.3,.94.6). (69.6,.84.1). (69.4,.82.5).

Rural. 93.2. 49.5. 61.1. 35.5. @. 82.2. 65.9. 64.5.(79.6,.98.0). (33.9,.65.2). (38.9,.79.5). (28.0,.43.8). @. (73.6,.88.4). (61.6,.69.9). (57.1,.71.3).

[email protected].!. . . . . . . . .

Urban. 93.0. 55.4. 65.7. 40.8. 99.3. 89.0. 76.2. 75.2.(84.5,.97.0). (39.8,.70.0). (54.9,.75.1). (30.7,.51.8). (94.2,.99.9). (82.0,.93.5). (68.6,.82.4). (68.5,.81.0).

Rural. 92.4. 49.5. 60.9. 32.5. @. 81.8. 64.6. 63.6.(75.6,.97.9). (33.9,.65.2). (38.7,.79.3). (24.8,.41.3). @. (73.1,.88.2). (61.8,.67.3). (56.8,.69.8).

Artesunate.amodiaquine.. . . . . . . . .

Urban. 86.7. 33.6. 52.7. 20.4. 27.2. 32.5. 29.1. 31.3.(78.7,.91.9). (22.4,.47.0). (45.4,.59.9). (11.8,.33.0). (15.2,.43.7). (25.7,.40.1). (23.8,.35.1). (26.6,.36.5).

Rural. 88.4. 29.1. 48.1. 28.6. @. 27.9. 28.1. 33.7.(66.8,.96.7). (12.9,.53.2). (21.2,.76.2). (21.0,.37.8). @. (19.6,.38.0). (22.5,.34.6). (23.2,.46.0).

Artemether.lumefantrine. . . . . . . . .

Urban. 41.8. 28.1. 31.0. 27.4. 96.1. 88.1. 71.8. 68.1.(34.9,.49.0). (10.0,.58.0). (19.6,.45.3). (21.0,.34.9). (83.1,.99.2). (81.1,.92.7). (64.7,.78.1). (60.9,.74.4).

Rural. 21.8. 27.8. 21.3. 11.1. @. 78.9. 55.2. 45.8.(10.0,.40.9). (20.9,.36.0). (12.1,.34.7). (7.8,.15.6). @. (65.9,.87.9). (49.0,.61.2). (37.3,.54.6).

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Artemisinin.piperaquine. . . . . . . . .

Urban. 3.0. 0.0. 1.3. 0.0. 46.9. 16.8. 12.8. 11.7.(0.6,.13.0). @. (0.3,.6.1). @. (34.6,.59.5). (10.5,.25.6). (7.8,.20.2). (7.3,.18.4).

Rural. 0.0. 1.0. 0.6. 0.0. @. 1.8. 1.2. 1.0.@. (0.1,.11.5). (0.0,.6.9). @. @. (0.6,.5.4). (0.4,.3.4). (0.3,.3.4).

Artesunate.mefloquine.. . . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 37.2. 4.4. 3.8. 3.5.@. @. @. @. (19.4,.59.3). (2.2,.8.9). (1.9,.7.4). (1.8,.6.7).

Rural. 0.0. 0.0. 0.0. 0.0. @. 0.6. 0.4. 0.3.@. @. @. @. @. (0.1,.6.9). (0.0,.4.7). (0.0,.3.5).

Artesunate.sulfadoxine.pyrimethamine.

. . . . . . . .

Urban' 6.0. 0.0. 2.6. 3.6. 89.8. 53.3. 40.5. 37.0.(2.0,.17.0). @. (0.9,.6.9). (1.2,.10.6). (81.3,.94.7). (45.0,.61.4). (32.7,.48.9). (29.7,.45.1).

Rural. 4.2. 7.7. 5.5. 3.3. @. 34.4. 23.5. 18.5.(0.5,.26.7). (5.1,.11.4). (2.1,.13.3). (0.2,.31.9). @. (17.3,.56.7). (11.6,.41.9). (9.3,.33.5).

Dihydroartemisinin.piperaquine.

. . . . . . . .

Urban' 10.9. 7.7. 8.2. 14.0. 70.5. 59.5. 47.4. 43.8.(6.2,.18.4). (2.2,.23.5). (4.2,.15.5). (8.6,.22.1). (54.2,.82.8). (51.7,.66.8). (39.8,.55.2). (36.6,.51.3).

Rural. 7.8. 4.3. 4.4. 4.3. @. 32.1. 22.3. 17.4.(1.5,.31.9). (1.5,.11.8). (1.4,.13.1). (2.5,.7.3). @. (14.7,.56.4). (11.6,.38.7). (8.8,.31.4).


. . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 25.7. 2.1. 2.0. 1.8.@. @. @. @. (16.0,.38.6). (0.8,.5.7). (0.8,.4.8). (0.7,.4.3).

Rural. 0.0. 0.0. 0.0. 0.0. @. 1.5. 0.9. 0.7.@. @. @. @. @. (0.4,.5.8). (0.3,.3.5). (0.2,.2.4).


. . . . . . . .

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Urban' 2.3. 0.0. 1.0. 0.0. 59.9. 34.2. 25.5. 23.2.(1.0,.5.6). @. (0.5,.2.1). @. (44.8,.73.4). (27.8,.41.3). (19.5,.32.5). (17.9,.29.5).

Rural. 0.8. 0.0. 0.2. 1.8. @. 23.4. 15.8. 11.5.(0.1,.10.4). @. (0.0,.2.7). (0.3,.9.3). @. (16.0,.33.0). (10.4,.23.4). (6.9,.18.5).

Other.ACT.β. . . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.

Rural. 12.0. 0.0. 2.9. 0.0. @. 0.0. 0.0. 0.8.(1.3,.57.9). @. (0.2,.30.1). @. @. @. @. (0.0,.13.3).

[email protected].(QA.ACT)'

. . . . . . . .

Urban. 84.7. 31.5. 50.9. 19.5. 64.3. 19.2. 20.1. 23.0.(76.6,.90.3). (19.5,.46.6). (42.6,.59.2). (11.0,.32.2). (46.1,.79.1). (15.1,.24.2). (15.8,.25.3). (19.0,.27.4).

Rural' 88.1. 24.8. 45.6. 25.5. @. 12.0. 16.7. 24.7.(63.1,.97.0). (9.8,.49.9). (18.0,.76.1). (14.6,.40.6). @. (7.0,.19.9). (13.1,.21.1). (15.6,.36.9).

QA.artesunate.amodiaquine.

. . . . . . . .

Urban. 84.7. 31.5. 50.9. 19.5. 5.4. 3.9. 8.1. 12.1.(76.6,.90.3). (19.5,.46.6). (42.6,.59.2). (11.0,.32.2). (1.4,.18.0). (2.4,.6.3). (5.2,.12.4). (9.2,.15.7).

Rural. 87.3. 24.8. 45.4. 25.5. @. 5.9. 12.7. 21.8.(62.5,.96.6). (9.8,.49.9). (18.0,.75.9). (14.6,.40.6). @. (2.4,.13.5). (8.8,.18.2). (12.7,.34.7).

QA.artemether.lumefantrine.

. . . . . . . .

Urban. 1.9. 0.0. 0.8. 0.0. 63.0. 16.3. 12.8. 11.7.(0.6,.6.1). @. (0.2,.2.7). @. (44.0,.78.7). (12.1,.21.7). (9.3,.17.3). (8.4,.15.9).

Rural. 1.7. 1.9. 1.5. 0.0. @. 6.1. 4.0. 3.3.(0.1,.19.3). (0.1,.24.5). (0.1,.17.3). @. @. (1.4,.23.0). (0.9,.15.3). (0.7,.14.2).

[email protected].([email protected])'

. . . . . . . .

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Urban. 45.1. 28.1. 32.5. 32.3. 98.1. 90.2. 74.7. 70.8.(38.0,.52.5). (10.0,.58.0). (21.0,.46.5). (25.9,.39.3). (89.5,.99.7). (83.2,.94.5). (66.9,.81.2). (63.2,.77.4).

Rural. 36.2. 28.8. 25.4. 15.9. @. 80.5. 57.9. 48.9.(22.9,.52.1). (23.4,.34.9). (19.1,.33.0). (11.9,.20.9). @. (71.2,.87.3). (51.5,.64.1). (41.0,.56.9).


Urban. 90.8. 44.9. 59.8. 33.9. 99.3. 86.6. 72.6. 71.4.(82.0,.95.5). (28.9,.62.1). (49.6,.69.2). (23.1,.46.6). (94.2,.99.9). (80.2,.91.1). (65.0,.79.0). (64.4,.77.5).

Rural. 92.4. 42.0. 56.5. 31.2. @. 75.5. 60.0. 59.0.(75.6,.97.9). (27.2,.58.3). (32.6,.77.7). (24.4,.38.9). @. (58.8,.86.9). (52.4,.67.2). (51.2,.66.5).


Urban' 78.9. 58.1. 61.0. 42.6. 100.0. 94.2. 80.4. 78.6.(66.3,.87.7). (37.1,.76.6). (45.4,.74.6). (31.9,.54.0). @. (90.5,.96.5). (74.2,.85.4). (73.0,.83.3).

Rural' 92.4. 67.0. 65.8. 63.1. @. 95.0. 83.8. 78.8.(78.8,.97.5). (61.3,.72.3). (57.0,.73.7). (48.7,.75.4). @. (93.1,.96.4). (81.2,.86.2). (74.9,.82.3).

Sulfadoxine.pyrimethamine' . . . . . . . .

Urban' 43.1. 35.6. 35.1. 12.6. 72.4. 68.7. 53.7. 51.9.(31.5,.55.6). (20.5,.54.2). (23.9,.48.3). (7.7,.20.0). (60.4,.81.8). (61.1,.75.5). (46.6,.60.6). (45.4,.58.4).

Rural' 56.0. 21.6. 30.8. 18.3. @. 80.4. 58.6. 50.9.(33.4,.76.5). (15.3,.29.6). (15.6,.51.8). (7.9,.36.8). @. (70.6,.87.5). (52.1,.64.8). (41.0,.60.8).

Oral.quinine' . . . . . . . .

Urban' 59.0. 40.9. 44.4. 27.3. 96.6. 89.1. 72.6. 70.0.(47.0,.70.0). (20.1,.65.6). (30.3,.59.4). (20.8,.35.0). (89.9,.98.9). (85.0,.92.2). (67.4,.77.2). (65.2,.74.3).

Rural. 80.8. 45.8. 46.1. 35.8. @. 81.4. 65.4. 60.1.(66.7,.89.9). (39.5,.52.3). (37.4,.55.1). (25.2,.48.0). @. (72.9,.87.7). (64.8,.66.0). (56.9,.63.1).

[email protected].^'

. . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 20.1. 0.5. 0.7. 0.6.@. @. @. @. (8.4,.40.8). (0.1,.3.4). (0.2,.2.6). (0.2,.2.4).

Rural' 0.0. 0.0. 0.0. 0.0. @. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'











Urban. 0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.4. 0.4.@. @. @. @. @. (0.1,.2.2). (0.1,.1.7). (0.1,.1.5).

Rural. 0.0. 0.0. 0.0. 0.0. @. 0.7. 0.5. 0.3.@. @. @. @. @. (0.1,.5.9). (0.1,.4.2). (0.0,.3.3).

[email protected].

. . . . . . . .

Urban. 47.2. 42.2. 40.0. 30.4. 86.8. 81.8. 68.1. 65.5.(35.3,.59.4). (18.6,.69.9). (26.4,.55.3). (22.0,.40.4). (80.5,.91.4). (77.5,.85.5). (63.0,.72.7). (60.6,.70.0).

Rural. 29.2. 41.2. 30.9. 48.0. @. 79.3. 68.4. 58.0.(15.3,.48.5). (33.2,.49.6). (16.4,.50.3). (34.4,.61.9). @. (67.9,.87.5). (62.0,.74.1). (47.9,.67.4).

Any.treatment.for.severe.malaria.

. . . . . . . .

Urban. 62.7. 46.8. 48.8. 41.5. 88.2. 84.2. 72.8. 70.5.(50.7,.73.4). (20.6,.74.9). (33.4,.64.4). (29.4,.54.7). (80.9,.93.0). (79.8,.87.8). (67.0,.77.9). (65.2,.75.4).

Rural. 78.0. 65.2. 56.6. 67.3. @. 85.2. 79.0. 72.8.(57.0,.90.4). (61.1,.69.2). (42.4,.69.8). (56.1,.76.8). @. (79.2,.89.8). (75.1,.82.4). (66.1,.78.6).

Artesunate.IV/IM.#. . . . . . . . .

Urban. 20.7. 18.2. 17.3. 10.1. 37.4. 18.8. 16.8. 16.9.(11.6,.34.0). (7.3,.38.4). (9.2,.30.4). (6.3,.15.8). (27.1,.48.9). (15.8,.22.2). (13.7,.20.4). (13.7,.20.5).

Rural. 6.2. 1.9. 2.6. 6.2. @. 7.5. 7.0. 5.8.(0.9,.31.6). (0.1,.24.5). (0.8,.8.2). (0.4,.49.7). @. (3.2,.16.6). (1.9,.22.6). (1.6,.18.7).


Urban. 7.9. 4.2. 5.4. 4.1. 43.3. 30.2. 23.4. 21.7.(3.2,.18.4). (0.7,.21.2). (1.6,.16.1). (1.8,.9.4). (32.1,.55.3). (25.4,.35.4). (20.1,.27.0). (19.0,.24.7).

Rural. 15.8. 10.2. 9.7. 15.6. @. 36.4. 29.2. 23.8.(7.1,.31.5). (4.8,.20.3). (5.0,.17.9). (7.6,.29.4). @. (29.3,.44.3). (21.8,.37.8). (18.0,.30.7).

Arteether.IV/IM. . . . . . . . .

Urban. 34.9. 33.8. 30.8. 26.8. 86.8. 80.1. 65.9. 62.6.(25.0,.46.2). (14.8,.59.9). (20.1,.43.9). (19.6,.35.5). (80.5,.91.4). (75.2,.84.3). (60.8,.70.6). (57.8,.67.2).




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Rural. 19.2. 34.7. 24.7. 36.6. @. 76.0. 62.2. 51.8.(11.6,.30.1). (26.9,.43.3). (15.0,.37.8). (29.8,.43.9). @. (64.3,.84.8). (58.6,.65.8). (43.4,.60.2).

Quinine.IV/IM' . . . . . . . .

Urban. 39.6. 16.5. 24.6. 23.6. 27.4. 21.6. 22.3. 22.5.(29.6,.50.6). (4.7,.44.2). (15.9,.36.1). (14.5,.36.1). (17.2,.40.7). (14.4,.31.1). (15.7,.30.5). (16.3,.30.2).

Rural. 70.1. 42.9. 41.8. 44.9. @. 39.6. 41.5. 41.6.(44.4,.87.3). (38.2,.47.7). (33.3,.50.9). (34.6,.55.7). @. (29.6,.50.5). (37.2,.45.8). (40.4,.42.7).

*. The.denominator.includes.24.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated!malaria..β. Other.types.of.ACT.include.artemisinin.napthoquine..^[email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'D2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'across'urban/rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Any.ACT. . . . . . . . .

Urban. 94.8. 82.4. 89.4. 70.0. 99.3. 92.3. 88.2. 88.3.(84.2,.98.4). (68.2,.91.1). (80.6,.94.5). (56.9,.80.5). (94.2,.99.9). (85.1,.96.1). (80.4,.93.2). (80.9,.93.1).

Rural.95.1. 58.9. 70.3. 45.5. @. 84.9. 73.0. 72.3.

(81.0,.98.9). (39.0,.76.2). (44.9,.87.3). (38.5,.52.8). @. (77.8,.90.0). (69.3,.76.4). (63.6,.79.5)[email protected].!. . . . . . . . .

Urban.94.4. 82.4. 89.2. 66.5. 99.3. 91.0. 86.5. 86.7.

(84.4,.98.1). (68.2,.91.1). (80.2,.94.4). (52.7,.77.9). (94.2,.99.9). (83.6,.95.2). (79.2,.91.6). (79.7,.91.6).

Rural. 94.3. 58.9. 70.0. 41.7. @. 84.5. 71.6. 71.2.(77.3,.98.8). (39.0,.76.2). (44.8,.87.1). (31.5,.52.6). @. (77.1,.89.9). (68.6,.74.4). (63.2,.78.0).

Artesunate.amodiaquine.. . . . . . . . .

Urban.87.9. 50.0. 71.6. 33.3. 27.2. 33.2. 33.1. 36.1.

(78.8,.93.4). (30.7,.69.3). (59.5,.81.2). (22.0,.46.9). (15.2,.43.7). (26.1,.41.2). (27.0,.39.9). (30.6,.42.0).

Rural. 90.3. 34.6. 55.4. 36.7. @. 28.8. 31.2. 37.7.(66.4,.97.8). (14.3,.62.5). (24.0,.83.0). (26.9,.47.8). @. (19.7,.40.0). (23.9,.39.5). (25.5,.51.7).


Urban.42.4. 41.8. 42.1. 44.6. 96.1. 90.0. 81.6. 78.5.

(35.3,.49.8). (15.7,.73.5). (28.8,.56.8). (32.7,.57.2). (83.1,.99.2). (82.5,.94.5). (74.1,.87.2). (70.8,.84.6).

Rural.22.2. 33.1. 24.6. 14.2. @. 81.5. 61.2. 51.3.

(10.2,.41.7). (24.8,.42.5). (13.2,.41.1). (9.9,.20.1). @. (70.2,.89.2). (54.6,.67.4). (41.3,.61.2).Artemisinin.piperaquine. . . . . . . . .

Urban.3.0. 0.0. 1.7. 0.0. 46.9. 17.1. 14.5. 13.5.

(0.6,.13.1). @. (0.4,.7.7). @. (34.6,.59.5). (10.8,.26.1). (9.0,.22.5). (8.5,.20.9).

Rural.0.0. 1.2. 0.6. 0.0. @. 1.9. 1.3. 1.1.@. (0.1,.14.1). (0.0,.8.1). @. @. (0.6,.5.5). (0.4,.3.8). (0.3,.3.8).

. . . . . . . . .

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Artesunate.mefloquine.. . . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 37.2. 4.5. 4.4. 4.0.@. @. @. @. (19.4,.59.3). (2.2,.9.1). (2.3,.8.3). (2.1,.7.6).

Rural.0.0. 0.0. 0.0. 0.0. @. 0.7. 0.5. 0.3.@. @. @. @. @. (0.1,.7.2). (0.0,.5.1). (0.0,.3.9).

Artesunate.sulfadoxine.pyrimethamine. . . . . . . . .

Urban' 6.1. 0.0. 3.5. 5.9. 89.8. 54.4. 46.0. 42.7.(2.0,.17.3). @. (1.3,.9.0). (1.8,.17.9). (81.3,.94.7). (46.4,.62.3). (38.2,.54.1). (35.1,.50.7).

Rural. 4.3. 9.1. 6.3. 4.2. @. 35.5. 26.0. 20.7.(0.5,.27.0). (5.6,.14.7). (2.4,.15.7). (0.3,.37.3). @. (18.1,.57.9). (13.3,.44.6). (10.5,.36.7).

Dihydroartemisinin.piperaquine. . . . . . . . .

Urban' 11.1. 11.4. 11.2. 22.9. 70.5. 60.8. 53.8. 50.5.(6.3,.18.6). (3.5,.31.3). (5.8,.20.5). (13.1,.36.9). (54.2,.82.8). (53.7,.67.4). (46.8,.60.7). (43.5,.57.5).

Rural. 8.0. 5.1. 5.0. 5.5. @. 33.1. 24.8. 19.4.(1.6,.32.3). (1.7,.14.3). (1.5,.15.4). (3.4,.8.8). @. (15.4,.57.3). (13.5,.41.0). (10.1,.34.1).


. . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 25.7. 2.1. 2.2. 2.1.@. @. @. @. (16.0,.38.6). (0.8,.5.8). (0.9,.5.3). (0.8,.4.9).

Rural. 0.0. 0.0. 0.0. 0.0. @. 1.5. 1.0. 0.8.@. @. @. @. @. (0.4,.5.9). (0.3,.3.7). (0.2,.2.6).


. . . . . . . .

Urban' 2.4. 0.0. 1.3. 0.0. 59.9. 35.0. 28.9. 26.8.(1.0,.5.7). @. (0.7,.2.8). @. (44.8,.73.4). (28.8,.41.7). (23.2,.35.4). (21.4,.32.8).

Rural. 0.8. 0.0. 0.2. 2.3. @. 24.2. 17.6. 12.9.(0.1,.10.5). @. (0.0,.3.2). (0.4,.12.2). @. (16.8,.33.4). (11.8,.25.4). (7.7,.20.7).




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Other.ACT. . . . . . . . .

Urban' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.

Rural. 12.2. 0.0. 3.3. 0.0. @. 0.0. 0.0. 0.9.(1.4,.58.0). @. (0.3,.32.0). @. @. @. @. (0.0,.14.5).


Urban. 85.9. 46.9. 69.1. 31.7. 64.3. 19.6. 22.8. 26.5.(76.6,.91.9). (26.2,.68.7). (54.2,.80.8). (20.4,.45.8). (46.1,.79.1). (15.3,.24.8). (18.2,.28.2). (22.3,.31.1).

Rural' 90.0. 29.4. 52.4. 32.6. @. 12.4. 18.5. 27.7.(62.0,.98.0). (11.0,.58.4). (20.3,.82.6). (19.7,.48.8). @. (7.3,.20.4). (15.1,.22.5). (17.5,.40.8).

QA.artesunate.amodiaquine. . . . . . . . .

Urban.85.9. 46.9. 69.1. 31.7. 5.4. 4.0. 9.2. 13.9.

(76.6,.91.9). (26.2,.68.7). (54.2,.80.8). (20.4,.45.8). (1.4,.18.0). (2.4,.6.4). (6.0,.13.9). (10.7,.17.9).

Rural.89.1. 29.4. 52.2. 32.6. @. 6.1. 14.1. 24.4.

(61.5,.97.7). (11.0,.58.4). (20.3,.82.4). (19.7,.48.8). @. (2.5,.13.9). (9.5,.20.4). (14.2,.38.6).QA.artemether.lumefantrine. . . . . . . . .

Urban.1.9. 0.0. 1.1. 0.0. 63.0. 16.7. 14.5. 13.4.

(0.6,.6.2). @. (0.3,.3.6). @. (44.0,.78.7). (12.3,.22.2). (10.6,.19.4). (9.8,.18.1).

Rural.1.7. 2.2. 1.7. 0.0. @. 6.3. 4.4. 3.7.

(0.1,.19.5). (0.1,.29.2). (0.1,.20.2). @. @. (1.5,.23.6). (1.1,.16.3). (0.8,.15.5)[email protected].([email protected])' . . . . . . . .

Urban.45.8. 41.8. 44.1. 52.6. 98.1. 92.1. 84.8. 81.6.

(38.4,.53.4). (15.7,.73.5). (30.5,.58.6). (40.6,.64.3). (89.5,.99.7). (85.0,.96.0). (76.9,.90.3). (73.5,.87.6).

Rural.37.0. 34.2. 29.2. 20.4. @. 83.1. 64.2. 54.7.

(24.3,.51.8). (27.1,.42.1). (21.4,.38.6). (16.5,.24.9). @. (75.7,.88.6). (57.2,.70.6). (45.3,.63.8).Nationally.registered.ACT' . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Urban.92.1. 66.8. 81.2. 55.2. 99.3. 88.4. 82.4. 82.3.

(82.9,.96.6). (45.9,.82.7). (69.4,.89.2). (40.9,.68.7). (94.2,.99.9). (81.8,.92.9). (75.6,.87.6). (75.5,.87.6).

Rural.94.3. 49.9. 65.0. 40.0. @. 78.0. 66.5. 66.1.

(77.3,.98.8). (30.8,.69.0). (37.6,.85.2). (31.9,.48.7). @. (61.9,.88.5). (61.2,.71.4). (58.3,.73.1)[email protected]. . . . . . . . .

Urban'80.1. 86.4. 82.8. 69.4. 100.0. 96.2. 91.3. 90.6.

(67.3,.88.7). (56.2,.96.9). (68.2,.91.6). (56.8,.79.6). @. (93.3,.97.9). (88.4,.93.5). (87.8,.92.8).

Rural'94.3. 79.6. 75.7. 80.8. @. 98.1. 92.9. 88.3.

(78.0,.98.7). (63.4,.89.8). (58.9,.87.2). (72.2,.87.2). @. (96.8,.98.9). (89.5,.95.3). (80.1,.93.4).Sulfadoxine.pyrimethamine' . . . . . . . .

Urban'43.8. 52.9. 47.7. 20.5. 72.4. 70.2. 60.9. 59.9.

(32.1,.56.1). (30.4,.74.3). (32.9,.62.9). (13.5,.30.0). (60.4,.81.8). (63.1,.76.5). (55.2,.66.4). (54.3,.65.3).

Rural'57.2. 25.7. 35.5. 23.4. @. 83.0. 65.0. 57.0.

(32.4,.78.9). (17.5,.36.1). (17.3,.59.1). (11.1,.42.8). @. (72.0,.90.3). (54.1,.74.5). (43.2,.69.8).Oral.quinine' . . . . . . . .

Urban'59.8. 60.8. 60.3. 44.5. 96.6. 91.0. 82.4. 80.7.

(47.7,.70.8). (31.5,.84.0). (44.7,.74.0). (36.6,.52.8). (89.9,.98.9). (86.8,.94.0). (78.7,.85.6). (76.7,.84.0).

Rural.82.5. 54.5. 53.0. 45.9. @. 84.1. 72.5. 67.3.

(68.9,.90.9). (44.4,.64.2). (42.7,.63.1). (30.2,.62.4). @. (77.5,.88.9). (67.9,.76.7). (62.6,.71.6)[email protected].^' . . . . . . . .

Urban'0.0. 0.0. 0.0. 0.0. 20.1. 0.5. 0.8. 0.7.@. @. @. @. (8.4,.40.8). (0.1,.3.5). (0.2,.2.9). (0.2,.2.7).

Rural'0.0. 0.0. 0.0. 0.0. @. 0.0. 0.0. 0.0.@. @. @. @. @. @. @. @.


Urban. 0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.5. 0.4.@. @. @. @. @. (0.1,.2.3). (0.1,.1.9). (0.1,.1.7).




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Rural.0.0. 0.0. 0.0. 0.0. @. 0.8. 0.5. 0.4.@. @. @. @. @. (0.1,.6.1). (0.1,.4.8). (0.0,.3.8).


Urban. 47.8. 62.7. 54.3. 49.5. 86.8. 83.6. 77.3. 75.5.(35.7,.60.3). (26.1,.88.9). (36.7,.70.8). (39.6,.59.6). (80.5,.91.4). (79.3,.87.2). (73.6,.80.6). (71.6,.78.9).

Rural.29.8. 48.9. 35.5. 61.5. @. 82.0. 75.8. 64.9.

(16.0,.48.7). (38.3,.59.7). (18.0,.58.0). (42.3,.77.7). @. (72.6,.88.6). (69.9,.80.8). (53.3,.75.0).Any.treatment.for.severe.malaria. . . . . . . . .

Urban. 63.7. 69.6. 66.2. 67.6. 88.2. 86.0. 82.6. 81.3.(51.4,.74.3). (26.7,.93.5). (46.7,.81.4). (52.2,.80.0). (80.9,.93.0). (81.8,.89.4). (79.1,.85.6). (77.8,.84.4).

Rural.79.6. 77.6. 65.1. 86.2. @. 88.0. 87.5. 81.5.

(59.0,.91.4). (65.5,.86.3). (45.9,.80.4). (69.2,.94.6). @. (84.2,.91.1). (85.8,.89.0). (73.6,.87.4).Artesunate.IV/IM.#. . . . . . . . .

Urban. 21.0. 27.0. 23.6. 16.4. 37.4. 19.2. 19.1. 19.4.(11.8,.34.3). (11.3,.51.8). (12.6,.39.7). (10.2,.25.5). (27.1,.48.9). (16.3,.22.6). (16.0,.22.6). (16.3,.23.0).

Rural.6.3. 2.2. 3.0. 7.9. @. 7.7. 7.8. 6.5.

(1.0,.32.0). (0.1,.29.2). (0.9,.9.8). (0.6,.56.4). @. (3.3,.16.9). (2.2,.24.1). (1.8,.20.5).Artemether.IV/IM. . . . . . . . .

Urban.8.0. 6.3. 7.3. 6.7. 43.3. 30.8. 26.6. 25.0.

(3.2,.18.6). (1.1,.28.3). (2.4,.20.2). (2.9,.14.9). (32.1,.55.3). (25.8,.36.4). (22.8,.30.7). (21.8,.28.6).

Rural.16.1. 12.1. 11.2. 20.0. @. 37.6. 32.3. 26.6.

(7.5,.31.4). (6.0,.22.9). (5.9,.20.3). (10.0,.36.0). @. (30.0,.45.9). (24.7,.41.0). (20.4,.33.9).Arteether.IV/IM. . . . . . . . .

Urban.35.4. 50.3. 41.8. 43.7. 86.8. 81.9. 74.8. 72.2.

(25.1,.47.2). (22.7,.77.7). (28.9,.55.9). (34.4,.53.5). (80.5,.91.4). (76.8,.86.0). (70.5,.78.6). (67.7,.76.3).

Rural.19.6. 41.2. 28.4. 46.9. @. 78.5. 69.0. 58.0.

(12.0,.30.4). (29.6,.53.9). (16.1,.45.0). (36.4,.57.7). @. (68.6,.86.0). (65.0,.72.7). (47.8,.67.6).Quinine.IV/IM' . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'










Urban.40.2. 24.5. 33.4. 38.5. 27.4. 22.1. 25.3. 25.9.

(30.0,.51.3). (7.1,.58.0). (23.0,.45.7). (24.3,.54.9). (17.2,.40.7). (14.8,.31.6). (18.2,.34.0). (19.1,.34.1).

Rural.71.6. 51.0. 48.1. 57.6. @. 40.9. 46.0. 46.5.

(45.5,.88.4). (40.8,.61.0). (38.1,.58.2). (46.7,.67.8). @. (29.9,.53.0). (40.0,.52.0). (43.8,.49.3).

*. The.denominator.includes.19.outlets.that.met.screening.criteria.for.a.full.interview.but.did.not.complete.the.interview.(were.not.interviewed.or.completed.a.partial.interview)....!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated!malaria..β. Other.types.of.ACT.include.artemisinin.naphthoquine..^[email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#....At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/[email protected]:.ACTwatch.Outlet.Survey,.DRC,.2015..

.

. .


.

Table'D4:'Antimalarial'market'composition,'across'urban/rural'location,'Kinshasa'




[email protected]'


[email protected].


%.(95%.CI).

%.(95%.CI)'

%.(95%.CI)'

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).


. . . . . . . .

Urban,.N=.552.outlets.8.1. 0.0. 3.3. 11.4. 16.9. 0.5. 71.2. 88.6.

(4.5,.14.1). @. (1.6,.6.6). (7.0,.18.0). (12.5,.22.5). (0.1,.2.3). (64.6,.77.0). (82.0,.93.0).

Rural,.N=.300.outlets'10.7. 4.4. 14.5. 29.6. 21.3. 0.0. 49.1. 70.4.

(6.6,.16.8). (1.3,.13.5). (8.8,.23.0). (20.4,.40.8). (16.3,.27.3). @. (39.1,.59.3). (59.2,.79.6).*..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..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'D5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'urban/rural'location,'Kinshasa''

'Private.

[email protected].






Any'ACT' . . . .

Urban' $0.00. $4.93. $3.84. $3.84.[[email protected]].(120). [[email protected]].(781). [[email protected]].(2,697). [[email protected]].(3,598).

Rural' $0.00. @. $3.84. $3.84.[[email protected]].(55). @. [[email protected]].(689). [[email protected]].(744).

[email protected].!. . . . .

Urban. $0.00. $4.93. $3.95. $3.95.[[email protected]].(102). [[email protected]].(474). [[email protected]].(1,776). [[email protected]].(2,352).

Rural. $0.00. @. $4.06. $3.84.[[email protected]].(50). @. [[email protected]].(490). [[email protected]].(540).

Artesunate.amodiaquine.' . . . .

Urban' $0.00. $3.29. $2.19. $1.75.[[email protected]].(60). [[email protected]].(24). [[email protected]].(182). [[email protected]].(266).


Artemether.lumefantrine' . . . .



[email protected].(QA.ACT)' . . . .



QA.artesunate.amodiaquine' . . . .



' . . . .' . . . .



'Private.

[email protected].






QA.artemether.lumefantrine. . . . .

Urban' @. $8.33. $6.58. $6.58.@. [[email protected]].(47). [[email protected]].(75). [[email protected]].(122).

Rural' @. @. $6.58. $6.58.@. @. [[email protected]].(15). [[email protected]].(15).

[email protected].([email protected]). . . . .



Artesunate.sulfadoxine.pyrimethamine. . . . .



Dihydroartemisinin.piperaquine. . . . .



Sulfadoxine.pyrimethamine. . . . .



' . . . .



'Private.

[email protected].






Oral.quinnine. . . . .

Urban. $3.31. $4.42. $3.31. $3.31.[[email protected]].(55). [[email protected]].(122). [[email protected]].(669). [[email protected]].(846).



!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artemether.lumefantrine.and.artesunate.amodiaquine.were.the.first@line.treatments.for.uncomplicated.malaria...Figures.in.this.table.are.derived.using.audited.products.with.price.information..The.numbers.of.tablet.antimalarials.captured.in.audit.sheets.with.missing.price.and/.or.product.information.are.as.follows:.

130.any.ACT,.10.artesunate.amodiaquine,.73.artemether.lumefantrine,.4.QA.artesunate.amodiaquine,.8.QA.artemether.lumefantrine,[email protected],.17.artesunate.sulfadoxine.pyrimethamine,.17.dihydroartemisinin.piperaquine,.13.sulfadoxine.pyrimethamine,.22.oral.quinine..



Table'D5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'across'urban/rural'location,'Kinshasa''

'Private.

[email protected].






[email protected]@assured.ACT.(QA.ACT).!. . . . .

Urban. $0.00. $6.25. $6.03. $5.48.[[email protected]].(16). [[email protected]].(30). [[email protected]].(51). [[email protected]].(97).


[email protected].(QA.ACT).artesunate.amodiaquine.' . . . .



[email protected].(QA.ACT).artemether.lumefantrine. . . . .

Urban' @. $6.36. $6.03. $6.03.@. [[email protected]].(27). [[email protected]].(46). [[email protected]].(73).


[email protected].(QA.ACT).!' . . . .



[email protected].(QA.ACT).artesunate.amodiaquine' . . . .

Urban' $0.00. $0.00. $1.64. $0.00.[[email protected]].(13). (1). [[email protected]].(7). [[email protected]].(21).



Table'D5b:'Price'of'preCpackaged'antimalarials,'by'outlet'type,'across'urban/rural'location,'Kinshasa''

'Private.

[email protected].


[email protected].(QA.ACT).artemether.lumefantrine.' . . . .

Urban' @. $3.12. $2.74. $2.74.

@. [[email protected]].(10). [[email protected]].(17). [[email protected]].(27).



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:.4.adult.QA.artemether.lumefantrine,.1.pediatric.QA.artesunate.amodiaquine,.4.pediatric.QA.artemether.lumefantrine..



sssss

Table'D6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'across'urban/rural'location,'Kinshasa'


[email protected].


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking. Urban.N=125.Rural.N=.76.

Urban.N=22.Rural.N=.42.








Urban. 96.8. 96.0. 96.5. 94.7. 14.8. 1.2. 20.5. 26.6.(84.3,.99.4). (75.4,.99.5). (87.5,.99.1). (87.2,.97.9). (5.3,.35.1). (0.4,.3.1). (16.1,.25.8). (21.9,.31.8).

Rural. 98.8. 100.0. 92.9. 90.2. @. 5.2. 32.8. 48.6.(87.3,.99.9). @. (58.4,.99.2). (69.0,.97.4). @. (2.2,.11.8). (23.6,.43.7). (35.3,.62.2).

. Urban.N=125.Rural.N=.76.









Urban. 88.4. 89.3. 88.8. 89.2. 1.2. 0.5. 18.6. 24.2.(74.6,.95.2). (67.6,.97.1). (78.2,.94.6). (82.8,.93.4). (0.1,.11.1). (0.1,.2.0). (14.7,.23.3). (20.1,.28.8).

Rural. 90.0. 97.4. 78.7. 85.8. @. 4.5. 31.0. 43.4.(73.4,.96.7). (73.4,.99.8). (42.0,.95.0). (66.6,.94.8). @. (1.9,.10.5). (21.2,.42.8). (30.5,.57.4).










Urban. 67.9. 43.1. 56.8. 31.1. 15.0. 0.9. 7.4. 11.4.(56.8,.77.2). (22.5,.66.3). (42.6,.70.0). (20.5,.44.1). (5.4,.35.1). (0.3,.3.0). (4.8,.11.3). (8.2,.15.5).

Rural. 71.8. 44.5. 54.9. 31.1. @. 1.4. 11.2. 22.8.(41.0,.90.3). (20.8,.71.0). (26.5,.80.3). (15.3,.53.0). @. (0.4,.5.0). (6.1,.19.6). (13.3,.36.2).









[email protected].(QARDTs)***. . . . . . . . .

Urban. 67.9. 38.3. 54.7. 30.3. 15.0. 0.3. 6.7. 10.6.(56.8,.77.2). (20.7,.59.6). (41.9,.66.9). (19.7,.43.4). (5.4,.35.1). (0.0,.2.0). (4.3,.10.5). (7.7,.14.5).

Rural. 71.8. 44.5. 54.9. 29.1. @. 1.4. 10.5. 22.3.(41.0,.90.3). (20.8,.71.0). (26.5,.80.3). (14.0,.50.9). @. (0.4,.5.0). (5.4,.19.6). (12.9,.35.7).

*. 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..12.antimalarial@stocking.outlets.were.missing.information.about.both.availability.of.microscopy.and.

availability.of.RDTs..22.antimalarial@stocking.outlets.had.partial.information.about.blood.testing.availability.and.are.included.in.the.denominator.of.the.indicator.“any.blood.testing.available.”.***.QA.RDT.status.could.not.be.determined.for.one.RDT.in.urban.locations.and.one.RDT.in.rural.locations.because.of.missing.product.information..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'D8:'Price'of'malaria'blood'testing,'by'outlet'type,'across'urban/rural'location,'Kinshasa''

'Private.

[email protected].






Malaria.microscopy. . . . .

Adult. . . . .

Urban. $1.10. $1.64. $1.10. $1.10.[[email protected]].(128). (1). [[email protected]].(3). [[email protected]].(132).


Child.under.five.years. . . . .

Urban. $1.10. $1.64. $1.10. $1.10.[[email protected]].(128). (1). [[email protected]].(3). [[email protected]].(132).


Rapid.diagnostic.tests.(RDTs). . . . .Adult. . . . .

Urban. $1.10. $0.00. $1.10. $1.10.[[email protected]].(46). (1). (1). [[email protected]].(48).


Child.under.five.years. . . . .

Urban. $1.10. $0.00. $1.10. $1.10.[[email protected]].(46). (1). (1). [[email protected]].(48).


*. 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:.12.adult.RDTs,.12.child.RDTs,.5.adult.microscopy.tests,.5.child.microscopy.tests..



Table'D9.1:'Antimalarial'market'share,'within'urban'location,'Kinshasa'



[email protected].


[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 5.5. 0.4. 5.9. 2.4. 0.1. 37.2. 39.7. 45.6.


Artesunate.piperaquine. 0.1. 0.0. 0.1. 0.0. 0.0. 0.4. 0.4. 0.5.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.0. 0.0. 0.0! 0.1! 0.0! 5.4! 5.5! 5.5!Dihydroartemisinin.piperaquine. 0.4. 0.0. 0.5! 0.3! 0.0! 3.2! 3.5! 4.0!Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0! 0.0! 0.0! 0.1! 0.1! 0.1!Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0. 0.0. 0.0! 0.0! 0.0! 2.1! 2.1! [email protected].(QA.ACT). 3.3. 0.2. 3.5! 0.8! 0.0! 1.1! 1.9! 5.4!QA.artesunate.amodiaquine. 3.3. 0.2. 3.5! 0.8! 0.0! 0.2! 0.9! 4.4!QA.artemether.lumefantrine. 0.0. 0.0. 0.0! 0.0! 0.0! 0.9! 0.9! 0.9!

[email protected]. 2.2. 0.2. 2.4! 1.7! 0.1! 36.1! 37.8! 40.2!Nationally.registered.ACT. 4.4. 0.3. 4.7! 1.5! 0.0! 20.4! 21.9! 26.6!

2.'Any'nonCartemisinin'therapy. 5.5. 0.5. 6.0! 1.9! 0.3! 37.1! 39.2! 45.2!Sulfadoxine.pyrimethamine. 3.7. 0.4. 4.1! 1.0! 0.2! 25.1! 26.4! 30.5!Oral.quinine. 1.7. 0.1. 1.8! 0.7! 0.0! 11.7! 12.5! 14.3!Quinine.IV/IM. 0.1. 0.0. 0.1. 0.1. 0.0. 0.2. 0.3. [email protected].^. 0.0. 0.0. 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!4.'NonCoral'artemisinin'monotherapy' 0.5. 0.2. 0.7! 0.8! 0.0! 7.8! 8.6! 9.3!

Artesunate.IV/IM.#. 0.1. 0.0. 0.1! 0.0! 0.0! 0.1! 0.1! 0.3!Artemether.IV/IM.. 0.0. 0.0. 0.0! 0.0! 0.0! 0.3! 0.3! 0.4!Arteether/Artemotil.IV/IM. 0.4. 0.1. 0.5! 0.8! 0.0! 7.3! 8.1! 8.6!

Any.severe.antimalarial.treatment. 0.6. 0.2. 0.8! 0.9! 0.0! 8.0! 8.9! 9.7!OUTLET'TYPE'TOTAL***' 11.5' 1.0' 12.5! 5.1! 0.4! 82.0! 87.5! 100.0!*. A.total.of.8497.3.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...A.total.of.9,415.antimalarials.(in.the.census.sample).were.audited..Of.these,.793.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.'Source:.ACTwatch.Outlet.Survey,.DRC,.2015.'


Table'D9.2:'Antimalarial'market'share,'within'rural'location,'Kinshasa'




[email protected].


[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 9.6. 1.2. 6.0. 16.9. 2.3. 22.6. 24.8. 41.7.


Artesunate.piperaquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.0! 0.0! 0.1. 0.1! 0.1! 2.8! 2.9! 3.0!Dihydroartemisinin.piperaquine. 0.0! 0.0! 0.0. 0.0! 0.1! 1.6! 1.7! 1.7!Dihydroartemisinin.piperaquine.trimethoprim. 0.0! 0.0! 0.0. 0.0! 0.0! 0.0! 0.0! 0.0!Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0! 0.0! 0.0. 0.0! 0.0! 1.3! 1.3! [email protected].(QA.ACT). 9.4! 1.2! 2.9. 13.5! 1.5! 0.9! 2.4! 15.9!QA.artesunate.amodiaquine. 9.3! 1.2! 2.5. 13.0! 1.5! 0.5! 1.9! 15.0!QA.artemether.lumefantrine. 0.1! 0.0! 0.4. 0.5! 0.0! 0.4! 0.4! 0.9!

[email protected]. 0.3! 0.0! 3.1. 3.4! 0.8! 21.6! 22.4! 25.8!Nationally.registered.ACT. 9.4! 1.2! 4.9. 15.6! 1.8! 13.1! 15.0! 30.6!

2.'Any'nonCartemisinin'therapy. 3.1! 0.5! 3.8. 7.3! 1.9! 42.1! 44.0! 51.3!Sulfadoxine.pyrimethamine. 2.4! 0.5! 2.2. 5.0! 0.9! 30.8! 31.6! 36.7!Oral.quinine. 0.5! 0.0! 1.3. 1.9! 0.9! 10.6! 11.5! 13.3!Quinine.IV/IM. 0.1. 0.0. 0.3. 0.4. 0.2. 0.7. 0.8. [email protected].^. 0.0! 0.0! 0.0. 0.0! 0.0! 0.0! 0.0! 0.0!

3.'Oral'artemisinin'monotherapy' 0.0! 0.0! 0.0. 0.0! 0.0! 0.0! 0.0! 0.0!4.'NonCoral'artemisinin'monotherapy' 0.1! 0.0! 1.2. 1.3! 1.3! 4.5! 5.8! 7.1!

Artesunate.IV/IM.#. 0.0! 0.0! 0.1. 0.1! 0.0! 0.1! 0.1! 0.2!Artemether.IV/IM.. 0.1! 0.0! 0.1. 0.2! 0.3! 0.4! 0.7! 0.9!Arteether/Artemotil.IV/IM. 0.0! 0.0! 1.0. 1.1! 0.9! 4.0! 4.9! 6.0!

Any.severe.antimalarial.treatment. 0.2! 0.0! 1.5. 1.7! 1.4! 5.2! 6.6! 8.3!OUTLET'TYPE'TOTAL***' 12.8! 1.7! 11.0' 25.5! 5.4! 69.1! 74.5! 100.0!*. A.total.of.4,950.2.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first@line.treatment.for.severe.malaria..Categories.1.through.4.sum.to.100%[email protected].–.antimalarial.total.column...A.total.of.3,485.antimalarials.(in.the.census.sample).were.audited..Of.these,.149.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.'Source:.ACTwatch.Outlet.Survey,.DRC,.2015.'


Table'D10.1:'Antimalarial'market'share'within'outlet'type,'within'urban'location,'Kinshasa'

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


[email protected]'


[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 48.1' 37.6' 47.2' 47.5' 15.0' 45.3' 45.3' 45.6'


Artesunate.piperaquine. 0.7. 0.0. 0.7. 0.0. 0.0. 0.5. 0.5. 0.5.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.3. 0.0. 0.2. 1.7. 0.8. 6.6. 6.3. 5.5.Dihydroartemisinin.piperaquine. 3.8. 3.4. 3.8. 6.4. 0.0. 3.9. 4.0. 4.0.Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1. 0.1.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.1. 0.0. 0.1. 0.0. 0.0. 2.6. 2.5. [email protected].(QA.ACT). 28.6. 21.8. 28.0. 14.8. 0.0. 1.3. 2.1. 5.4.QA.artesunate.amodiaquine. 28.6. 21.8. 28.0. 14.8. 0.0. 0.2. 1.0. 4.4.QA.artemether.lumefantrine. 0.0. 0.0. 0.0. 0.0. 0.0. 1.1. 1.1. 0.9.

[email protected]. 19.5. 15.9. 19.2. 32.7. 15.0. 44.0. 43.2. 40.2.Nationally.registered.ACT. 38.3. 26.0. 37.3. 29.5. 6.0. 24.9. 25.1. 26.6.




Any.severe.antimalarial.treatment. 5.0' 18.5' 6.2' 17.4' 2.7' 9.8' 10.2' 9.7'*. 8,497.3.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.days:.742.0.public.health.facilities,.0.community.health.workers,[email protected],[email protected],.45.0.pharmacies,.

7,008.5.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.9,415.antimalarials.were.audited..Of.these,.793.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.31.public.health.facilities,.0.community.health.workers,[email protected],[email protected],.12.pharmacies,.656.drug.stores..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'D10.2:'Antimalarial'market'share'within'outlet'type,'within'rural'location,'Kinshasa'

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



[email protected]'


[email protected].



%. %. %. %. %. %. %. %.1.'Any'ACT' 75.2' 72.7' 54.7' 66.2' 41.6' 32.6' 33.3' 41.7'


Artesunate.piperaquine. 0.0. 0.0. 0.3. 0.1. 0.0. 0.0. 0.0. 0.0.Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Artesunate.sulfadoxine.pyrimethamine. 0.0. 0.0. 1.0. 0.4. 1.7. 4.0. 3.8. 3.0.Dihydroartemisinin.piperaquine. 0.0. 0.0. 0.3. 0.1. 1.4. 2.4. 2.3. 1.7.Dihydroartemisinin.piperaquine.trimethoprim. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0.Dihydroartemisinin.sulfadoxine.pyrimethamine. 0.0. 0.0. 0.0. 0.0. 0.0. 1.9. 1.7. [email protected].(QA.ACT). 73.1. 72.7. 26.3. 52.9. 26.8. 1.3. 3.2. 15.9.QA.artesunate.amodiaquine. 72.6. 72.7. 22.6. 51.1. 26.8. 0.7. 2.6. 15.0.QA.artemether.lumefantrine. 0.5. 0.0. 3.7. 1.8. 0.0. 0.6. 0.6. 0.9.

[email protected]. 2.1. 0.0. 28.4. 13.3. 14.8. 31.3. 30.1. 25.8.Nationally.registered.ACT. 73.8. 72.7. 44.8. 61.3. 33.6. 19.0. 20.1. 30.6.



Artesunate.IV/IM.#. 0.2. 0.0. 0.6' 0.3' 0.5' 0.1' 0.1' 0.2'Artemether.IV/IM.. 0.5. 0.0. 0.8' 0.6' 5.3' 0.6' 1.0' 0.9'Arteether/Artemotil.IV/IM. 0.2. 0.0. 9.5' 4.2' 17.3' 5.8' 6.6' 6.0'

Any.severe.antimalarial.treatment. 1.8. 0.0. 13.3' 6.6' 26.3' 7.5' 8.9' 8.3'*. A.total.of.4,950.2.AETDs.were.reportedly.sold.or.distributed.in.the.previous.7.days:.460.1.public.health.facilities,.45.1.community.health.workers,[email protected],[email protected],.0.

pharmacies,.3,698.8.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first@line.treatments.for.uncomplicated.malaria..^. [email protected],.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.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.3,485.antimalarials.were.audited..Of.these,.149.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information,.including.the.following.number.of.antimalarials.by.outlet.type:.13.public.health.facilities,.0.community.health.workers,[email protected],[email protected],.0.pharmacies,.88.drug.stores..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


'Table'D13:'Provider'case'management'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'


%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).










Yes.–.sometimes. . . . . . . . .

Urban.51.0. 67.9. 58.1. 52.4. 41.6. 36.1. 41.2. 42.9.

(41.6,.60.4). (26.5,.92.5). (39.4,.74.7). (41.9,.62.6). (31.2,.52.9). (30.3,.42.3). (35.1,.47.6). (36.3,.49.9).

Rural.56.7. 63.2. 63.0. 67.5. @. 45.7. 54.8. 57.4.

(31.0,.79.3). (54.5,.71.1). (44.5,.78.3). (66.6,.68.4). @. (36.4,.55.4). (47.0,.62.4). (47.2,.67.0).

Yes.–.always' . . . . . . . .

Urban'21.7. 8.0. 16.0. 22.2. 11.1. 12.1. 15.1. 15.2.

(11.0,.38.4). (1.3,.36.9). (7.8,.29.9). (14.5,.32.5). (5.1,.22.3). (7.6,.18.7). (10.8,.20.8). (10.9,.20.8).

Rural.30.4. 21.5. 21.5. 13.2. @. 9.3. 10.9. 14.3.

(15.6,.50.7). (16.3,.27.9). (12.8,.34.0). (8.3,.20.3). @. (6.6,.12.9). (7.7,.15.3). (10.8,.18.6).Circumstances.cited.for.recommending.antimalarial.treatment.to.a.client.who.tested.negative.for.malaria:*.









Patient.has.signs.and.symptoms.of.malaria. . . . . . . . .

Urban'87.6. 100.0. 92.9. 76.0. 89.0. 82.9. 80.3. 82.0.

(79.4,.92.8). @. (85.5,.96.7). (63.2,.85.4). (80.4,.94.1). (71.3,.90.5). (72.4,.86.3). (74.6,.87.6).

Rural'83.9. 65.0. 74.6. 82.5. @. 76.3. 79.5. 77.7.

(69.0,.92.5). (46.8,.79.7). (60.4,.84.9). (61.6,.93.3). @. (56.3,.88.9). (60.7,.90.7). (67.6,.85.3).

When.the.patient.has.visited.a.malaria.endemic.area.' . . . . . . . .

Urban'20.8. 7.5. 15.1. 25.8. 8.2. 17.2. 20.4. 19.7.

(12.4,.32.9). (0.8,.45.1). (7.6,.28.0). (18.0,.35.4). (1.1,.41.9). (9.3,.29.6). (14.3,.28.3). (14.0,.27.1).

Rural'22.8. 39.1. 29.9. 32.6. @. 25.7. 29.2. 29.5.

(15.0,.33.2). (21.5,.60.2). (15.5,.49.9). (19.6,.48.9). @. (19.1,.33.6). (25.0,.33.8). (23.8,.35.9).

Provider.doesn't.trust.the.test.results. . . . . . . . .

Urban'12.3. 7.5. 10.3. 10.5. 8.6. 7.9. 9.0. 9.1.

(5.4,.25.6). (0.8,.45.1). (4.2,.23.2). (4.7,.22.0). (3.5,.19.5). (4.4,.13.9). (5.8,.13.6). (6.1,.13.4).

Rural'9.8. 3.0. 4.8. 12.3. @. 5.3. 8.9. 7.3.

(4.9,.18.6). (0.2,.30.6). (2.4,.9.0). (4.1,.31.4). @. (2.2,.12.3). (3.4,.21.0). (4.2,.12.6).


'Table'D13:'Provider'case'management'knowledge'and'practices,'by'outlet'type,'across'urban/rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'


%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Other.(all.other.reasons)' . . . . . . . .

Urban' 7.2. 0.0. 4.1. 7.9. 1.9. 9.7. 8.8. 8.2.(1.9,.24.1). @. (1.0,.16.0). (2.9,.19.9). (0.2,.18.0). (3.7,.23.1). (4.6,.16.4). (4.5,.14.5).

Rural' 5.9. 32.0. 20.6. 11.5. @. 11.1. 11.3. 14.8.(0.9,.30.5). (19.4,.47.9). (7.5,.45.3). (3.3,.33.2). @. (1.7,.47.8). (2.4,.39.4). (4.8,.37.4).

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....Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Table'D14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'urban'rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).









Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria.!. . . . . . . . .

Urban.60.6. 39.6. 51.3. 47.6. 44.6. 14.2. 21.7. 24.1.

(51.1,.69.3). (20.1,.63.2). (39.8,.62.6). (37.7,.57.7). (31.2,.58.9). (11.4,.17.7). (17.9,.26.0). (20.7,.27.8).

Rural.83.3. 41.2. 57.1. 41.1. @. 11.0. 20.8. 30.6.

(62.1,.93.9). (20.7,.65.3). (31.0,.79.8). (36.5,.45.9). @. (7.1,.16.8). (16.7,.25.6). (20.8,.42.4)[email protected]:. . . . . . . . .

An.adult:. . . . . . . . .

Urban.19.8. 3.5. 12.3. 3.9. 3.4. 0.6. 1.3. 2.2.

(13.9,.27.4). (0.4,.25.2). (7.4,.19.8). (1.4,.10.3). (1.1,.10.1). (0.1,.3.0). (0.6,.3.1). (1.2,.4.0).

Rural.27.9. 5.3. 11.9. 5.7. @. 0.0. 1.8. 4.6.

(9.1,.59.8). (2.3,.11.8). (5.3,.24.4). (2.9,.10.9). @. @. (0.7,.4.9). (2.0,.10.2).

A.two@[email protected]:. . . . . . . . .

Urban.26.5. 0.0. 14.4. 8.4. 5.6. 1.0. 2.6. 3.5.

(17.9,.37.3). @. (8.4,.23.5). (3.3,.19.6). (2.8,.10.8). (0.3,.3.2). (1.3,.5.1). (2.0,.6.0).

Rural.36.9. 8.9. 16.4. 9.8. @. 2.1. 4.7. 7.8.

(16.2,.63.9). (4.1,.18.2). (10.6,.24.4). (5.2,.17.9). @. (0.9,.5.1). (2.8,.7.6). (4.6,.13.1).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for:. . . . . . . . .

An.adult:. . . . . . . . .

Urban.60.5. 36.9. 50.0. 36.9. 52.0. 15.9. 20.9. 23.3.

(43.2,.75.5). (15.0,.66.1). (34.0,.66.0). (27.6,.47.4). (31.6,.71.7). (12.7,.19.7). (17.4,.24.9). (19.8,.27.1).

Rural.71.1. 38.0. 52.0. 33.4. @. 17.9. 23.0. 30.8.

(57.2,.81.9). (22.2,.57.0). (32.8,.70.6). (23.2,.45.6). @. (9.0,.32.7). (12.6,.38.1). (20.7,.43.1).

. . . . . . . . .


Table'D14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'urban'rural'location,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).









A.child:. . . . . . . . .

Urban.67.0. 27.9. 49.7. 52.5. 58.7. 30.9. 35.9. 37.0.

(54.3,.77.7). (9.7,.58.1). (36.2,.63.2). (43.8,.61.1). (35.8,.78.4). (25.2,.37.2). (30.4,.41.8). (32.1,.42.2).

Rural.77.1. 46.1. 59.6. 42.2. @. 32.9. 35.9. 42.3.

(65.4,.85.7). (41.5,.50.7). (40.7,.76.0). (30.2,.55.2). @. (19.8,.49.2). (23.9,.50.0). (31.4,.54.0).

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.DRC’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:.6.providers.were.missing.information.on.the.national.first@line.treatment,.21.providers.were.missing.information.on.the.first@line.dosing.regimen.for.adults.and.children,.and.10.providers.were.missing.information.on.the.most.effective.antimalarial.medicine.for.adults.and.children..Source:.ACTwatch.Outlet.Survey,.DRC,.2015..


Results'Section'E:'Results'by'survey'year,'Katanga'Province'

Table'E1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'across'survey'round,'Katanga.


[email protected]'

ALL'Public'/'Not'ForC

Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:. 2013.N=53.2015.N=266.

2013.N=53.2015.N=23.

2013.N=106.2015.N=324.

2013.N=162.2015.N=152.

2013.N=566.2015.N=568.

2013.N=2,164.2015.N=728.

2013.N=2,270.2015.N=1,052.

Any.antimalarial.at.the.time.of.survey.visit. . . . . . . .

2013.95.3. 88.3. 92.5. 82.7. 92.6. 30.1. 34.0.

(87.0,.98.4). (73.0,.95.5). (85.1,.96.4). (67.9,.91.5). (88.6,.95.3). (25.2,.35.5). (29.1,.39.2).

2015.98.0. 88.7. 97.3. 72.1. 96.0. 90.8. 92.5.

(94.6,.99.3). (68.1,.96.6). (93.9,.98.8). (59.4,.82.0). (92.1,.98.0). (85.9,.94.1). (89.0,.94.9).Any.ACT. . . . . . . .

2013.79.5. 59.3. 71.4. 48.7. 66.1. 20.1. 23.3.

(62.2,.90.1). (40.7,.75.5). (59.8,.80.7). (38.2,.59.2). (57.5,.73.7). (15.9,.25.1). (19.2,.28.1).

2015.91.8. 58.7. 88.6. 41.1. 71.9. 65.7. 71.5.

(83.8,.96.0). (34.5,.79.2). (80.4,.93.6). (31.5,.51.4). (62.3,.79.8). (56.7,.73.6). (65.4,.77.0).

Artesunate.amodiaquine. . . . . . . .

2013.73.0. 42.5. 60.8. 33.5. 26.3. 9.2. 12.4.

(56.5,.84.8). (25.9,.60.9). (48.4,.71.9). (23.1,.45.7). (21.1,.32.2). (7.2,.11.6). (10.2,.15.0).

2015.89.7. 49.1. 86.4. 32.1. 60.8. 52.7. 42.0.

(82.3,.94.2). (26.1,.72.5). (78.1,.91.9). (23.2,.42.5). (50.7,.70.0). (43.2,.62.1). (33.0,.51.6).Artemether.lumefantrine. . . . . . . .

2013.8.3. 20.5. 13.2. 24.7. 56.5. 15.6. 15.5.

(3.3,.19.3). (11.2,.34.6). (7.0,.23.6). (16.5,.35.3). (47.4,.65.2). (11.7,.20.5). (11.7,.20.2).

2015.15.2. 13.4. 11.1. 20.2. 33.0. 32.2. 46.1.

(10.8,.20.9). (4.0,.36.6). (7.0,.17.0). (13.4,.29.4). (26.5,.40.3). (26.4,.38.5). (40.4,.51.8)[email protected].(QA.ACT). . . . . . . .

2013.67.5. 40.0. 56.5. 40.2. 45.4. 14.4. 17.0.

(51.1,.80.5). (24.2,.58.2). (44.2,.68.1). (29.2,.52.3). (38.5,.52.6). (11.3,.18.3). (13.7,.21.0).

2015.89.8. 54.4. 86.9. 34.7. 50.3. 47.2. 57.4.

(82.3,.94.4). (31.4,.75.8). (78.7,.92.3). (25.7,.44.9). (43.3,.57.2). (41.1,.53.5). (52.8,.61.9)[email protected].([email protected])' . . . . . . .

. . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2013.N=53.2015.N=23.

2013.N=106.2015.N=324.

2013.N=162.2015.N=152.

2013.N=566.2015.N=568.

2013.N=2,164.2015.N=728.

2013.N=2,270.2015.N=1,052.

2013.17.0. 33.4. 23.6. 19.2. 47.5. 13.0. 13.6.

(8.2,.32.0). (18.7,.52.1). (14.8,.35.2). (11.7,.30.0). (38.5,.56.6). (9.7,.17.1). (10.3,.17.7).

2015.13.3. 15.7. 11.0. 17.1. 55.2. 47.8. 38.4.

(9.4,.18.4). (5.0,.39.9). (7.8,.15.3). (11.0,.25.5). (45.3,.64.7). (37.9,.57.9). (29.6,.47.9)[email protected]. . . . . . . .

2013.82.0. 70.9. 77.6. 72.4. 91.1. 28.9. 32.0.

(66.9,.91.1). (52.6,.84.2). (66.1,.85.9). (59.5,.82.4). (87.7,.93.6). (24.1,.34.2). (27.3,.37.0).

2015. 81.3. 88.7. 62.8. 64.3. 92.9. 86.7. 80.6.(74.0,.86.9). (68.1,.96.6). (41.6,.80.0). (53.1,.74.1). (89.0,.95.4). (81.9,.90.4). (71.6,.87.2).

Sulfadoxine.pyrimethamine' . . . . . . .

2013.54.9. 47.3. 51.8. 32.2. 64.4. 19.1. 21.1.

(37.4,.71.3). (30.6,.64.5). (39.2,.64.2). (24.1,.41.6). (59.3,.69.2). (15.8,.22.8). (17.9,.24.7).

2015. 44.7. 33.6. 33.5. 25.4. 60.2. 52.6. 47.7.(35.2,.54.7). (16.1,.57.2). (21.9,.47.5). (17.4,.35.5). (53.1,.66.8). (46.8,.58.3). (41.1,.54.4).

Oral.quinine. . . . . . . .

2013. 57.7. 58.3. 58.0. 53.0. 85.8. 26.0. 28.0.(42.5,.71.6). (39.7,.74.8). (46.5,.68.7). (41.6,.64.2). (82.9,.88.2). (21.9,.30.5). (24.1,.32.3).

2015.63.2. 50.8. 46.4. 38.8. 84.3. 74.7. 67.5.

(53.9,.71.5). (26.4,.74.8). (31.2,.62.3). (27.5,.51.5). (78.6,.88.6). (67.9,.80.5). (58.9,.75.0).Oral.artemisinin.monotherapy. . . . . . . .

2013. 0.0. 0.0. 0.0. 0.0. 0.6. 0.1. 0.1.@. @. @. @. (0.1,.3.3). (0.0,.0.8). (0.0,.0.7).

2015.0.2. 0.0. 0.1. 0.0. 0.2. 0.2. 0.1.

(0.0,.1.0). @. (0.0,.0.7). @. (0.0,.1.3). (0.0,.1.0). (0.0,.0.7)[email protected]' . . . . . . .

2013.13.5. 24.5. 17.9. 17.7. 35.3. 9.9. 10.4.

(6.2,.27.0). (11.7,.44.2). (10.4,.29.1). (10.4,.28.3). (26.0,.45.9). (6.6,.14.4). (7.2,.14.7).

2015.25.4. 30.7. 24.0. 21.6. 46.5. 41.5. 37.0.

(18.2,.34.2). (12.4,.58.3). (18.2,.30.9). (15.8,.28.9). (38.2,.54.9). (33.7,.49.8). (30.3,.44.3).Any.treatment.for.severe.malaria' . . . . . . .

2013'72.3. 53.1. 64.6. 55.4. 57.3. 18.9. 21.8.

(56.7,.83.8). (34.8,.70.6). (52.5,.75.1). (43.4,.66.7). (49.5,.64.8). (14.9,.23.7). (17.6,.26.7).. . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2013.N=53.2015.N=23.

2013.N=106.2015.N=324.

2013.N=162.2015.N=152.

2013.N=566.2015.N=568.

2013.N=2,164.2015.N=728.

2013.N=2,270.2015.N=1,052.

2015'65.7. 86.4. 54.9. 53.4. 63.2. 61.6. 59.9.

(56.7,.73.6). (66.7,.95.2). (41.6,.67.6). (41.9,.64.4). (56.7,.69.3). (55.2,.67.7). (53.1,.66.3).Artesunate.IV/IM. . . . . . . .

2013'9.6. 14.4. 11.5. 5.7. 11.1. 3.1. 3.6.

(3.8,.22.0). (4.1,.39.8). (5.4,.23.0). (3.0,.10.4). (7.4,.16.2). (2.1,.4.6). (2.5,.5.2).

2015'14.0. 8.8. 9.9. 3.9. 4.2. 4.1. 5.6.

(8.5,.22.1). (3.0,.23.0). (5.6,.17.0). (1.5,.9.8). (2.6,.6.8). (2.6,.6.4). (3.9,.7.9).

*. 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,.DRC,.2013,.2015..

.

. .


'Table'E2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'across'survey'round,'Katanga'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2013.N=44.2015.N=19.

2013.N=93.2015.N=311.

2013.N=131.2015.N=121.

2013.N=532.2015.N=554.

2013.N=678.2015.N=682.

2013.N=771.2015.N=993.

Any.ACT. . . . . . . .

2013. 83.3. 67.1. 77.2. 58.8. 71.4. 66.8. 68.6.(63.8,.93.4). (46.6,.82.7). (64.2,.86.4). (46.9,.69.8). (62.5,.78.8). (59.3,.73.6). (62.3,.74.3).

2015.93.7. 66.1. 91.0. 57.0. 74.9. 72.3. 77.4.

(84.9,.97.5). (38.7,.85.8). (83.1,.95.4). (45.8,.67.4). (66.5,.81.7). (64.5,.79.0). (72.1,.81.9).

Artesunate.amodiaquine. . . . . . . .

2013. 76.5. 48.1. 65.7. 40.5. 28.4. 30.5. 36.5.(58.7,.88.2). (29.5,.67.2). (52.8,.76.5). (28.8,.53.3). (22.9,.34.6). (25.1,.36.6). (31.6,.41.7).

2015.15.5. 15.1. 11.4. 28.0. 63.3. 58.1. 45.5.

(11.0,.21.4). (4.5,.40.3). (7.2,.17.6). (18.5,.40.1). (53.8,.71.9). (48.6,.67.0). (36.1,.55.1).Artemether.lumefantrine. . . . . . . .

2013. 8.7. 23.2. 14.3. 29.9. 61.0. 52.0. 45.6.(3.5,.20.2). (12.7,.38.6). (7.6,.25.3). (20.1,.41.9). (51.9,.69.5). (43.8,.60.0). (37.9,.53.5).

2015.91.6. 55.3. 88.8. 44.5. 34.4. 35.4. 49.9.

(83.8,.95.8). (29.1,.78.9). (80.8,.93.7). (34.6,.55.0). (27.9,.41.5). (29.7,.41.6). (43.9,.55.9)[email protected].(QA.ACT). . . . . . . .

2013. 70.8. 45.3. 61.1. 48.6. 49.1. 47.9. 50.1.(53.4,.83.7). (27.4,.64.5). (48.2,.72.6). (36.0,.61.5). (42.1,.56.1). (41.5,.54.4). (44.1,.56.1).

2015.91.7. 61.4. 89.4. 48.1. 52.4. 52.0. 62.1.

(83.8,.95.9). (35.2,.82.3). (81.4,.94.2). (38.3,.58.0). (46.0,.58.7). (46.6,.57.4). (57.8,.66.3)[email protected].([email protected])' . . . . . . .

2013. 17.9. 37.8. 25.5. 23.3. 51.2. 43.0. 40.1.(8.6,.33.6). (21.5,.57.3). (15.9,.38.2). (14.4,.35.4). (41.9,.60.6). (35.2,.51.2). (32.5,.48.1).

2015.13.5. 17.7. 11.3. 23.7. 57.5. 52.7. 41.5.

(9.6,.18.8). (5.6,.43.9). (8.1,.15.7). (15.3,.34.8). (47.9,.66.6). (42.5,.62.6). (32.4,.51.3)[email protected]. . . . . . . .

2013. 86.0. 80.3. 83.8. 87.5. 98.4. 96.1. 94.0.(70.1,.94.2). (60.7,.91.4). (72.1,.91.2). (80.9,.92.1). (97.0,.99.1). (94.4,.97.3). (91.9,.95.6).

2015.83.0. 100.0. 64.6. 89.1. 96.7. 95.5. 87.1.

(75.7,.88.4). @. (42.0,.82.1). (79.5,.94.5). (94.1,.98.2). (93.0,.97.2). (77.3,.93.1).. . . . . . . .. . . . . . . .


Table'E2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'across'survey'round,'Katanga'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2013.N=44.2015.N=19.

2013.N=93.2015.N=311.

2013.N=131.2015.N=121.

2013.N=532.2015.N=554.

2013.N=678.2015.N=682.

2013.N=771.2015.N=993.

Sulfadoxine.pyrimethamine' . . . . . . .

2013. 57.6. 53.5. 56.0. 39.0. 69.5. 63.3. 62.1.(39.4,.73.9). (35.1,.71.0). (43.2,.68.1). (30.5,.48.2). (64.1,.74.5). (58.4,.67.9). (57.2,.66.7).

2015.45.7. 37.9. 34.5. 35.2. 62.7. 57.9. 51.6.

(35.9,.55.7). (18.0,.63.0). (22.4,.48.9). (24.4,.47.7). (55.7,.69.2). (52.0,.63.6). (44.5,.58.7).Oral.quinine. . . . . . . .

2013. 60.5. 66.0. 62.6. 64.1. 92.6. 86.4. 82.3.(44.7,.74.5). (46.7,.81.2). (50.5,.73.3). (53.0,.74.0). (89.2,.95.0). (82.8,.89.2). (79.0,.85.3).

2015.64.5. 57.3. 47.7. 53.9. 87.8. 82.3. 73.0.

(55.1,.72.9). (31.1,.80.0). (31.8,.64.2). (39.0,.68.1). (83.5,.91.0). (76.7,.86.8). (64.4,.80.1).Oral.artemisinin.monotherapy. . . . . . . .

2013. 0.0. 0.0. 0.0. 0.0. 0.6. 0.5. 0.4.@. @. @. @. (0.1,.3.5). (0.1,.2.7). (0.1,.2.2).

2015.0.2. 0.0. 0.1. 0.0. 0.2. 0.2. 0.1.

(0.0,.1.0). @. (0.0,.0.7). @. (0.0,.1.4). (0.0,.1.1). (0.0,.0.7)[email protected]' . . . . . . .

2013. 14.2. 27.7. 19.3. 21.3. 38.1. 32.7. 30.5.(6.5,.28.3). (13.5,.48.6). (11.3,.31.2). (12.4,.34.2). (28.5,.48.7). (24.2,.42.5). (23.0,.39.1).

2015.25.9. 34.7. 24.6. 30.0. 48.4. 45.8. 40.1.

(18.6,.34.8). (13.8,.63.8). (18.7,.31.7). (22.3,.39.0). (40.0,.56.9). (37.5,.54.3). (32.9,.47.7).Any.treatment.for.severe.malaria' . . . . . . .

2013' 75.8. 60.2. 69.8. 66.9. 61.9. 62.9. 64.1.(59.4,.87.0). (39.8,.77.5). (57.0,.80.2). (53.9,.77.8). (54.4,.68.8). (55.7,.69.6). (57.2,.70.4).

2015'67.0. 97.4. 56.4. 74.0. 65.8. 67.9. 64.8.

(58.2,.74.8). (84.1,.99.6). (42.4,.69.5). (63.0,.82.6). (59.4,.71.7). (61.4,.73.7). (57.7,.71.2).Artesunate.IV/IM. . . . . . . .

2013' 10.1. 16.3. 12.5. 6.9. 12.0. 10.2. 10.6.(4.0,.23.1). (4.7,.43.7). (5.8,.24.7). (3.6,.12.7). (8.1,.17.3). (7.2,.14.4). (7.6,.14.6).

2015'14.3. 9.9. 10.2. 5.4. 4.4. 4.5. 6.0.

(8.7,.22.5). (3.3,.26.4). (5.7,.17.5). (2.0,.13.5). (2.8,.7.0). (2.9,.7.0). (4.2,.8.5).*. 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....

Source:.ACTwatch.Outlet.Survey,.DRC,.2013,.2015...


Table'E4:'Antimalarial'market'composition,'across'survey'round'Katanga.



Community.Health...

Worker.Ω.

[email protected]'


[email protected].

Pharmacy. Drug.Store. General.Retailer.Ω.

ALL.Private.

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

. %.(95%.CI).

%.(95%.CI).

2013,.N=771'outlets.10.5. @. 6.5. 17.0. 17.8. 0.0. 60.9. 4.3. 83.0.

(7.1,.15.2). @. (4.5,.9.1). (13.3,.21.4). (13.5,.23.2). @. (54.6,.66.8). (1.7,.10.2). (78.6,.86.7).

2015,.N=843.outlets'19.6. 7.1. 1.9. 28.6. 12.1. 0.7. 58.5. @. 71.4.

(15.7,.24.3). (2.9,.16.3). (1.2,.3.3). (22.4,.35.8). (8.9,.16.3). (0.1,.4.1). (51.7,.65.1). @. (64.2,.77.6).

*. 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..Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2013.DRC.outlet.survey.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..


.

. .


'

Table'E5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'survey'round,'Katanga.

'Private.

[email protected].





Any.ACT' . . .

2013' $0.00. $2.55. $2.12.[[email protected]].(172). [[email protected]].(1,672). [[email protected]].(1,852).

2015. $0.69. $2.15. $1.72.[[email protected]].(198). [[email protected]].(1,605). [[email protected]].(1,831).

Artesunate.amodiaquine. . . .

2013' $0.00. $1.19. $0.85.[[email protected]].(103). [[email protected]].(249). [[email protected]].(354).


Artemether.lumefantrine. . . .



[email protected].(QA.ACT)' . . .



[email protected].([email protected]). . . .


2015. $1.72. $3.44. $3.44.[[email protected]].(54). [[email protected]].(1,062). [[email protected]].(1,139).

Sufladoxine.pyrimethamine' . . .



*[email protected][email protected].(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..

Source:.ACTwatch.Outlet.Survey,.DRC,.2013,.2015..''''


Table'E6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'across'survey'round,'Katanga.


[email protected].

ALL'Public/Not'ForC

Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking. 2013.N=51.2015.N=261.

2013.N=45.2015.N=19.

2013.N=96.2015.N=315.

2013.N=134.2015.N=141.

2013.N=529.2015.N=558.

2013.N=677.2015.N=706.

2013.N=773.2015.N=1,021.

Any.malaria.blood.testing. . . . . . . .

2013' 75.8. 75.6. 75.7. 72.7. 6.2. 20.6. 30.0.(59.1,.87.2). (51.6,.90.0). (62.9,.85.2). (61.1,.81.8). (4.3,.8.7). (16.5,.25.4). (26.5,.33.7).

2015. 86.8. 100.0. 88.5. 55.6. 9.8. 19.0. 37.1.(79.5,.91.7). @. (80.4,.93.5). (45.8,.65.1). (6.4,.14.8). (14.9,.24.0). (30.7,.43.9).

. . . . . . . .

Malaria.microscopy. . . . . . . .

2013' 45.0. 50.2. 47.0. 49.2. 2.1. 12.3. 18.2.(31.0,.59.8). (29.8,.70.5). (35.7,.58.5). (35.2,.63.3). (0.9,.4.8). (9.7,.15.6). (15.6,.21.2).

2015. 28.0. 55.2. 23.3. 23.4. 0.8. 5.4. 10.1.(21.3,.35.8). (30.3,.77.7). (16.8,.31.4). (15.6,.33.4). (0.4,.1.8). (4.0,.7.4). (8.2,.12.3).

. . . . . . . .

Rapid.diagnostic.tests.(RDTs). . . . . . . .

2013' 54.0. 39.2. 48.4. 45.4. 5.4. 14.1. 19.9.(34.5,.72.3). (21.7,.59.9). (34.4,.62.6). (33.4,.58.0). (3.8,.7.8). (10.3,.18.9). (16.1,.24.4).

2015. 84.1. 89.1. 85.1. 45.9. 9.6. 16.9. 34.5.(76.2,.89.7). (63.2,.97.5). (77.5,.90.4). (36.5,.55.5). (6.2,.14.7). (12.7,.22.1). (28.2,.41.5).

*. 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'E8:'Price'of'malaria'blood'testing'for'adults,'by'outlet'type,'across'survey'round,'Katanga'

'Private.

[email protected].





Microscopy.for.adults. .. .



Microscopy.for.children.under.five. . . .



Malaria.RDT.for.adults. .. .



Malaria.RDT.for.children.under.five. . . .



*. Total.price.to.the.consumer.including.consultation.and/or.service.fees..

Source:.ACTwatch.Outlet.Survey,.DRC,.2013,.2015..'' '


'

Table'E9:'Antimalarial'market'share,'across'survey'round,'Katanga'.

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


Community.Health.

Worker.Ω.

[email protected]'

TOTAL'Public/Not'ForCProfit'

[email protected].


TOTAL'Private.

ANTICMALARIAL'TOTAL***'

%. . %. %. %. . %. . %. %.

'2013.1.'Any'ACT' 6.0' C' 2.5' 8.5' 8.9' 0.0' 22.0' 0.1' 31.0' 39.5'

Artesunate.amodiaquine. 5.5. @. 1.2. 6.7. 8.0. 0.0. 3.7. 0.0. 11.8. 18.4.Artemether.lumefantrine. 0.4. @. 1.3. 1.7. 0.7. 0.0. 14.5. 0.1. 15.3. 16.9.Quality@assured.(QA).ACT. 5.3. @. 1.8. 7.1. 8.4. 0.0. 9.8. 0.1. 18.2. [email protected].([email protected]). 0.7. @. 0.7. 1.4. 0.5. 0.0. 12.3. 0.0. 12.8. 14.2.Nationally.registered.ACT. 4.8. @. 1.3. 6.2. 8.1. 0.0. 5.4. 0.0. 13.6. 19.7.

2.'Any'nonCartemisinin'therapy' 4.2' C' 1.5' 5.7' 6.7' 0.0' 43.8' 0.0' 53.1' 58.7'Sufladoxine.pyrimethamine. 3.4. @. 1.0. 4.5. 4.0. 0.0. 32.5. 0.0. 38.6. 43.1.

3.'Oral'artemisinin'monotherapy' 0.0' C' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 0.2' C' 0.2' 0.3' 0.2' 0.0' 1.2' 0.0' 1.4' 1.7'

Artesunate.IV/IM. 0.0. @. 0.0. 0.0. 0.0. 0.0. 0.2. 0.0. 0.2. 0.3.Artemether.IV/IM. 0.0. @. 0.1. 0.2. 0.1. 0.0. 1.0. 0.0. 1.1. 1.3.

Any.treatment.for.severe.malaria. 0.3. @. 0.2. 0.5. 0.4. 0.0. 1.8. 0.0. 2.2. 2.7.OUTLET'TYPE'TOTAL**' 10.4' C' 4.2' 14.5' 15.8' 0.0' 67.0' 0.1' 85.5' 100.0'

2015.1.'Any'ACT' 14.5. 0.6. 0.9. 16.0. 5.1. 1.0. 29.5. C. 35.6. 51.6.

Artesunate.amodiaquine. 13.6. 0.6. 0.7. 14.9. 2.6. 0.0. 7.1. @. 9.7. 24.7.Artemether.lumefantrine. 0.9. 0.0. 0.2. 1.0. 2.2. 0.6. 18.1. C. 20.9. 21.9.Quality@assured.(QA).ACT. 13.8. 0.6. 0.8. 15.2. 3.2. 0.3. 12.5. @. 16.0. [email protected].([email protected]). 0.8. 0.0. 0.1. 0.8. 1.9. 0.7. 17.0. C. 19.6. 20.4.Nationally.registered.ACT. 13.8. 0.6. 0.9. 15.3. 3.9. 0.7. 19.2. @. 23.8. 39.1.

2.'Any'nonCartemisinin'therapy' 8.3. 0.0. 2.0. 10.3. 5.6. 0.5. 28.8. C. 34.9. 45.2.Sufladoxine.pyrimethamine. 6.4. 0.0. 1.2. 7.6. 4.3. 0.2. 19.3. @. 23.9. 31.5.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. C. 0.0. 0.0.4.'NonCoral'artemisinin'monotherapy' 0.1. 0.0. 0.1. 0.2. 0.4. 0.1. 2.6. @. 3.0. 3.1.

Artesunate.IV/IM. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. C. 0.1. 0.1.Artemether.IV/IM. 0.0. 0.0. 0.0. 0.1. 0.2. 0.0. 0.6. @. 0.8. 0.8.

Any.treatment.for.severe.malaria' 0.5. 0.0. 0.1. 0.6. 0.6. 0.1. 3.1. C. 3.7. 4.3.OUTLET'TYPE'TOTAL**' 22.9. 0.6. 3.0. 26.5. 11.1. 1.6. 60.9. @. 73.5. 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%[email protected].–.antimalarial.total.column.(within.survey.round)...Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2013.DRC.outlet.survey.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..

Source:.ACTwatch.Outlet.Survey,.DRC,.2013,.2015...'


Table'E10:'Antimalarial'market'share'within'outlet'type,'across'survey'round,'Katanga'.




Ω.

[email protected]'


[email protected].


TOTAL'Private.

%. . %. %. %. . %. . %.

'2013.1.'Any'ACT' 57.6' C' 61.1' 58.6' 56.4' 0.0' 32.9' 3.5' 36.3'

Artesunate.amodiaquine. 52.6. @. 29.4. 46.0. 50.5. 0.0. 5.6. 1.5. 13.8.Artemether.lumefantrine. 3.9. @. 30.4. 11.5. 4.7. 0.0. 21.6. 1.9. 17.9.Quality@assured.(QA).ACT. 50.8. @. 44.6. 49.0. 53.0. 0.0. 14.6. 3.4. [email protected].([email protected]). 6.8. @. 16.6. 9.6. 3.4. 0.0. 18.3. 0.1. 15.0.Nationally.registered.ACT. 46.8. @. 31.6. 42.4. 51.1. 0.0. 8.1. 1.5. 15.9.

2.'Any'nonCartemisinin'therapy' 40.7' C' 35.2' 39.1' 42.6' 0.0' 65.3' 96.5' 62.1'Sufladoxine.pyrimethamine. 33.3. @. 25.0. 30.9. 25.4. 0.0. 48.6. 75.9. 45.1.

3.'Oral'artemisinin'monotherapy' 0.0' C' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 1.7' C' 3.7' 2.3' 1.1' 0.0' 1.8' 0.0' 1.6'

Artesunate.IV/IM. 0.1. @. 0.2. 0.1. 0.1. 0.0. 0.3. 0.0. 0.3.Artemether.IV/IM. 0.3. @. 3.4. 1.2. 0.9. 0.0. 1.5. 0.0. 1.3.

Any.treatment.for.severe.malaria. 2.7. @. 4.9. 3.3. 2.6. 0.0. 2.6. 1.2. 2.6.2015.1.'Any'ACT' 63.5. 94.7. 30.5. 60.5. 45.9. 63.8. 48.4. C. 48.4.

Artesunate.amodiaquine. 59.5. 94.7. 23.2. 56.2. 23.8. 0.0. 11.7. @. 13.3.Artemether.lumefantrine. 3.7. 0.0. 5.9. 3.9. 19.7. 36.2. 29.8. C. 28.4.Quality@assured.(QA).ACT. 60.2. 94.7. 27.4. 57.3. 29.1. 17.2. 20.5. @. [email protected].([email protected]). 3.3. 0.0. 3.1. 3.2. 16.7. 46.6. 27.9. C. 26.7.Nationally.registered.ACT. 60.4. 94.7. 28.7. 57.7. 35.0. 45.5. 31.6. @. 32.4.

2.'Any'nonCartemisinin'therapy' 36.2. 3.5. 67.5. 38.9. 50.8. 32.7. 47.3. C. 47.5.Sufladoxine.pyrimethamine. 27.8. 3.5. 42.0. 28.8. 38.9. 14.0. 31.8. @. 32.5.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. C. 0.0.4.'NonCoral'artemisinin'monotherapy' 0.4. 1.7. 2.0. 0.6. 3.3. 3.5. 4.2. @. 4.1.

Artesunate.IV/IM. 0.0. 0.0. 0.0. 0.0. 0.3. 0.0. 0.0. C. 0.1.Artemether.IV/IM. 0.1. 0.0. 1.5. 0.2. 1.4. 0.0. 1.0. @. 1.1.

Any.treatment.for.severe.malaria' 2.0. 1.7. 4.2. 2.2. 5.3. 4.5. 5.0. C. 5.1.*. Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2013.DRC.outlet.survey.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..

Categories.1.through.4.sum.to.100%.within.each.column..

Source:.ACTwatch.Outlet.Survey,.DRC,.2013,.2015..'' '


'

Table'E14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'survey'round,'Katanga.


[email protected]'

ALL'Public'/'Not'forC

profit'

[email protected].


ALL'Outlets'

. %.(95%.CI).

.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'providers'who:' 2013.N=51.2015.N=261.

2013.N=45.2015.N=20.

2013.N=96.2015.N=316.

2013.N=134.2015.N=141.

2013.N=536.2015.N=563.

2013.N=689.2015.N=711.

2013.N=785.2015.N=1,027.

Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria!' . . . . . . .

2013' 70.6. 56.5. 65.3. 39.7. 17.4. 21.5. 28.8.(53.1,.83.6). (37.3,.73.9). (52.7,.76.0). (28.6,.52.0). (14.4,.20.7). (18.0,.25.5). (25.3,.32.7).

2015.82.5. 76.3. 75.6. 45.4. 28.6. 32.0. 43.3.

(74.1,.88.6). (54.1,.89.8). (63.5,.84.6). (37.5,.53.6). (23.2,.34.7). (27.6,.36.8). (39.6,.47.1)[email protected]' . . . . . . .

2013' 34.4. 16.3. 27.6. 6.7. 2.4. 3.4. 7.4.(20.0,.52.4). (6.3,.36.2). (17.6,.40.5). (2.7,.15.6). (1.2,.4.9). (1.9,.5.8). (5.1,.10.7).

2015'39.4. 19.0. 27.5. 12.5. 5.8. 7.1. 12.4.

(31.1,.48.4). (3.9,.57.4). (18.6,.38.8). (6.9,.21.6). (3.9,.8.6). (5.0,.9.9). (9.7,.15.6)[email protected]@[email protected]' . . . . . . .

2013' 37.3. 18.3. 30.1. 14.0. 3.7. 5.7. 9.8.(21.0,.57.1). (7.1,.39.8). (18.2,.45.5). (5.9,.29.6). (1.9,.7.1). (3.1,.10.5). (6.4,.14.7).

2015'54.6. 5.4. 42.1. 17.0. 5.0. 7.4. 16.4.

(45.9,.63.1). (0.8,.28.5). (31.1,.54.0). (11.1,.25.2). (3.2,.7.6). (5.2,.10.3). (13.3,.19.9).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for.adults. . . . . . . .

2013' 65.2. 61.2. 63.7. 44.3. 20.9. 25.7. 32.1.(47.1,.79.7). (42.1,.77.4). (50.6,.75.0). (33.5,.55.7). (16.7,.25.8). (21.7,.30.1). (27.2,.37.4).

2015.79.7. 71.3. 67.7. 39.6. 28.8. 31.2. 40.7.

(72.7,.85.2). (45.3,.88.2). (58.0,.76.2). (31.3,.48.6). (21.7,.37.0). (25.3,.37.9). (36.5,.45.1).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for.children. . . . . . . .

2013. 65.3. 52.3. 60.4. 51.2. 22.5. 28.3. 33.7.(47.0,.80.0). (34.4,.69.6). (47.7,.71.8). (40.2,.62.1). (17.6,.28.2). (23.7,.33.4). (28.8,.39.0).

2015'78.6. 61.3. 71.4. 40.1. 22.6. 27.0. 38.5.

(71.2,.84.5). (36.8,.81.1). (61.2,.79.7). (31.0,.50.0). (17.1,.29.2). (21.6,.33.3). (34.0,.43.3).

!. At.the.time.of.the.2013.and.2015.ACTwatch.outlet.surveys,.artesunate.amodiaquine.and.artemether.lumefantrine.were.DRC’s.first@line.treatment.for.uncomplicated.malaria..Numbers.of.providers.(N).in.this.table.are.the.total.number.of.providers.eligible.for.table.indicators..


.

.

.'


Results'Section'F:'Results'by'survey'year,'Kinshasa'Province'

Table'F1:'Availability'of'antimalarials,'among'all'screened'outlets,'by'outlet'type,'across'survey'round,'Kinshasa'


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'

Proportion'of'outlets*'stocking:.2009.N=28.2013.N=26.2015.N=205.

2009.N=6.2013.N=66.2015.N=79.

2009.N=34.2013.N=92.2015.N=296.

2009.N=125.2013.N=367.2015.N=327.

2009.N=29.2013.N=3.2015.N=61.

2009.N=654.2013.N=741.2015.N=574.

2009.N=2,334.2013.N=3,272.2015.N=872.

2009.N=2,368.2013.N=3,364.2015.N=1,168.

Any.antimalarial.at.the.time.of.survey.visit. . . . . . . . .

2009.87.6. 100. 90.5. 49.8. 100. 98.6. 12.4. 13.4.

(60.3,.97.0). @. (73.5,.97.1). (38.7,.60.9). @. (95.3,.99.6). (9.6,.15.8). (10.9,.16.4).

2013. 77.2. 50.4. 57.7. 50.4. 100. 94.5. 27.6. 28.4.(58.1,.89.2). (29.3,.71.4). (39.5,.74.0). (43.1,.57.6). @. (92.4,.96.0). (24.8,.30.5). (25.7,.31.2).

2015.98.5. 72.8. 77.5. 63.4. 100.0. 97.8. 88.3. 87.0.

(95.8,.99.4). (60.2,.82.6). (68.2,.84.6). (52.7,.73.0). @. (94.5,.99.1). (82.4,.92.4). (82.2,.90.7).Any.ACT. . . . . . . . .

2009. 59.9. 61.9. 60.4. 16.5. 100. 74.3. 8.2. 8.9.(33.5,.81.6). (35.6,.82.7). (39.8,.77.9). (9.4,.27.4). @. (68.5,.79.3). (6.6,.10.1). (7.4,.10.6).

2013.45.2. 31.3. 35.1. 31.5. 100. 85.5. 23.6. 23.9.

(21.0,.71.8). (17.8,.49.1). (23.0,.49.5). (26.5,.37.0). @. (82.1,.88.4). (21.5,.25.8). (21.9,.26.1).

2015.93.4. 53.4. 64.5. 42.1. 99.3. 89.6. 76.6. 75.2.

(86.5,.96.9). (42.1,.64.4). (55.5,.72.6). (33.9,.50.7). (94.2,.99.9). (83.4,.93.7). (69.4,.82.5). (68.8,.80.6).


. 43.2. 48.6. 44.5. 13.0. 69.0. 46.0. 5.3. 5.8.(27.3,.60.6). (20.0,.78.1). (28.9,.61.2). (7.0,.23.1). (47.0,.84.8). (40.8,.51.2). (4.2,.6.7). (4.7,.7.1).

2013.45.2. 23.2. 29.1. 17.3. 0.0. 23.8. 7.3. 7.9.

(21.0,.71.8). (11.7,.40.7). (17.9,.43.7). (13.4,.21.9). @. (19.6,.28.5). (6.4,.8.4). (7.0,.9.0).

2015.87.0. 32.1. 51.4. 21.4. 27.2. 32.1. 29.0. 31.6.


2009.1.4. 0.0. 1.1. 4.7. 63.7. 44.5. 4.6. 4.6.

(0.1,.14.3). @. (0.1,.10.4). (2.1,.10.1). (46.0,.78.4). (38.2,.51.0). (3.5,.6.1). (3.4,.6.1).

2013.13.7. 12.5. 12.8. 20.1. 100. 83.9. 22.1. 21.9.

(4.3,.35.9). (5.6,.25.7). (6.8,.22.9). (14.7,.26.9). @. (80.5,.86.9). (20.0,.24.5). (19.8,.24.2).

2015. 38.0. 28.0. 28.2. 25.4. 96.1. 87.2. 70.2. 65.4.(31.9,.44.5). (14.4,.47.5). (19.8,.38.6). (19.6,.32.2). (83.1,.99.2). (80.9,.91.7). (63.7,.76.0). (59.0,.71.3).

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=66.2015.N=79.

2009.N=34.2013.N=92.2015.N=296.

2009.N=125.2013.N=367.2015.N=327.

2009.N=29.2013.N=3.2015.N=61.

2009.N=654.2013.N=741.2015.N=574.

2009.N=2,334.2013.N=3,272.2015.N=872.

2009.N=2,368.2013.N=3,364.2015.N=1,168.

[email protected].(QA.ACT). . . . . . . . .

2009.42.5. 48.6. 43.9. 7.8. 45.9. 10.9. 1.7. 2.3.

(26.5,.60.3). (20.0,.78.1). (28.2,.61.0). (3.6,.16.1). (31.7,.60.8). (8.4,.14.1). (1.3,.2.3). (1.7,.3.1).

2013.45.2. 22.5. 28.7. 12.5. 61.7. 8.6. 3.3. 4.0.

(21.0,.71.8). (11.2,.40.1). (17.5,.43.2). (8.2,.18.5). (11.3,.95.3). (5.5,.13.2). (2.5,.4.4). (3.1,.5.1).

2015.85.4. 29.3. 49.4. 20.2. 64.3. 18.6. 19.8. 23.2.

(78.3,.90.4). (19.5,.41.4). (40.2,.58.6). (12.4,.31.2). (46.1,.79.1). (14.7,.23.1). (15.9,.24.4). (19.6,.27.1)[email protected].([email protected])' . . . . . . . .

2009.19.6. 13.3. 18.1. 9.5. 94.8. 71.5. 7.5. 7.6.

(11.7,.30.9). (1.1,.68.3). (9.6,.31.5). (5.4,.16.1). (66.7,.99.4). (64.9,.77.4). (6.0,.9.4). (6.2,.9.4).

2013.13.7. 13.3. 13.4. 22.1. 100. 85.5. 22.7. 22.5.

(4.3,.35.9). (6.1,.26.5). (7.2,.23.6). (16.2,.29.5). @. (82.1,.88.4). (20.5,.25.1). (20.3,.24.8).

2015.43.5. 28.3. 30.4. 30.3. 98.1. 89.3. 73.1. 68.2.

(37.4,.49.7). (14.6,.47.7). (22.0,.40.4). (24.6,.36.6). (89.5,.99.7). (83.1,.93.4). (66.0,.79.1). (61.4,.74.3)[email protected]. . . . . . . . .

2009.83.1. 72.8. 80.6. 46.4. 98.2. 97.7. 12.0. 12.9.

(48.2,.96.3). (52.9,.86.4). (52.3,.94.1). (35.1,.58.1). (85.1,.99.8). (95.0,.98.9). (9.3,.15.5). (10.4,.15.9).

2013.62.5. 43.1. 48.3. 36.0. 80.0. 91.5. 25.5. 26.1.

(39.1,.81.3). (24.4,.64.0). (32.4,.64.7). (29.2,.43.4). (25.0,.98.0). (88.7,.93.7). (22.8,.28.3). (23.6,.28.8).

2015.81.5. 61.1. 62.4. 45.1. 100.0. 94.3. 80.7. 78.6.


2009.36.3. 51.4. 39.9. 12.3. 46.9. 75.6. 7.7. 8.1.

(20.4,.55.9). (21.9,.80.0). (26.3,.55.2). (7.3,.20.0). (13.4,.83.4). (70.9,.79.7). (5.7,.10.3). (6.3,.10.4).

2013.20.9. 19.9. 20.2. 12.0. 80.0. 70.0. 18.0. 18.1.

(9.4,.40.4). (9.8,.36.1). (11.7,.32.5). (8.0,.17.5). (25.0,.98.0). (64.1,.75.3). (15.9,.20.4). (16.0,.20.4).

2015.45.6. 31.0. 33.9. 13.3. 72.4. 69.8. 54.1. 51.8.

(35.3,.56.2). (19.9,.44.7). (24.9,.44.2). (8.6,.19.9). (60.4,.81.8). (62.8,.76.0). (47.7,.60.4). (46.0,.57.6).Oral.quinine. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=66.2015.N=79.

2009.N=34.2013.N=92.2015.N=296.

2009.N=125.2013.N=367.2015.N=327.

2009.N=29.2013.N=3.2015.N=61.

2009.N=654.2013.N=741.2015.N=574.

2009.N=2,334.2013.N=3,272.2015.N=872.

2009.N=2,368.2013.N=3,364.2015.N=1,168.

2009.79.8. 56.1. 74.2. 26.5. 95.0. 89.0. 10.1. 10.9.

(42.5,.95.5). (29.0,.79.9). (42.4,.91.8). (17.5,.38.2). (80.2,.98.9). (85.4,.91.7). (7.7,.13.1). (8.7,.13.6).

2013.42.0. 26.0. 30.3. 22.3. 80.0. 88.0. 23.3. 23.5.

(25.8,.60.2). (14.5,.42.0). (20.5,.42.3). (17.4,.28.0). (25.0,.98.0). (84.6,.90.8). (20.9,.25.9). (21.2,.26.0).

2015.63.1. 42.5. 44.9. 28.4. 96.6. 88.4. 71.9. 68.8.

(52.7,.72.3). (27.6,.59.0). (34.5,.55.7). (22.6,.35.0). (89.9,.98.9). (84.8,.91.2). (67.3,.76.1). (64.6,.72.6).Oral.artemisinin.monotherapy. . . . . . . . .

2009.26.7. 13.3. 23.5. 16.3. 76.2. 82.0. 8.7. 8.9.

(19.5,.35.4). (1.1,.68.3). (14.4,.36.1). (9.5,.26.6). (45.1,.92.6). (77.3,.85.9). (6.6,.11.3). (6.9,.11.4).

2013.0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.0. 0.0.@. @. @. @. @. (0.0,.0.4). (0.0,.0.1). (0.0,.0.1).

2015.0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.4. 0.4.@. @. @. @. @. (0.2,.2.0). (0.1,.1.4). (0.1,.1.3).

[email protected]' . . . . . . . .

2009.16.4. 13.3. 15.7. 15.7. 27.4. 31.5. 3.9. 4.0.

(7.8,.31.4). (1.1,.68.3). (7.3,.30.7). (9.0,.26.1). (8.3,.61.4). (27.5,.35.8). (2.9,.5.2). (3.1,.5.2).

2013.34.6. 21.8. 25.3. 29.1. 80.0. 72.6. 20.3. 20.4.

(16.7,.58.3). (11.0,.38.7). (15.1,.39.2). (24.0,.34.9). (25.0,.98.0). (68.4,.76.4). (18.1,.22.6). (18.3,.22.6).

2015.43.8. 41.8. 37.3. 32.6. 86.8. 81.6. 68.1. 64.6.

(33.9,.54.2). (24.9,.61.0). (27.0,.48.9). (24.9,.41.3). (80.5,.91.4). (77.7,.85.0). (63.5,.72.3). (60.3,.68.6).Any.treatment.for.severe.malaria' . . . . . . . .

2009.38.7. 34.7. 37.8. 39.9. 38.2. 41.7. 6.3. 6.8.

(22.5,.57.8). (16.5,.58.8). (23.5,.54.5). (30.4,.50.2). (12.0,.73.7). (37.4,.46.2). (4.7,.8.5). (5.3,.8.6).

2013'61.3. 31.8. 39.8. 40.2. 80.0. 76.3. 22.2. 22.7.

(38.6,.80.0). (17.7,.50.1). (26.4,.54.8). (34.3,.46.5). (25.0,.98.0). (71.7,.80.4). (19.6,.25.1). (20.2,.25.4).

2015'65.6. 52.9. 51.0. 44.7. 88.2. 84.3. 73.4. 70.8.

(55.3,.74.6). (32.9,.72.1). (39.4,.62.6). (33.5,.56.4). (80.9,.93.0). (80.4,.87.6). (68.2,.78.0). (66.1,.75.1).. . . . . . . . .. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=66.2015.N=79.

2009.N=34.2013.N=92.2015.N=296.

2009.N=125.2013.N=367.2015.N=327.

2009.N=29.2013.N=3.2015.N=61.

2009.N=654.2013.N=741.2015.N=574.

2009.N=2,334.2013.N=3,272.2015.N=872.

2009.N=2,368.2013.N=3,364.2015.N=1,168.

Artesunate.IV/IM. . . . . . . . .

2009.2.2. 0.0. 1.7. 0.0. 4.2. 0.2. 0.0. 0.1.

(0.2,.18.6). @. (0.2,.10.5). @. (0.8,.19.3). (0.0,.0.8). (0.0,.0.1). (0.0,.0.2).

2013'6.4. 9.0. 8.3. 5.1. 41.7. 31.6. 8.1. 8.1.

(0.9,.35.3). (3.9,.19.6). (3.8,.17.3). (2.8,.9.2). (5.4,.89.9). (26.7,.36.9). (6.5,.10.0). (6.6,.9.9).

2015'17.9. 12.8. 13.1. 9.6. 37.4. 17.8. 15.8. 15.5.

(10.4,.29.1). (5.1,.28.3). (7.1,.22.9). (6.1,.14.9). (27.1,.48.9). (15.0,.21.1). (12.9,.19.3). (12.6,.19.0).

*. 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,.DRC,.2009,.2013,.2015..

.

. .


.

Table'F2:'Availability'of'antimalarials,'among'outlets'stocking'at'least'one'antimalarial,'by'outlet'type,'across'survey'round,'Kinshasa.


[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=41.2015.N=63.

2009.N=34.2013.N=62.2015.N=269.

2009.N=62.2013.N=172.2015.N=163.

2009.N=29.2013.N=3.2015.N=61.

2009.N=647.2013.N=693.2015.N=563.

2009.N=738.2013.N=869.2015.N=787.

2009.N=766.2013.N=931.2015.N=1,056.

Any.ACT. . . . . . . . .

2009.68.4. 61.9. 66.7. 33.1. 100. 75.3. 66.4. 66.4.

(45.5,.84.9). (35.6,.82.7). (49.1,.80.6). (18.0,.52.7). @. (69.6,.80.2). (59.3,.72.7). (59.6,.72.6).

2013.58.5. 62.1. 60.8. 62.6. 100. 90.6. 85.6. 84.3.

(26.1,.85.0). (45.9,.76.0). (44.3,.75.2). (52.9,.71.4). @. (86.8,.93.4). (81.1,.89.2). (79.9,.87.8).

2015.94.8. 73.4. 83.2. 66.4. 99.3. 91.6. 86.7. 86.4.

(86.9,.98.1). (60.5,.83.2). (73.9,.89.7). (55.3,.75.9). (94.2,.99.9). (85.3,.95.4). (79.8,.91.5). (79.8,.91.0).


2009.49.3. 48.6. 49.1. 26.2. 69.0. 46.6. 42.9. 43.4.

(34.0,.64.8). (20.0,.78.1). (33.4,.65.0). (13.4,.44.9). (47.0,.84.8). (41.5,.51.8). (37.2,.48.7). (38.0,.49.0).

2013.58.5. 45.9. 50.5. 34.3. 0.0. 25.1. 26.6. 27.9.

(26.1,.85.0). (27.7,.65.4). (34.1,.66.8). (26.8,.42.5). @. (20.8,.30.0). (23.3,.30.2). (24.7,.31.3).

2015.88.4. 44.1. 66.3. 33.8. 27.2. 32.8. 32.9. 36.3.

(80.8,.93.2). (29.4,.59.9). (54.3,.76.6). (24.0,.45.2). (15.2,.43.7). (26.3,.40.1). (27.4,.39.0). (31.4,.41.6).


2009.1.6. 0.0. 1.2. 9.4. 63.7. 45.1. 37.4. 34.2.

(0.1,.17.2). @. (0.1,.11.8). (4.6,.18.3). (46.0,.78.4). (38.8,.51.6). (32.2,.43.0). (29.0,.39.9).

2013.17.7. 24.8. 22.2. 40.0. 100. 88.9. 80.3. 77.1.

(5.6,.43.7). (12.3,.43.7). (12.2,.37.1). (29.1,.52.0). @. (85.2,.91.7). (74.6,.85.0). (71.9,.81.6).

2015.38.6. 38.5. 36.4. 40.1. 96.1. 89.2. 79.5. 75.1.

(32.3,.45.3). (20.8,.59.8). (26.8,.47.4). (29.7,.51.4). (83.1,.99.2). (82.6,.93.5). (72.7,.85.0). (68.2,.81.0)[email protected].(QA.ACT). . . . . . . . .

2009.48.5. 48.6. 48.5. 15.7. 45.9. 11.1. 14.1. 17.2.

(33.3,.64.1). (20.0,.78.1). (32.8,.64.6). (6.7,.32.5). (31.7,.60.8). (8.6,.14.2). (10.6,.18.6). (12.3,.23.4).




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=41.2015.N=63.

2009.N=34.2013.N=62.2015.N=269.

2009.N=62.2013.N=172.2015.N=163.

2009.N=29.2013.N=3.2015.N=61.

2009.N=647.2013.N=693.2015.N=563.

2009.N=738.2013.N=869.2015.N=787.

2009.N=766.2013.N=931.2015.N=1,056.

2013.58.5. 44.6. 49.7. 24.7. 61.7. 9.1. 12.1. 14.2.

(26.1,.85.0). (26.5,.64.3). (33.4,.66.0). (16.1,.36.0). (11.3,.95.3). (5.8,.14.0). (9.0,.16.1). (10.9,.18.2).

2015.86.7. 40.2. 63.7. 31.9. 64.3. 19.0. 22.4. 26.6.

(78.7,.92.0). (24.9,.57.6). (50.1,.75.4). (22.0,.43.8). (46.1,.79.1). (15.0,.23.7). (18.2,.27.2). (22.8,.30.8)[email protected].([email protected])' . . . . . . . .

2009.22.3. 13.3. 20.0. 19.0. 94.8. 72.6. 60.7. 57.1.

(15.3,.31.5). (1.1,.68.3). (11.4,.32.8). (11.3,.30.3). (66.7,.99.4). (65.9,.78.3). (55.2,.66.0). (51.8,.62.3).

2013.17.7. 26.3. 23.2. 44.0. 100. 90.5. 82.4. 79.1.

(5.6,.43.7). (13.3,.45.3). (12.9,.38.1). (31.5,.57.2). @. (86.7,.93.3). (76.4,.87.1). (73.7,.83.7).

2015.44.1. 38.9. 39.3. 47.7. 98.1. 91.3. 82.8. 78.3.

(38.0,.50.5). (21.2,.60.1). (29.7,.49.8). (37.3,.58.3). (89.5,.99.7). (85.0,.95.1). (75.6,.88.1). (71.0,.84.2)[email protected]. . . . . . . . .

2009.94.8. 72.8. 89.1. 93.2. 98.2. 99.1. 97.6. 96.8.

(69.1,.99.3). (52.9,.86.4). (65.8,.97.2). (82.4,.97.6). (85.1,.99.8). (98.0,.99.6). (95.1,.98.8). (94.6,.98.2).

2013.81.0. 85.4. 83.8. 71.4. 80.0. 96.9. 92.4. 91.9.

(59.6,.92.5). (71.5,.93.1). (72.9,.90.9). (63.8,.78.0). (25.0,.98.0). (94.1,.98.4). (89.6,.94.4). (89.4,.93.8).

2015.82.7. 83.8. 80.5. 71.1. 100.0. 96.4. 91.4. 90.3.


2009.41.5. 51.4. 44.1. 24.7. 46.9. 76.7. 62.3. 60.7.

(28.4,.55.9). (21.9,.80.0). (31.4,.57.5). (16.1,.36.0). (13.4,.83.4). (72.3,.80.6). (57.4,.67.0). (54.9,.66.2).

2013.27.1. 39.4. 34.9. 23.8. 80.0. 74.1. 65.4. 63.7.

(12.2,.49.9). (22.0,.60.0). (21.5,.51.3). (16.3,.33.4). (25.0,.98.0). (67.8,.79.6). (60.0,.70.4). (58.7,.68.5).

2015.46.3. 42.5. 43.7. 20.9. 72.4. 71.4. 61.3. 59.5.

(36.0,.56.9). (27.0,.59.6). (32.3,.55.9). (14.6,.29.1). (60.4,.81.8). (64.8,.77.1). (56.1,.66.3). (54.5,.64.4).Oral.quinine. . . . . . . . .

2009.91.1. 56.1. 81.9. 53.3. 95.0. 90.2. 81.5. 81.5.

(62.9,.98.4). (29.0,.79.9). (52.1,.95.0). (39.3,.66.8). (80.2,.98.9). (87.2,.92.6). (75.8,.86.1). (75.5,.86.3).

. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=41.2015.N=63.

2009.N=34.2013.N=62.2015.N=269.

2009.N=62.2013.N=172.2015.N=163.

2009.N=29.2013.N=3.2015.N=61.

2009.N=647.2013.N=693.2015.N=563.

2009.N=738.2013.N=869.2015.N=787.

2009.N=766.2013.N=931.2015.N=1,056.

2013.54.4. 51.5. 52.6. 44.2. 80.0. 93.2. 84.6. 82.8.

(31.6,.75.5). (37.2,.65.6). (40.6,.64.2). (37.1,.51.6). (25.0,.98.0). (90.1,.95.4). (82.1,.86.7). (80.2,.85.1).

2015.64.1. 58.4. 57.9. 44.7. 96.6. 90.4. 81.4. 79.0.

(53.6,.73.3). (39.8,.74.9). (47.1,.68.0). (37.8,.51.9). (89.9,.98.9). (86.7,.93.1). (78.1,.84.3). (75.6,.82.1).Oral.artemisinin.monotherapy. . . . . . . . .

2009.30.4. 13.3. 26.0. 32.7. 76.2. 83.2. 70.4. 66.5.

(19.7,.43.9). (1.1,.68.3). (15.4,.40.3). (19.9,.48.7). (45.1,.92.6). (78.7,.86.9). (65.4,.75.0). (59.2,.73.1).

2013.0.0. 0.0. 0.0. 0.0. 0.0. 0.1. 0.1. 0.1.@. @. @. @. @. (0.0,.0.5). (0.0,.0.4). (0.0,.0.4).

2015.0.0. 0.0. 0.0. 0.0. 0.0. 0.6. 0.5. 0.4.@. @. @. @. @. (0.2,.2.0). (0.1,.1.6). (0.1,.1.5).

[email protected]' . . . . . . . .

2009.18.7. 13.3. 17.3. 31.6. 27.4. 32.0. 31.6. 30.3.

(10.5,.31.1). (1.1,.68.3). (8.7,.31.5). (19.8,.46.4). (8.3,.61.4). (27.8,.36.4). (27.9,.35.6). (26.6,.34.3).

2013.44.9. 43.3. 43.9. 57.9. 80.0. 76.8. 73.5. 71.8.

(23.3,.68.6). (25.6,.62.9). (29.4,.59.5). (47.2,.67.9). (25.0,.98.0). (72.7,.80.5). (69.8,.76.8). (68.2,.75.2).

2015.44.5. 57.4. 48.2. 51.4. 86.8. 83.5. 77.1. 74.2.

(34.4,.55.0). (34.8,.77.4). (35.5,.61.2). (42.8,.59.8). (80.5,.91.4). (79.6,.86.8). (73.8,.80.1). (70.7,.77.4).Any.treatment.for.severe.malaria' . . . . . . . .

2009.44.2. 34.7. 41.7. 80.1. 38.2. 42.3. 51.3. 50.5.

(30.3,.59.0). (16.5,.58.8). (28.8,.55.9). (65.7,.89.4). (12.0,.73.7). (38.0,.46.8). (46.4,.56.2). (45.6,.55.3).

2013'79.4. 62.9. 68.9. 79.9. 80.0. 80.8. 80.6. 79.9.

(58.2,.91.5). (45.2,.77.8). (55.0,.80.1). (71.4,.86.4). (25.0,.98.0). (76.2,.84.6). (76.6,.83.9). (76.2,.83.2).

2015'66.6. 72.6. 65.9. 70.4. 88.2. 86.2. 83.1. 81.4.

(56.2,.75.7). (44.1,.89.9). (52.2,.77.4). (57.2,.80.9). (80.9,.93.0). (82.4,.89.3). (80.0,.85.8). (78.2,.84.1).Artesunate.IV/IM. . . . . . . . .

2009.2.5. 0.0. 1.8. 0.0. 4.2. 0.2. 0.4. 0.5.

(0.2,.22.8). @. (0.3,.11.9). @. (0.8,.19.3). (0.0,.0.8). (0.1,.1.0). (0.2,.1.1).. . . . . . . . .




[email protected]'


Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI)'


2009.N=6.2013.N=41.2015.N=63.

2009.N=34.2013.N=62.2015.N=269.

2009.N=62.2013.N=172.2015.N=163.

2009.N=29.2013.N=3.2015.N=61.

2009.N=647.2013.N=693.2015.N=563.

2009.N=738.2013.N=869.2015.N=787.

2009.N=766.2013.N=931.2015.N=1,056.

2013'8.3. 17.9. 14.4. 10.2. 41.7. 33.4. 29.4. 28.6.

(1.1,.41.9). (8.8,.32.9). (7.1,.27.1). (5.4,.18.5). (5.4,.89.9). (28.5,.38.7). (25.2,.33.9). (24.6,.32.8).

2015'18.2. 17.5. 16.9. 15.2. 37.4. 18.2. 18.0. 17.8.

(10.6,.29.4). (7.1,.37.1). (9.2,.29.1). (9.5,.23.4). (27.1,.48.9). (15.4,.21.4). (15.0,.21.3). (14.8,.21.3).

*. 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..

Source:.ACTwatch.Outlet.Survey,.DRC,.2009,.2013,.2015..... .


.

.

Table'F4:'Antimalarial'market'composition,'across'survey'round'Kinshasa'



Community.Health...

Worker.Ω.

[email protected]'


[email protected].


ALL'Private.

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

. %.(95%.CI).

%.(95%.CI).

2009,.N=766.outlets. 1.3. @. 1.5. 2.8. 14.9. 2.6. 79.8. 0.0. 97.2.(0.5,.3.8). @. (0.4,.5.3). (1.2,.6.5). (11.8,.18.6). (1.4,.4.7). (74.9,.4.7). @. (93.5,.98.8).

2013,.N=.917.outlets. 1.7. @. 3.1. 4.8. 15.7. 0.4. 79.1. 0.1. 95.2.(0.9,.3.1). @. (1.8,.5.3). (3.1,.7.3). (12.8,.19.1). (0.1,.1.4). (75.7,.82.1). (0.0,.0.4). (92.7,.96.9).

2015,.N=.852.outlets'8.4. 0.5. 4.7. 13.6. 17.5. 0.4. 68.5. @. 86.4.

(5.2,.13.2). (0.2,.1.6). (2.9,.7.5). (9.6,.19.0). (13.6,.22.2). (0.1,.1.9). (62.7,.73.7). @. (81.0,.90.4).

*. 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..Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2009.or.2013.DRC.outlet.surveys.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..


.

. .


'

Table'F5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'survey'round,'Kinshasa.

'Private.

[email protected].






Any.ACT' . . . .

2009. $3.40. $4.11. $3.43. $3.50.[[email protected]].(39). [[email protected]].(148). [[email protected]].(1,237). [[email protected]].(1,424).

2013' $1.70. $3.56. $3.06. $2.97.[[email protected]].(172). [[email protected]].(43). [[email protected]].(3,073). [[email protected]].(3,288).


Artesunate.amodiaquine. . . . .

2009. $1.37. $1.37. $1.37. $1.37.[[email protected]].(23). [[email protected]].(36). [[email protected]].(384). [[email protected]].(443).

2013' $0.00. @. $1.70. $1.44.[[email protected]].(84). @. [[email protected]].(197). [[email protected]].(281).

2015' $0.00. $2.58. $1.72. $1.38.[[email protected]].(100). [[email protected]].(24). [[email protected]].(253). [[email protected]].(377).

Artemether.lumefantrine. . . . .




[email protected].(QA.ACT)' . . . .




[email protected].([email protected]). . . . .




. . . . .


Table'F5a:'Price'of'tablet'formulation'antimalarials,'by'outlet'type,'across'survey'round,'Kinshasa.

'Private.

[email protected].






Sulfadoxine.pyrimethamine' . . . .




*[email protected][email protected].(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..

Source:.ACTwatch.Outlet.Survey,.DRC,.2009,.2013,.2015..'' '


'''

Table'F6:'Availability'of'malaria'blood'testing'among'antimalarialCstocking'outlets*,'by'outlet'type,'across'survey'round,'Kinshasa.


[email protected].

ALL'Public/Not'ForC

Profit'

[email protected].


ALL'Outlets'

' %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

. %.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'outlets**'stocking.2009.N=21.2013.N=22.2015.N=201.

2009.N=6.2013.N=47.2015.N=64.

2009.N=27.2013.N=69.2015.N=270.

2009.N=71.2013.N=200.2015.N=176.

2009.N=29.2013.N=3.2015.N=60.

2009.N=633.2013.N=690.2015.N=560.

2009.N=733.2013.N=894.2015.N=796.

2009.N=760.2013.N=963.2015.N=1,066.


2009. 83.1. 100.0. 87.6. 85.2. 0.0. 0.9. 24.1. 29.4.(67.1,.92.2). @. (64.6,.96.5). (74.0,.92.1). @. (0.4,.2.2). (19.0,.29.9). (23.0,.36.9).

2013' 90.1. 91.3. 90.9. 92.8. 20.0. 0.3. 18.0. 22.5.(74.2,.96.7). (79.5,.96.6). (82.9,.95.4). (87.2,.96.1). (2.0,.75.0). (0.1,.1.5). (15.1,.21.3). (19.4,.26.0).

2015. 97.2. 97.5. 95.3. 94.0. 14.8. 1.5. 21.7. 29.3.(87.5,.99.4). (83.7,.99.7). (87.8,.98.3). (88.1,.97.1). (5.3,.35.1). (0.7,.3.1). (17.5,.26.6). (24.7,.34.3).

. . . . . . . . .


2009. 83.1. 100.0. 87.6. 84.6. 0.0. 0.9. 23.9. 29.2.(67.1,.92.2). @. (64.6,.96.5). (73.4,.91.6). @. (0.4,.2.1). (18.8,.29.8). (22.7,.36.7).

2013' 88.9. 83.2. 85.1. 89.3. 0.0. 0.0. 16.9. 21.2.(72.7,.96.0). (69.3,.91.6). (74.9,.91.6). (84.2,.92.8). @. @. (14.2,.20.2). (18.2,.24.6).

2015. 88.7. 92.2. 85.7. 88.7. 1.2. 0.9. 19.9. 26.6.(77.9,.94.6). (77.5,.97.6). (75.6,.92.0). (83.2,.92.5). (0.1,.11.1). (0.4,.2.0). (16.1,.24.2). (22.4,.31.2).

. . . . . . . . .


2009. 3.9. 0.0. 2.9. 5.1. 0.0. 0.1. 1.5. 1.6.(0.6,.22.2). @. (0.5,.14.2). (1.9,.13.0). @. (0.0,.1.0). (0.7,.3.4). (0.8,.3.4).

2013' 29.4. 32.2. 31.3. 18.3. 20.0. 0.3. 3.8. 5.6.(14.0,.51.5). (15.1,.55.8). (17.8,.48.8). (13.2,.25.0). (2.0,.75.0). (0.1,.1.5). (2.6,.5.6). (4.1,.7.4).

2015. 68.6. 43.6. 56.2. 31.1. 15.0. 1.0. 7.8. 12.8.(58.7,.77.0). (28.3,.60.2). (44.2,.67.5). (21.8,.42.2). (5.4,.35.1). (0.3,.2.7). (5.3,.11.3). (9.7,.16.5).

*. 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'F8:'Price'of'malaria'blood'testing'for'adults,'by'outlet'type,'across'survey'round,'Kinshasa.

'Private.

[email protected].



. Median.[IQR].(N.of.Antimalarials).


Microscopy.for.adults. . .. .

2009. $0.57. @. $0.57. $0.57.[[email protected]].(47). @. [[email protected]].(3). [[email protected]].(31).

2013' $1.70. @. @. $1.70.[[email protected]].(238). @. @. [[email protected]].(238).

2015' $0.86. $1.29. $0.86. $0.86.[[email protected]].(198). (1). [[email protected]].(9). [[email protected]].(208).

Microscopy.for.children.under.five. . . . .

2009. @. @. @. @.@. @. @. @.

2013' $1.70. @. @. $1.70.[[email protected]].(238). @. @. [[email protected]].(238).


Malaria.RDT.for.adults. .. . .

2009. $0.34. @. @. $0.34.[[email protected]].(5). @. @. [[email protected]].(5).



Malaria.RDT.for.children.under.five. . . . .

2009. @. @. @. @.@. @. @. @.



*. Total.price.to.the.consumer.including.consultation.and/or.service.fees..



'

Table'F9:'Antimalarial'market'share,'across'survey'round,'Kinshasa'.



Community.Health.

Worker.Ω.

[email protected]'


[email protected].


TOTAL'Private.


%. . %. %. %. . %. . %. %.

'2009.

1.'Any'ACT' 0.7' C' 0.4' 1.1' 1.5' 2.0' 16.2' 0.0' 19.7' 20.8'Artesunate.amodiaquine. 0.7. @. 0.4. 1.1. 0.8. 0.4. 3.4. 0.0. 4.6. 5.7.Artemether.lumefantrine. 0.0. @. 0.0. 0.0. 0.1. 0.7. 3.1. 0.0. 3.9. 3.9.Quality@assured.(QA).ACT. 0.7. @. 0.4. 1.1. 0.6. 0.2. 0.9. 0.0. 1.8. [email protected].([email protected]). 0.0. @. 0.0. 0.0. 0.9. 1.7. 15.3. 0.0. 17.9. 17.9.Nationally.registered.ACT. 0.0. @. 0.0. 0.0. 0.4. 0.6. 5.4. 0.0. 6.4. 6.4.




Any.treatment.for.severe.malaria. 0.0. @. 0.0. 0.0. 0.5. 0.3. 1.6. 0.0. 2.4. 2.4.OUTLET'TYPE'TOTAL**' 2.8. @. 1.2. 3.9. 9.6. 8.3. 78.1. 0.0. 96.1. 100.0.

2013.

1.'Any'ACT' 0.8' C' 1.1' 1.9' 3.0' 1.4' 36.2' 0.0' 40.6' 42.6'Artesunate.amodiaquine. 0.7. @. 1.0. 1.7. 1.7. 0.0. 1.1. 0.0. 2.9. 4.6.Artemether.lumefantrine. 0.1. @. 0.1. 0.2. 1.0. 0.8. 22.8. 0.0. 24.6. 24.8.Quality@assured.(QA).ACT. 0.7. @. 1.0. 1.7. 1.7. 0.2. 0.6. 0.0. 2.4. [email protected].([email protected]). 0.1. @. 0.2. 0.2. 1.3. 1.3. 35.6. 0.0. 38.2. 38.5.Nationally.registered.ACT. 0.7. @. 1.0. 1.8. 2.0. 0.2. 10.1. 0.0. 12.2. 14.0.




Any.treatment.for.severe.malaria' 0.0. @. 0.1. 0.2. 0.9. 0.2. 6.5. 0.0. 7.6. 7.8.OUTLET'TYPE'TOTAL**' 1.1. @. 2.2. 3.3. 5.7. 1.9. 89.1. 0.0. 96.7. 100.0.' ' ' ' ' ' ' ' ' ' '


Table'F9:'Antimalarial'market'share,'across'survey'round,'Kinshasa'.



Community.Health.

Worker.Ω.

[email protected]'


[email protected].


TOTAL'Private.


%. . %. %. %. . %. . %. %.

2015'

1.'Any'ACT' 6.0' 0.1' 1.0' 7.1' 2.4' 0.0' 35.6' C' 38.1' 45.1'Artesunate.amodiaquine. 4.7. 0.1. 0.5. 5.3. 0.9. 0.0. 1.3. C' 2.2' 7.5'Artemether.lumefantrine. 0.7. 0.0. 0.5. 1.2. 1.2. 0.0. 23.6. C' 24.8' 26.1'Quality@assured.(QA).ACT. 3.9. 0.1. 0.5. 4.6. 0.8. 0.0. 1.1. C' 1.9' 6.5'[email protected].([email protected]). 2.0. 0.0. 0.5. 2.5. 1.6. 0.0. 34.5. C' 36.1' 38.7'Nationally.registered.ACT. 4.9. 0.1. 0.8. 5.9. 1.5. 0.0. 19.6. C' 21.2' 27.0'

2.'Any'nonCartemisinin'therapy' 5.2' 0.1' 0.8' 6.1' 1.9' 0.3' 37.6' C' 39.7' 45.8'Sufladoxine.pyrimethamine' 3.6. 0.1. 0.6. 4.2. 1.0. 0.2. 25.7. C' 27.0' 31.1'

3.'Oral'artemisinin'monotherapy' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' C' 0.0' 0.0'4.'NonCoral'artemisinin'monotherapy' 0.4' 0.0' 0.3' 0.7' 0.9' 0.0' 7.4' C' 8.3' 9.0'

Artesunate.IV/IM. 0.1. 0.0. 0.1. 0.1. 0.0. 0.0. 0.1. C' 0.1' 0.2'Artemether.IV/IM. 0.1. 0.0. 0.0. 0.1. 0.1. 0.0. 0.3. C' 0.4' 0.4'

Any.treatment.for.severe.malaria. 0.5. 0.0. 0.3. 0.9. 0.9. 0.0. 7.7. C' 8.7' 9.5'OUTLET'TYPE'TOTAL**' 11.6. 0.2. 2.1. 13.9. 5.1. 0.3. 80.6. C' 86.1' 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%[email protected].–.antimalarial.total.column.(within.survey.round)...Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2009.or.2013.DRC.outlet.surveys.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..

Source:.ACTwatch.Outlet.Survey,.DRC,.2009,.2013,.2015.... .


.

.'

Table'F10:'Antimalarial'market'share'within'outlet'type,'across'survey'round,'Kinshasa'.




Ω.

[email protected]'


[email protected].


TOTAL'Private.

%. . %. %. %. . %. . %.

'2009.

1.'Any'ACT' 25.4' C' 38.2' 29.2' 15.8' 23.6' 20.7' 0.0' 20.5'


2.'Any'nonCartemisinin'therapy' 73.9' C' 58.0' 69.2' 72.1' 65.3' 66.2' 0.0' 66.7'

Sufladoxine.pyrimethamine. 47.5. @. 35.2. 43.9. 53.0. 41.7. 38.8. 0.0. 40.5.3.'Oral'artemisinin'monotherapy' 0.7' C' 3.6' 1.5' 8.7' 10.7' 11.5' 0.0' 11.1'

4.'NonCoral'artemisinin'monotherapy' 0.0' C' 0.2' 0.1' 3.4' 0.4' 1.6' 0.0' 1.7'


Any.treatment.for.severe.malaria. 1.3. @. 0.4. 1.0. 4.8. 3.6. 2.1. 0.0. 2.5.

2013.

1.'Any'ACT' 74.5' C' 51.0' 58.6' 52.4' 75.6' 40.7' 0.0' 42.0'


2.'Any'nonCartemisinin'therapy' 23.8' C' 43.3' 37.0' 35.3' 12.0' 52.3' 0.0' 50.5'

Sufladoxine.pyrimethamine. 9.0. @. 17.0. 14.4. 14.9. 8.8. 33.2. 0.0. 31.6.3.'Oral'artemisinin'monotherapy' 0.0' C' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0' 0.0'

4.'NonCoral'artemisinin'monotherapy' 1.7' C' 5.7' 4.4' 12.4' 12.4' 7.0' 0.0' 7.5'


Any.treatment.for.severe.malaria' 2.6. @. 6.7. 5.4. 16.1. 12.4. 7.3. 0.0. 7.9.


Table'F10:'Antimalarial'market'share'within'outlet'type,'across'survey'round,'Kinshasa'.




Ω.

[email protected]'


[email protected].


TOTAL'Private.

%. . %. %. %. . %. . %.

2015'

1.'Any'ACT. 51.3. 72.7. 47.2. 51.0. 46.8. 15.0. 44.2. C. 44.2.Artesunate.amodiaquine. 40.5. 72.7. 22.3. 38.2. 16.8. 0.0. 1.7. C. 2.6.Artemether.lumefantrine. 6.4. 0.0. 22.6. 8.8. 22.5. 14.2. 29.3. C. 28.8.Quality@assured.(QA).ACT. 33.9. 72.7. 24.3. 32.9. 16.2. 0.0. 1.3. C. [email protected].([email protected]). 17.4. 0.0. 22.9. 18.0. 30.7. 15.0. 42.8. C. 42.0.Nationally.registered.ACT. 42.6. 72.7. 36.6. 42.1. 29.9. 6.0. 24.4. C. 24.6.

2.'Any'nonCartemisinin'therapy. 45.0. 27.3. 38.9. 43.8. 36.5. 82.3. 46.6. C. 46.2.Sufladoxine.pyrimethamine. 30.6. 27.3. 27.0. 30.0. 19.8. 69.9. 31.9. C. 31.3.

3.'Oral'artemisinin'monotherapy' 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. 0.0. C. 0.0.4.'NonCoral'artemisinin'monotherapy' 3.7. 0.0. 13.9. 5.2. 16.7. 2.7. 9.2. C. 9.6.

Artesunate.IV/IM. 0.5. 0.0. 2.4. 0.7. 0.2. 0.0. 0.2. C. 0.2.Artemether.IV/IM. 0.4. 0.0. 0.4. 0.4. 1.3. 0.0. 0.4. C. 0.5.Any.treatment.for.severe.malaria. 4.7. 0.0. 15.6. 6.2. 18.4. 2.7. 9.6. C. 10.1.

*. Ω. Community.health.workers.were.not.screened.for.eligibility.during.the.2013.and.2015.DRC.outlet.surveys.and.general.retailers.were.not.screened.during.the.2015.DRC.outlet.survey.(see.introduction)..Categories.1.through.4.sum.to.100%.within.each.column..



'

Table'F14:'Provider'antimalarial'treatment'knowledge'and'practices,'by'outlet'type,'across'survey'round,'Kinshasa.


[email protected]'

ALL'Public'/'Not'forCprofit'

[email protected].


ALL'Outlets'

. %.(95%.CI).

.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

%.(95%.CI).

Proportion'of'providers'who:' 2013.N=22.2015.N=209.

2013.N=47.2015.N=66.

2013.N=69.2015.N=275.

2013.N=201.2015.N=177.

2013.N=3.2015.N=61.

2013.N=703.2015.N=565.

2013.N=908.2015.N=803.

2013.N=977.2015.N=1,078.

Correctly.state.the.national.first@line.treatment.for.uncomplicated.malaria!' . . . . . . . .

2013' 41.8. 42.5. 42.3. 40.6. 61.7. 14.3. 19.4. 20.8.(19.6,.68.0). (22.6,.65.3). (26.2,.60.2). (31.6,.50.2). (11.3,.95.3). (11.3,.17.8). (16.0,.23.4). (17.3,.24.9).

2015.64.9. 40.2. 53.2. 46.6. 44.6. 14.0. 21.6. 24.9.

(56.1,.72.8). (26.0,.56.3). (43.2,.62.8). (38.2,.55.2). (31.2,.58.9). (11.3,.17.1). (18.2,.25.5). (21.8,.28.2)[email protected]' . . . . . . . .

2013' 22.6. 7.2. 12.4. 1.6. 20.0. 0.1. 0.5. 1.2.(8.1,.49.1). (2.2,.20.9). (6.2,.23.3). (0.6,.4.5). (2.0,.75.0). (0.0,.0.9). (0.2,.1.3). (0.7,.2.2).

2015'21.4. 4.2. 12.2. 4.1. 3.4. 0.6. 1.4. 2.5.

(15.3,.29.2). (1.2,.13.1). (8.3,.17.6). (1.8,.9.1). (1.1,.10.1). (0.1,.2.7). (0.7,.2.9). (1.6,.4.0)[email protected]@[email protected]' . . . . . . . .

2013' 19.7. 8.1. 12.0. 2.5. 0.0. 0.5. 0.8. 1.5.(7.4,.42.9). (3.1,.19.8). (5.7,.23.4). (1.0,.5.9). @. (0.1,.2.0). (0.4,.1.9). (0.9,.2.6).

2015'28.5. 3.3. 15.0. 8.6. 5.6. 1.1. 2.8. 4.0.

(20.4,.38.3). (1.1,.9.6). (10.4,.21.2). (4.0,.17.5). (2.8,.10.8). (0.4,.2.9). (1.6,.4.9). (2.6,.6.2).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for.adults. . . . . . . . .

2013' 36.4. 37.9. 37.4. 25.0. 61.7. 11.9. 14.6. 16.0.(16.8,.62.0). (21.8,.57.1). (24.0,.53.0). (17.9,.33.7). (11.3,.95.3). (9.3,.15.0). (12.1,.17.4). (13.6,.18.7).

2015.62.5. 37.3. 50.6. 36.4. 52.0. 16.0. 21.1. 24.2.

(48.1,.74.9). (21.6,.56.4). (38.7,.62.5). (28.4,.45.3). (31.6,.71.7). (13.1,.19.5). (17.9,.24.8). (21.0,.27.7).Report.an.ACT.as.the.most.effective.antimalarial.medicine.for.children. . . . . . . . .

2013. 39.4. 41.2. 40.6. 34.3. 61.7. 23.5. 25.7. 26.6.(16.1,.68.8). (25.6,.58.7). (26.9,.56.0). (27.0,.42.4). (11.3,.95.3). (19.3,.28.2). (22.3,.29.3). (23.5,.29.9).

2015'68.9. 34.7. 52.8. 51.0. 58.7. 31.1. 35.9. 37.7.

(58.3,.77.9). (20.5,.52.2). (42.3,.63.1). (43.5,.58.4). (35.8,.78.4). (25.8,.36.8). (30.9,.41.2). (33.3,.42.2).

!. At.the.time.of.the.2013.and.2015.ACTwatch.outlet.surveys,.artesunate.amodiaquine.and.artemether.lumefantrine.were.DRC’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.multi9country.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. high9quality. 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. scale9up. of. first9line. ACT. and. blood. testing. using. RDTs.. This. has. included. adaptation. of.

project.methods.for.the.evaluation.of. the.Affordable.Medicines.Facility9malaria. (AMFm).pilot.2F

3.Project.scale9up. in.

the.Greater.Mekong.sub9Region.(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. quality9assured. ACT. relative. to. other. antimalarial. medicines;. the. demand. for.

appropriate.malaria.case.management.captured.through.consumer.knowledge,.attitudes,.and.fever.treatment9

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.anti9malarial.

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),&multiAcountry&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.anti9malarial.market..

Malaria&Journal,&12:.52..


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. peer9reviewed. publications. have. appeared. in.Malaria& Journal. and. The.Lancet.5F

67

,.7..&& &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. mid9level.

distributers.in.between..Retail.prices.are.documented.along.the.supply.chain.to.facilitate.calculation.of.commodity.

mark9ups..From.2008.through.2012,.ACTwatch.conducted.eight.national.supply.chain.studies..Reports.are.available.

at.www.actwatch.info,.and.a.peer9reviewed.publication.has.appeared.in.PLoS&One.6F

8...

.

2015.outlet.surveys.in.the.Greater.Mekong.sub9Region.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.! Population9based.surveys..

.

Population9based. surveys. are. conducted. among. consumers. to. document. fever. treatment9seeking. 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.and.monitor.equity.in.access.to.malaria.case.management..From.2008.through.2012,.

ACTwatch.conducted.14.household.surveys. focused.on.fever.treatment9seeking.behavior..Reports.are.available.at.

www.actwatch.info,.and.a.peer9reviewed.publication.has.appeared.in.Malaria&Journal.7F

9&&.

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. private9sector. 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.sub9national...

6.O’Connell.K,.Gatakaa.H,.Poyer.S,.et.al..2011..Got.ACTs?.Availability,.price,.market.share.and.provider.knowledge.of.anti9malarial.medicines.in.

public.and.private.sector.outlets.in.six.malaria9endemic.countries..Malaria&Journal,.10:.326..7.Tougher.S,.the.ACTwatch.Group,.Ye.Y,.et.al..2013..Effect.of.the.Affordable.Medicines.Facility9malaria.(AMFm).on.the.availability,.price,.and.

market.share.of.quality9assured.artemisinin9based.combination.therapies.in.seven.countries:.a.before9and9after.analysis.of.outlet.survey.data..

Lancet,&380:.1916926..8.Palafox.B,.Patouillard.E,.Tougher.S,.et.al..2014..Understanding.private.sector.antimalarial.distribution.chains:.a.cross9sectional.mixed.methods.

study.in.six.malaria9endemic.countries..PLoS&One,&9(4)..9.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. provider9client. 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%DRC%.

ACTwatch. outlet. surveys. were. conducted. in. DRC. in. 2009,. 2013,. and. 2015.. All. reports. are. available. at.

www.actwatch.info.. .


Annex%2:%Country%Background%.

The.Democratic.Republic.of.the.Congo.(DRC).is.the.second.largest,.and.third.most.populous,.country.in.Africa.with.an.

estimated.population.of.77.3.million.people.in.2015.and.an.annual.population.growth.rate.of.3.4%10..The.majority.of.

the.population.lives.in.rural.areas..According.to.the.2014.Human.Development.Index,11.the.DRC.is.ranked.186.out.of.

187.countries..64%.of.its.population.lives.below.the.national.official.poverty.line12,.and.UNDP.estimates.real.income.

per. capita.has.declined.by.58%. from.1980. to.2012.13. The. country.has. some.of. the.worst.health. indicators. in. the.

world,.with.58.in.1000.children.dying.before.their.first.birthday,.under.five9mortality.at.10.5%,.and.a.life.expectancy.

at.birth.of.58.7.years.3,14According.to.the.most.recent.Demographic.and.Health.Survey,.95%.of.the.population.has.no.

health.insurance15...

.

Since. its. independence. in. 1960,. the. DRC. has. experienced. great. political. instability,. as. well. as. a. succession. of.

conflicts;.it.remains.a.fragile.post9conflict.country.with.huge.reconstruction.needs..The.DRC.is.a.decentralized.state.

and.is.divided.into.ten.provinces.and.one.city9province,.Kinshasa..Kinshasa.is.the.capital.and.the.largest.city. in.the.

DRC..Located.on.the.Congo.River,.Kinshasa.is.home.to.an.estimated.10.million.people.16.Katanga.province.is.located.

in.the.south9eastern.part.of.the.country.and.forms.the.Congolese.border.with.Angola.and.Zambia..The.province.also.

borders. Tanzania. through. Lake. Tanganyika.. The.province.has. an. estimated.population.of. 7.million.17. The. eastern.

part.of.Katanga.is.a.rich.mining.region.and.its.capital,.Lubumbashi,.is.the.second.largest.city.in.the.country...

.

Healthcare.system.

.The&public&health&sector&&At.its.independence.in.1960,.the.DRC.inherited.a.health.system.primarily.designed.to.manage.large.epidemics,.based.

mainly. on. hospitals. and. dispensaries. and. supported. by. mobile. teams.18. Health. zones. (“zones. de. santé”). were.

created.in.the.mid91980s.and.serve.as.the.operational.basis.for.health.care.organization.and.planning.in.the.country..

The.public.health.system.has.three.administrative.tiers:.the.central,.provincial,.and.health.zone.levels..

.

Political.crises.and.gradual.economic.decline.have.resulted.in.a.deteriorating.public.health.system,.characterized.by.

a.lack.of.equipment.in.medical.facilities,.supply.chain.failures,.deteriorating.infrastructure,.and.poor.coordination.in.

the.public.health. system.9. Indeed,. the.poor. state.of. the.national. supply. chain.means. that.a.parallel. structure.has.

been.developed.by.non9state.actors. involved.in.the.provision.of.antimalarials.19.Access.to.healthcare.in.the.DRC.is.

extremely. limited:.the.World.Bank.estimated.national.utilization.of.health.services.at.0.2.consultations.per.person.

per.year.in.2005.(corresponding.to.one.visit.per.person.every.five.years),.compared.to.0.6.consultations.in.the.1980s..

Up.to.two.thirds.of.people.who.are.ill.do.not.seek.care.in.the.formal.health.system,.preferring.to.not.seek.treatment,.

or.to.self9medicate..20.Health.services.are.financed.by.the.government,.bilateral,.and.multilateral.donors,.but.up.to.

70%.of.operating.costs.are.covered.by.fees.charged.to.users..Financial.barriers.are.one.of.the.main.reasons.for.low.

10.http://dhsprogram.com/pubs/pdf/FR300/FR300.pdf.accessed.19.August.2016..

11.http://hdr.undp.org/en/statistics/.accessed.24.August.2014..

12.http://data.worldbank.org/country/congo9dem9rep.accessed.19.August.2016..

13.http://hdr.undp.org/sites/default/files/Country9Profiles/COD.pdf.

14.https://dhsprogram.com/pubs/pdf/SR218/SR218.e.pdf.accessed.19.August.2016..


16.http://www.diplomatie.gouv.fr/fr/dossiers9pays/republique9democratique9du9congo/presentation9de9la9republique91274/...

17.http://dhsprogram.com/pubs/pdf/FR300/FR300.pdf.accessed.19.August.2016


19.KII.with.WHO.representative..

20.http://siteresources.worldbank.org/INTAFRREGTOPEDUCATION/Resources/44465991212165766431/H_CSR_DRC.pdf.accessed.19.August.

2016..


healthcare.utilization..In.a.household.study.in.Kinshasa,.the.incidence.of.catastrophic.health.expenditures.was.found.

to.be.between.46%.and.81%.for.families.seeking.treatment.for.a.child.with.severe.malaria.21.

.

The. public. health. system. in. the.DRC. is. supported. by. faith9based. networks. (FBNs),.which. in. addition. to. providing.

health.care.services,.play.a.key.role.in.the.management.or.co9management.of.health.zones..The.Catholic.Church.is.

estimated.to.be.present.in.half.of.health.zones,.fully.supporting.27%.and.partially.supporting.63%.of.facilities..40%.of.

the.country’s.health.zones.are.co9managed.by.FBNs.alongside.the.Ministry.of.Health.22.

.

The&private&health&sector&&DRC’s.private.health.sector.is.estimated.to.provide.60%.of.health.care.services.used.by.the.population,.and.extends.

to.all.areas.of.the.country..It.is.divided.into.two.categories:.the.non9profit.private.sector,.which.includes.faith9based.

organizations.(FBOs).and.non9governmental.organizations.(NGOs),.and.the.private.for9profit.sector,.which.includes.

private.health.facilities,.pharmacies,.and.drug.outlets..However,.as.noted.above,.FBNs.are.integrated.into.the.public.

health.system.to.a.large.extent,.meaning.the.distinction.between.public.and.not9for9profit.sectors.is.unclear..A.large.

number.of.private/informal.health.structures.are.being.created.outside.the.health.system,.leading.to.the.emergence.

of.an.uncoordinated,.unregulated,.and.low9quality.private.for9profit.sector.23..

.

The.pharmaceutical.sector.in.the.DRC.is.largely.unregulated:.more.than.3,000.types.of.medicines.are.available.on.the.

market,. yet. the.Drugs,. Pharmacy.and.Medicinal. Plants.Directorate. (DPM).has. issued.marketing. authorizations. for.

only.400.24.A.considerable.portion.of.the.pharmaceutical.retail.sector.in.the.DRC.operates.without.a.license—from.

the. wholesaler. to. the. pharmacy. level—although. recent. policy. shifts. have. aimed. to. increase. the. number. of.

pharmacies. authorised. to. dispense. RDTs. and. antimalarials.. Additionally,. private9sector. pharmacies. are. now.

authorized. to. carry. out. rapid. diagnostic. testing. prior. to. dispensing. treatment. for.malaria.25. A. national. initiative,.

DEFEAT.Malaria,.also.aims.to.reduce.the.costs.of.antimalarials.and.RDTs.in.the.private.sector..The.private.sector.has.

a.wide.range.of.inputs,.largely.insulating.it.from.the.supply.chain.challenges.that.have.affected.the.public.sector.in.

the.country.26..

..

. .

21.Ilunga9Ilunga,.Félicien,.et.al.."Incidence.of.catastrophic.health.expenditures.for.households:.An.example.of.medical.attention.for.the.

treatment.of.severe.childhood.malaria.in.Kinshasa.reference.hospitals,.Democratic.Republic.of.Congo.".Journal&of&infection&and&public&health.8.2.(2015):.1369144..22.iati.dfid.gov.uk/iati_documents/3833337.DOC.accessed.19.August.2016..

23.ScaleAup&strategy&for&Essential&Medicines&for&Child&Survival&2012A2015,.Ministère.de.la.Santé,.République.Démocratique.du.Congo,.Décembre.

2011..24.Ibid.&

25.KII.with.representative.from.DPM.(Department.of.Pharmacies,.Medicines.and.Traditional.Medicine)..

26.KII.with.DFID.representative..


Malaria.risk.and.burden..

.

Figure%X1.%Prevalence%of%malaria%in%children%age%6G59%months%by%Division%Provinciale%de%la%Santé,%DRCGDHS%II%2013G1427 .

.

..

.

.Malaria. is. a.major. cause. of.morbidity. and.mortality. in. the. DRC,. and. the. greatest. burden. of. the. disease. falls. on.

pregnant.women. and. children. under. five.. Despite. some. improvements. in. the. last. five. years,. at. a. national. level,.

malaria. accounts. for. an. estimated. 40%. of. outpatient. visits. and. 19%. of. mortality. of. children. under. five,.

respectively.28.DRC.accounts.for.11%.of.all.cases.of.Plasmodium&falciparum&(&P.&falciparum).in.sub9Saharan.Africa.29.

Malaria.prevalence. in. the.under. five.population.was.estimated. to.be.between.22.6%.and.30.8%. in.2013/14,.with.

only.29.2%.of.children.with.fevers.treated.with.antimalarials.30.In.2011,.9.4.million.cases.and.almost.24,000.deaths.

due.to.malaria.were.reported. in.the.DRC,.making. it. the.biggest.cause.of.morbidity.and.mortality. in. the.country.15.

97%.of.the.population.lives.in.areas.of.high.and.stable.malaria.transmission,.while.the.remaining.3%.live.in.highland..

areas.in.the.east.(Kivu.and.Katanga)..The.three.malaria.epidemiology.zones.in.the.DRC.are.equatorial,.tropical,.and.

highland..The.equatorial.forest.zone.is.characterized.by.intense.transmission.with.high.morbidity.in.children.under.

five..In.the.tropical.zone,.transmission.increases.during.the.long.rainy.season,.which.lasts.from.five.to.eight.months,.

and.morbidity.is.highest.in.children.under.10..The.highland.zone.is.located.in.the.eastern.mountainous.area.of.the.

country. and. is. prone. to. epidemics.. The. most. common. parasite. species. in. the. DRC. is. P.. falciparum,. which. is.

responsible. for. 95%. of. infections.. P.& vivax. accounts. for. the. other. 5%. of. cases.. The. main. vectors. are. Anopheles&gambiae.(92%).and.A.&funestus.(the.main.vector.in.the.eastern.high.plateaux),.and.A.&arabiensis.has.been.reported.in.the. east.. A.& nili,. A.& moucheti,. A.& brunnipes,. and. A.& paludis. represent. secondary. vectors.31. Resistance. to. non9artemisinin. antimalarial. drugs. was. estimated. to. be. between. 29%. and. 80%. for. chloroquine,. and. up. to. 60%. for.

sulfadoxine9pyrimethamine.(SP).in.2001.32.

.

. .

27. Map. taken. from. Democratic. Republic. of. the. Congo:. Demographic. and. Health. Survey. 2013914,. Supplemental. Malaria. Report..

http://dhsprogram.com/pubs/pdf/FR300/FR300.Mal.pdf..28.https://www.pmi.gov/docs/default9source/default9document9library/malaria9operational9plans/fy915/fy920159democratic9republic9of9the9

congo9malaria9operational9plan.pdf?sfvrsn=3..29.Ibid..

30.Ibid..

31.“Faire.reculer.le.Paludisme”.Plan.Stratégique.200992013,.Ministère.de.la.Santé.Publique,.Kinshasa,.République.Démocratique.du.Congo,.

2009..32.https://www.pmi.gov/docs/default9source/default9document9library/malaria9operational9plans/fy915/fy920159democratic9republic9of9the9

congo9malaria9operational9plan.pdf?sfvrsn=3..


Malaria.case.management.guidelines..

In.March. 2005,. the. national.malaria. program. adopted. artesunate. amodiaquine. (ASAQ). as. first9line. treatment. for.

uncomplicated.malaria,.and.the.program.made.oral.quinine.the.recommended.treatment.for.patients.who.failed.to.

respond.or.had.intolerance.to.ASAQ..Implementation.of.this.new.policy.began.in.2006,.but.scale9up.has.been.slow,.

due. to. a.number.of. challenges.. These. include.difficulties. tracking.needs. given. the. fragmented. supply. system.and.

poor. reporting.of.consumption.data..Anecdotal.evidence. indicates. low.take9up.of. the.drug.due. to.perceived.side9

effects. from. amodiaquine.. Finally,. scale9up. has. been. challenging. given. the. relatively. large. role. of. the. informal,.

unregulated.private.sector.that.does.not.follow.national.treatment.guidelines.33.Guidelines.supporting.community9

based.treatment.of.uncomplicated.malaria.using.ACTs.were.issued.in.the.DRC.in.2007...

.

In.2012,.a.forum.of.experts.convened.and.recommended.the.use.of.artemether9lumefantrine.(AL).as.an.alternative.

first9line.treatment.to.ASAQ..This.group.also.suggested.that.parenteral.artesunate.be.used.for.severe.malaria..These.

recommendations.were.approved.by.the.MOH,.with.a.three9year.period.to.transition.to.parenteral.artesunate.for.

the.treatment.of.severe.malaria.34..

.

In. 2013,. the. national. guidelines. were. revised. to. stipulate. that. pregnant. women. should. receive. the. intermittent.

preventive. therapy. (IPTp). SP. at. every. antenatal. clinic. visit. after. their. first. trimester.. Confirmed.malaria. infections.

during.pregnancy.should.be.treated.with.quinine.during.the.first.trimester.of.pregnancy.and.with.ASAQ.during.the.

second.and.third.trimesters..Severe.malaria.cases.are.managed.at.the.hospital.level.with.parenteral.quinine;.rectal.

artesunate.may.be.used.as.a.pre9referral.treatment.for.severe.cases...

.

According. to.national. policy. and. in. line.with.WHO. recommendations,. all. patients.with. fever. should.be. tested. for.

malaria,.either.using.microscopy.or.RDTs..Microscopy.is.expected.to.be.the.primary.diagnostic.procedure.in.hospitals.

and.larger.health.centers,.while.RDTs.are.to.be.used.in.smaller.health.facilities.and.at.the.community.level..However,.

health.workers.reportedly.often.disregard.test.results.and.rely.on.clinical.findings.to.diagnose.malaria..National.roll9

out.of.RDTs.in.the.public.sector.is.hindered.by.commodity.shortages,.as.well.as.a.shortage.of.trained.health.facility.

and.community.workers.to.perform.these.tests.35..

.

Oral.artemisinin.monotherapy.was.officially.banned.in.the.DRC.in.2007.36.

.

Financing.and.major.initiatives.to.improve.case.management..

Malaria.control.in.the.DRC.is.largely.financed.by.donors,.together.with.a.government.commitment.of.approximately.

$2.million.per.year.37.Malaria.control.activities.are.implemented.with.the.coordination.of.the.NMCP..

.

The.major.donor.for.malaria.control.activities.in.the.DRC.is.the.Global.Fund.to.fight.AIDS,.Tuberculosis.and.Malaria.

(GFATM)..GFATM.has. committed. almost. $660.million. for.malaria. control. activities. in. the. country. and. distributed.

36.7.million.LLINs.38.

.

The.World. Bank. Booster. Program. is. contributing. to.malaria. control. in. the. DRC. through. two. projects:. the. Health.

Sector.Rehabilitation.Project,.a.four9year,.$150.million.project.with.a.$30.million.malaria.component,.and.the.$180.

million.Emergency.Urban.and.Social.Rehabilitation.Project,.which.includes.a.$13.million.grant.for.malaria.39.One.of.

the.four.components.of.the.“Primary.Health.Care.Project”.is.to.boost.malaria.control.interventions.40..

33.Ibid.&

34.Malaria&Operational&Plan&FY&2014,.President’s.Malaria.Initiative,.Democratic.Republic.of.Congo,.2014..

35.Ibid.&&

36..World.Malaria.report,.2009,.WHO,.2009...

37.“Faire.reculer.le.Paludisme”.Plan.Stratégique.200992013,.Ministère.de.la.Santé.Publique,.Kinshasa,.République.Démocratique.du.Congo,.

2009...38.http://portfolio.theglobalfund.org/en/Country/Index/COD,.accessed.19.August.2016...

39http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRBOOPRO/0,,contentMDK:21308291~menuPK:3713164~pageP

K:64168445~piPK:64168309~theSitePK:2128617,00.html,.accessed.29.August.2014..40.http://www.worldbank.org/projects/P126088?lang=en&tab=overview.,..accessed.19.August.2016..


&The. Department. for. International. Development. (DFID). is. fighting. malaria. in. DRC. under. the. “Support. to. Malaria.

Control.in.the.Democratic.Republic.of.Congo”.program,.with.a.project.budget.of.£40.million.to.be.implemented.from.

2013. to. 2019.41. One. of. this. project’s. activities. is. to. support. providers. in. malaria. case. management,. including.

stocking. management. and. quality. assurance.. More. than. 500. providers. have. been. trained. as. of. 2015.. RDTs. are.

distributed.for.free.to.private.health.facilities.and.pharmacies.to.allow.consumers.to.have.low9cost.access.to.RDTs..

.

As. part. of. the. “Support. to. Malaria. Control. in. the. Democratic. Republic. of. Congo”. program,. PSI/ASF. RDC. is.

implementing.a.project.called.“Defeat.Malaria”,.with.the.goal.of.reducing.the.retail.cost.of.quality9assured.ACTs..This.

project.consists.of.providing.a.subsidy.to.manufacturers.of.quality9assured.ACTs.with.the.“Green.Leaf”.logo.to.offer.

the. product. at. an. affordable. price. for.most. consumers.. However,. these. products. were. not. available. in. the. DRC.

market.before.March.2016..42.

.

Between.2010.and.2015,. PMI.has. committed.over. $232.million. to.malaria. control. activities. in. the.DRC,. including.

procurement.of.over.10.million.ITNs,.over.22.7.million.ACTs,.16.million.RDTs,.and.3.7.million.doses.of.SP.43.With.FY.

2015. funding,. PMI. support. expands. to. 181. health. zones. in. six. provinces. (Kinshasa,.West. Kasai,. East. Kasai,. South.

Kivu,. Katanga,. and. Orientale),. with. procurement. of. 10. million. RDTs,. 7.5. million. ASAQ. treatments,. and. 340,000.

treatments. for.severe.malaria..PMI.also.supports. training.and.supervision.of.health.workers. in.case.management..

Additionally,. PMI. provides. technical. assistance. to. the. NMCP. and. MOH. to. strengthen. the. supply. chain. and.

pharmaceutical. management. systems. at. the. national,. provincial,. and. health9zone. levels. in. those. six. provinces,.

working.directly.with.NMCP.staff.to.quantify.drug.needs.and.assist.in.the.implementation.of.more.efficient.stock.and.

distribution.systems..PMI.funds.will.be.used.to.procure.600,000.doses.of.rectal.artesunate.for.pre9referral.treatment.

for.cases.of.severe.malaria.identified.at.the.community.level..Finally,.PMI.will.support.the.scale9up.of.iCCM.sites.with.

RDTs.and.ACTs.for.uncomplicated.cases.and.rectal.artesunate.for.pre9referral.treatments.of.severe.cases..44..

.

.

.

.

.

. .

41.https://devtracker.dfid.gov.uk/projects/GB919203458/,.accessed.19.August.2016..

42.http://psiimpact.com/2016/03/drc9ministry9of9health9uk9minister9for9africa9psi9launch9major9effort9to9provide9quality9malaria9medications9

to9congolese9through9the9private9sector/..Accessed.19.August.2016..43.https://www.pmi.gov/docs/default9source/default9document9library/country9profiles/drc_profile.pdf?sfvrsn=14..accessed.19.August.2016..

44.Malaria&Operational&Plan&FY&2015,.President’s.Malaria.Initiative,.Democratic.Republic.of.Congo,.2015..(https://www.pmi.gov/docs/default9

source/default9document9library/malaria9operational9plans/fy915/fy920159democratic9republic9of9the9congo9malaria9operational9

plan.pdf?sfvrsn=3),.accessed.19.August.2016.


Annex%3:%Outlet%Survey%Methods%.

Design.and.Study.Population...

ACTwatch.implements.repeat.cross9sectional.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.DRC,.

this.includes.the.following.outlet.types:..

.

.

Public.health.facilities.

.

(Referral).hospitals,.(referral).health.centers,.health.posts,.and.dispensaries..This.

category.is.comprised.of.government9managed.facilities.that.provide.medicines.

according.to.prescription..This.category.also.includes.any.private.not9for9profit.or.for9

profit.health.facilities.that.are.designated.by.the.government.as.the.public.health.

facility.for.the.health.area.and.equipped.with.a.minimum.basic.package.of.services.

and.commodities..

.

.

Community.health.worker..

.

These. health. workers. are. community9based. 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.public9sector.outlets...

.

.

Private.not9for9profit.health.

facilities.

.

Private.(referral).hospitals,.(referral).health.centers,.health.posts.and.laboratories,.

managed.by.charitable.or.religious.organizations.on.a.non9profit.basis..

.

.

Private.for.profit.health.

facilities.

.

Private.(referral).hospitals,.(referral).health.centers,.health.posts.and.laboratories,.

run.on.a.for9profit.basis..

.

.

Pharmacies.

(Pharmacies&agréées)&&

.

Pharmacies.are.licensed.and.regulated.by.the.national.medical.authority.(the.3eme&

Direction),.and.are.staffed.by.pharmacists.and.qualified.health.practitioners..They.sell.

all.classes.of.medicine.and.are.generally.located.in.urban.areas..

.

.

Drug.stores.

(Pharmacies&informelles).

.

Drug.stores.are.smaller.in.size.and.scope.than.pharmacies..These.facilities.are.not.

licensed.by.the.national.medical.authority..They.are.sometimes.owned.or.run.by.staff.

with.primary.health.qualifications,.such.as.nurses,.but.are.most.commonly.owned.by.

staff.with.no.health.qualification..They.are.ubiquitous.in.urban.areas.in.the.DRC..

.

.

Stratification...

The.DRC.outlet.survey.employed.two.levels.of.stratification..At.the.first.level,.independent.surveys.were.conducted.

in.two.geographically.different.regions:.Kinshasa.Province.and.Katanga.Province.(see.Figure.X2)..Each.province.was.

further.divided.into.urban.and.rural.domains,.with.urbanicity.defined.at.the.health.zone.level..Urban.and.rural.health.

zones.in.Kinshasa.were.defined.with.reference.to.the.Plan&Provincial&de&Developpement&Sanitaire&(PPDS)&de&Kinshasa&2011A2015.. Classifications. for. Katanga. Province. were. primarily. defined. in. consultation. with. key. informants. in.

Lubumbashi. who. were. familiar. with. health. service. provision. across. the. province.. The. classifications. were.

independently.cross9checked.against.the.sampling.frame.used.for.the.2013.Demographic.and.Health.Survey.(DHS),.

where.the.latter.included.health.zone.information..

.

. .


Figure%X2.%Map%of%the%Study%Provinces%.

.

..

.

.

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. for9profit,. private. not9for9profit),.

community. health.workers,. pharmacies,. and. drug. shops.. Outlets. that. exclusively. served. the.military. and. did. not.

serve.the.general.public.were.excluded.from.the.study....

.

In.the.2013.outlet.study,.eligible.outlets.included:.1).general.retail.outlets.(grocery.stores,.kiosks,.and.stalls.

selling.a.range.of.fast9moving.consumer.goods).and.2).itinerant.drug.vendors.(mobile.providers.found.

around.markets.and.in.rural.areas,.typically.working.within.a.radius.of.the.market.or.their.home)..These.

were.not.included.in.the.2015.study.as.only.15/3,649.general.retail.outlets.and.1/22.itinerant.drug.vendors.

had.any.antimalarial.in.stock....

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.senior9most.provider.at.the.outlet.had.

to.provide.informed.consent...

Sample.Size..

.

A.series.of.calculations.was.completed.to.identify.minimum.sample.size.requirements.to.detect.an.increase.

or.decrease. in.availability.of.QA.ACT.and.of.malaria.blood. testing.between.2013.and.2015..Calculations.

examined. the. sample. size. required. to. detect. a. 159percentage. point. and. a. 209percentage. point. change.

among.the.public.sector,.the.private.sector,.public.health.facilities,.pharmacies,.and.drug.shops...

.


The. required. sample. size. for. each. research. domain. was. calculated. in. three. steps:. 1). determine. the.

required.number.of.antimalarial9stocking.outlets,.2).determine.the.number.of.outlets.to.be.enumerated.to.

arrive. at. this. number. of. antimalarial9stocking. outlets,. and. 3). determine. the. number. of. clusters. for. the.

census.to.arrive.at.this.number.of.outlets..

.

Required.number.of.antimalarial9stocking.outlets.

.The. number. of. antimalarial9stocking. outlets. required. to. detect. a. given. minimum. difference. in. availability. of. ACT.

between.domains.is.given.by:.

.

( ) ( ) ( )[ ]( )212

2

221112/ 1112PP

PPPPZPPZdeffn

!

!+!+!"= !#$ .

where:.

.

•! n=. desired.number.of.antimalarial9stocking.outlets.

•! P1=. the.proportion.of.antimalarial9stocking.outlets.with.QA.ACT.in.stock.in.domain.1.

•! P2=. the.proportion.of.antimalarial9stocking.outlets.with.QA.ACT.in.stock.in.domain.2.

•! P=. (P1+P2)/2.

•! Zα/2=. the.standard.normal.value.corresponding.an.α.(type.I).error.of.5%.with.a.two9sided.test.(1.96).

•! Z19β=. the.standard.normal.value.corresponding.to.a.test.power.of.80%,.or.a.type.II.error.of.20%,.(0.84)..

•! deff=. design.effect.anticipated.due.to.the.cluster.survey.design.

.

.

Estimates.of.these.parameters.for.2015.were.based.on.the.findings.of.the.2013.ACTwatch.Outlet.Survey.in.DRC..The.

2013.survey.employed.a.different.sampling.strategy.to.the.2015.survey.and.2015.domain.estimates.were.calculated.

from.2009.as.follows:.

.

For.the.calculation.based.on.the.proportion.of.antimalarial9stocking.outlets.with.QA.ACT.in.stock,.these.sources.gave.

the.following.parameter.estimates:.

.. Kinshasa. Katanga.

. Urban.

domain.

Rural.

domain.

Urban.

domain.

Rural.

domain.

P1. 0.14. 0.14. 0.53. 0.49.deff. 1.874. 1.000. 2.309. 2.137.

.

For. the. calculation. based. on. the. proportion. of. outlets. stocking. malaria. blood. testing,. these. sources. gave. the.

following.parameter.estimates:.


. Urban.

domain.

Rural.

domain.

Urban.

domain.

Rural.

domain.

P1. 0.21. 0.29. 0.30. 0.30.deff. 1.072. 1.217. 0.545. 1.000.

.

Based.on.these.parameters,.the.estimated.number.of.antimalarial9stocking.outlets.(health.facilities,.pharmacies,.and.

drug.shops).required.in.each.domain.was.as.follows:.Kinshasa.urban,.339;.Kinshasa.rural,.348;.Katanga.urban,.304;.

Katanga.rural,.342..

.

Required.number.of.outlets.

The. estimated. total. number. of. outlets. required. to. obtain. a. minimum. number. of. antimalarial9stocking. outlets. is.

determined.by:..


..

where:.

.

•! N=. desired.number.of.outlets.for.screening.

•! n=. desired.number.of.antimalarial9stocking.outlets.

•! Pam.=. the.proportion.of.outlets.stocking.any.antimalarial.at.the.time.of.the.survey..

.Applying.2013.estimates.to.these.parameters.leads.to.the.following.required.number.of.outlets.for.screening:.


. Urban.

domain.

Rural.

domain.

Urban.

domain.

Rural.

domain.

n. 339. 348. 304. 342.

Pam. 0.72. 0.59. 0.81. 0.84.

N% 472% 591% 376% 408%

.

Required.number.of.clusters.(health.areas)..

.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. are. selected.with.

cluster. probability. of. selection. proportionate. to. size. (PPS).. A. census. of. all. outlets. with. the. potential. to. sell. or.

distribute. antimalarials. is. then. conducted. in. sampled. clusters.. The. closest. appropriate. administrative. unit. in.DRC.

matching.this.desired.population.size.is.the.health.area.(aire&de&santé)...

The.sample.size. to.meet.public9.and.private9sector.sample.size. requirements.within.each.research.domain.was.as.

follows:.17.urban.and.17.rural.clusters.in.Kinshasa,.and.20.urban.and.60.rural.clusters.in.Katanga...

.

Booster.Sample..

A.booster. sample.was. collected.by. selecting.additional. clusters. for. 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.pharmacies.as.well.as.public.health.facilities,.including.government9owned.public.and.government9

supported.private.health.facilities..Within.both.Kinshasa.and.Katanga.provinces,.public.health.facilities.were.visited.

in.50%.of.urban.health.areas.within.health.zones.where.one.or.more.health.area.was.selected.in.the.main.sample..

All.public.health.facilities.located.within.the.same.health.zone.as.a.sampled.rural.health.area.were.visited.in.Kinshasa.

province,. whereas. in. Katanga. province,. public. health. facilities. were. visited. within. two. randomly. selected. health.

areas.within.each.health.zone.that.included.a.sampled.rural.health.area..A.census.of.all.pharmacies.was.conducted.

in.Kinshasa.and.Katanga.provinces..

.

Sampling..

A.representative.sample.of.health.areas.was.selected.in.each.research.domain.using.PPS.sampling..A.list.of.selected.

health.areas.is.provided.in.Annex.4...

Selection.of.health.areas.with.PPS.was.completed.based.on.population.estimates.obtained. from.a. series.of. local9

level.census.activities.conducted.between.2001.and.2004..This.data.series.was.also.used.as.the.basis.for.the.2007.

DHS.as.the.most.recent.national9level.census.in.the.DRC.was.conducted.in.1984..A.population9based.sampling.frame.

was.used.for.selecting.the.sample.because.accurate.estimates.on.the.total.number.of.outlets.per.cluster.that.may.be.

eligible.for.a.medicine.outlet.survey.do.not.exist..The.major.assumption.in.using.population.figures.for.sampling.is.

that.distribution.of.outlets.and/or.distribution.of.medicines.moving.through.outlets. in.a.given.cluster. is.correlated.

with.population.size...

Within.each.health.area,.a.census.of.all.outlets.with.the.potential.to.sell.or.distribute.antimalarials.and/or.provide.

malaria.blood.testing.was.conducted...

amPnN /=


.

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.October.9th.–.December.2nd,.2015.....

A. structured.paper.questionnaire.was.used. for. all. interviews. (see.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. senior9most. provider. regarding. malaria. case. management. knowledge. and.

practices,. as. well. as. provider. training. and. qualifications.. Geo9coordinates. were. collected. for. each. outlet. using.

Garmin.Etrex.®.GPS.devices...

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.were.double.entered.and.verified. in.Nairobi,.Kenya.using.a.Microsoft.Access.database..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.Ethics.Committee.of.the.Public.Health.School.at.

the.University.of.Kinshasa.(ref:.ESP/CE/096/2015)..Provider.interviews.and.product.audits.were.completed.only.after.

the. administration. of. a. standard. informed. consent. form. and. the. 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%Clusters%.

Table%X1.%Sampled%Clusters%PROVINCE% URBAN/RURAL% HEALTH%ZONE% HEALTH%AREA% POPULATION%KATANGA. URBAN. DILALA. LUILU. .15,735....

KATANGA. URBAN. KAMPEMBA. CITÉ.DES.JEUNES. .17,976....

KATANGA. URBAN. KAMPEMBA. KABANGA. .33,491....

KATANGA. URBAN. KAMPEMBA. SAFINA. .10,148....

KATANGA. URBAN. KATUBA. DU.MARCHÉ. .22,753....

KATANGA. URBAN. KATUBA. NGEMENA. .12,202....

KATANGA. URBAN. KENYA. KENYA.I. .13,892....

KATANGA. URBAN. KIKULA. KAPENDA.. .14,770....

KATANGA. URBAN. KIKULA. NKOLOMONI. .16,276....

KATANGA. URBAN. KIPUSHI. LUMATA. .16,699....

KATANGA. URBAN. KISANGA. KIBOKO. .11,245....

KATANGA. URBAN. KOWE. DILALA/KOLWEZI. .2,059....

KATANGA. URBAN. LIKASI. SIX9SAPINS. .13,991....

KATANGA. URBAN. LUBUMBASHI. MAKUTANO. .10,968....

KATANGA. URBAN. MANIKA. HGR.MWANGEJI. .19,465....

KATANGA. URBAN. MANIKA. PCI.RAYON. .14,175....

KATANGA. URBAN. MUMBUNDA. MAMPALA.I. .25,681....

KATANGA. URBAN. PANDA. KIWELE. .8,167....

KATANGA. URBAN. RWASHI. KAWAMA. .26,194....

KATANGA. URBAN. TSHAMILEMBA. K.E. .41,420....

KATANGA. RURAL. ANKORO. KASONGO. .3,606....

KATANGA. RURAL. ANKORO. KYOFWE. .5,846....

KATANGA. RURAL. BUKAMA. KABWE. .8,731....

KATANGA. RURAL. BUKAMA. MBALA. .13,989....

KATANGA. RURAL. BUNKEYA. MUNTO. .11,212....

KATANGA. RURAL. BUTUMBA. KISUNGI. .11,023....

KATANGA. RURAL. DILOLO. MUYEYE. .10,661....

KATANGA. RURAL. FUNGURUME. LUKOTOLA. .6,902....

KATANGA. RURAL. KABALO. LUKUNDULA. .10,519....

KATANGA. RURAL. KABONDO9DIANDA. KAPAKO. .11,243....

KATANGA. RURAL. KABONDO9DIANDA. NYEMBO. .11,374....

KATANGA. RURAL. KABONGO. KAMUSENGA. .11,818....

KATANGA. RURAL. KABONGO. LENGE. .13,785....

KATANGA. RURAL. KAFANKUMBA. KALAMPOJI. .5,602....

KATANGA. RURAL. KAFUBU. KIWELE. .4,172....

KATANGA. RURAL. KALEMIE. BWANAKUCHA. .13,672....

KATANGA. RURAL. KALEMIE. KIMENA. .7,447....

KATANGA. RURAL. KAMBOVE. DISANGA.3. .7,641....

KATANGA. RURAL. KAMINA. CENTRE.URBAIN. .20,214....

KATANGA. RURAL. KAMINA. KINGO. .7,334....

KATANGA. RURAL. KAMINA. Q.53. .12,491....

KATANGA. RURAL. KANIAMA. KIMPANGA. .14,658....

KATANGA. RURAL. KANSIMBA. KASENGA. .4,816....

KATANGA. RURAL. KANZENZE. MUNANGA. .3,749....

KATANGA. RURAL. KAPANGA. MUTIY. .7,870....

KATANGA. RURAL. KAPOLOWE. KYEMBE.. .11,208....

KATANGA. RURAL. KASAJI. KAMBALALA. .7,675....

KATANGA. RURAL. KASENGA. CALWE. .7,687....

KATANGA. RURAL. KASENGA. KASOMENO. .9,979....

KATANGA. RURAL. KASHOBWE. KABIMBI. .21,459....

KATANGA. RURAL. KAYAMBA. KAMAYI. .6,686....

KATANGA. RURAL. KILWA. DUBIE. .10,186....

KATANGA. RURAL. KILWA. KYONA. .5,412....

KATANGA. RURAL. KINDA. KANENE. .3,743....

KATANGA. RURAL. KINKONDJA. KIPAMBA.2. .11,477....

KATANGA. RURAL. KITENGE. KASHUKULU. .8,527....

KATANGA. RURAL. KONGOLO. BENA.HAMBA. .5,671....


Table%X1.%Sampled%Clusters%PROVINCE% URBAN/RURAL% HEALTH%ZONE% HEALTH%AREA% POPULATION%KATANGA. RURAL. KONGOLO. LUBUNDA. .7,390....

KATANGA. RURAL. LUBUDI. KALUPETA. .2,856....

KATANGA. RURAL. LUKAFU. MINGA. .3,391....

KATANGA. RURAL. LWAMBA. KABUNDULU. .8,133....

KATANGA. RURAL. MALEMBA.NKULU. KABALA. .19,772....

KATANGA. RURAL. MALEMBA.NKULU. NYOKA. .12,503....

KATANGA. RURAL. MANONO. KANTEBA. .12,949....

KATANGA. RURAL. MANONO. SHINDANO. .7,048....

KATANGA. RURAL. MBULULA. MWANA.NGOY. .11,774....

KATANGA. RURAL. MOBA. KIPIRI. .12,390....

KATANGA. RURAL. MOBA. MULONDE. .12,648....

KATANGA. RURAL. MUKANGA. KINA. .12,773....

KATANGA. RURAL. MULONGO. KABAMBA. .19,734....

KATANGA. RURAL. MULONGO. MPANGWE.II. .6,329....

KATANGA. RURAL. MUTSHATSHA. TSHIPAYA. .3,395....

KATANGA. RURAL. NYEMBA. TABAC. .11,990....

KATANGA. RURAL. PWETO. KAKONONA. .22,518....

KATANGA. RURAL. PWETO. MWENGE. .8,460....

KATANGA. RURAL. SAKANIA. KASUMBALESA. .46,092....

KATANGA. RURAL. SAKANIA. TSHINSENDA. .7,150....

KATANGA. RURAL. SANDOA. SAMUTOMA. .8,716....

KATANGA. RURAL. SONGA. KIPASA. .6,348....

KATANGA. RURAL. KIPUSHI. KIPOPO. .5,064....

KINSHASA. URBAN. BARUMBU. MOZINDO. .27,371....

KINSHASA. URBAN. BINZA9MÉTÉO. LUBUDI. .37,673....

KINSHASA. URBAN. BINZA9OZONE. MFINDA. .48,879....

KINSHASA. URBAN. BUMBU. LUKENI. .13,707....

KINSHASA. URBAN. KALAMU.I. MATONGE.II. .12,813....

KINSHASA. URBAN. KIKIMI. LOBIKO. .33,070....

KINSHASA. URBAN. KIMBANSEKE. NSUMABUA. .30,449....

KINSHASA. URBAN. KINGASANI. LISANGA. .27,326....

KINSHASA. URBAN. KISENSO. 179MAY. .19,676....

KINSHASA. URBAN. LEMBA. GOMBELE. .15,310....

KINSHASA. URBAN. LIMETE. MFUMU.MVULA. .44,485....

KINSHASA. URBAN. MAKALA. SELO. .20,263....

KINSHASA. URBAN. MASINA.I. SANS.FIL. .44,676....

KINSHASA. URBAN. MATETE. LOEKA. .11,004....

KINSHASA. URBAN. N'JILI. Q7. .10,944....

KINSHASA. URBAN. NGIRI9NGIRI. 249NOV. .13,589....

KINSHASA. URBAN. SELEMBAO. NGAFANI. .26,710....

KINSHASA. RURAL. MALUKU.II. BUSIRA. .2,105....

KINSHASA. RURAL. MALUKU.II. YOSSO. .5,173....

KINSHASA. RURAL. MONT9NGAFULA.II. ANTENNE. .11,574....

KINSHASA. RURAL. MONT9NGAFULA.II. KIMBWALA. .16,400....

KINSHASA. RURAL. MONT9NGAFULA.II. MATOKAMA. .18,679....

KINSHASA. RURAL. MONT9NGAFULA.II. NGOMBE. .9,006....

KINSHASA. RURAL. MALUKU.I. BITA. .15,920....

KINSHASA. RURAL. MALUKU.I. KINGANKATI.2. .6,816....

KINSHASA. RURAL. MALUKU.I. MENKAO. .15,255....

KINSHASA. RURAL. MONT9NGAFULA.I. KIMWENZA.RURALE. .12,781....

KINSHASA. RURAL. MONT9NGAFULA.I. MANENGA. .14,425....

KINSHASA. RURAL. MONT9NGAFULA.I. MAZAMBA. .14,897....

KINSHASA. RURAL. MONT9NGAFULA.I. NGASELE. .16,918....

KINSHASA. RURAL. N'SELE. BAHUMBU.2. .15,848....

KINSHASA. RURAL. N'SELE. KINDOBO. .9,128....

KINSHASA. RURAL. N'SELE. MIKONDO. .12,900....

KINSHASA. RURAL. N'SELE. MPASA.2. .28,674....


Figure%X3.%Maps%of%Study%Area%.

Kinshasa.Province,.Selected.Clusters.and.Booster.Areas*.

.

Katanga.Province,.Urban.and.Rural.Health.Zones**.

.

..

*.. All.outlet.types.were.screened.for.eligibility.within.selected.clusters.(dark.blue/purple)..Additional.pharmacies.and.government.supported.

health.facilities.were.visited.outside.of.selected.clusters..Within.both.Kinshasa.and.Katanga.provinces,.pharmacies.were.visited.within.all.

areas.of.Kinshasa/Katanga.that.were.not.excluded.for.security/military.reasons..The.strategy.employed.to.visit.government9supported.health.

facilities.differed.between.provinces.(see.Annex.3.for.further.details)..Within.Kinshasa.province,.health.areas.for.which.additional.

government9supported.health.facilities.were.visited.are.displayed.as.booster.health.areas.(light.blue/purple)..

**. Selected.and.booster.health.areas.could.not.be.mapped.for.Katanga.province.as.map.files.at.the.health9area.level.were.not.available.at.the.

time.survey.maps.were.created..

DRC.ACTwatch.Outlet.Survey,.2015.


Annex%5:%Detailed%Sample%Description%%

Table%X2:%Detailed%sample%description%

%Public.Health.Facility.


Private.Not.ForAProfit.Facility. ALL.Public.

Private.ForAProfit.Facility.

Pharmacy. Drug.Store. ALL.Private% ALL%Outlets%

Number%of%outlets%screened%(Figure%2%Box%B)%

.. . . . . . . .

Katanga. . . . . . . . . .Urban. 95. 0. 16. 111. 81. 8. 349. 438. 549.

Census. 26. 0. 16. 42. 81. 6. 349. 436. 478.Booster. 69. 0. 0. 69. 0. 2. 0. 2. 71.

Rural. 171. 35. 7. 213. 71. 0. 219. 290. 503.Census. 84. 35. 7. 126. 71. 0. 219. 290. 416.Booster.. 87. 0. 0. 87. 0. 0. 0. 0. 87.

TOTAL. 266. 35. 23. 324. 152. 8. 568. 728. 1,052.Kinshasa. . . . . . . . . .

Urban. 127. 5. 28. 160. 155. 61. 402. 618. 778.Census. 34. 5. 28. 67. 155. 2. 402. 559. 626.Booster. 93. 0. 0. 93. 0. 59. 0. 59. 152.


TOTAL. 205. 12. 79. 296. 237. 61. 574. 872. 1,168.Number%of%outlets%eligible%and%interviewed%(Figure%2%Box%D)% . . . . . . . . .

Katanga. . . . . . . . . .Urban. 127. 0. 26. 153. 145. 61. 397. 603. 756.

Census. 34. 0. 26. 60. 145. 2. 397. 544. 604.Booster. 93. 0. 0. 93. 0. 59. 0. 59. 152.


TOTAL. 205. 5. 75. 285. 227. 61. 565. 853. 1,138.Kinshasa. . . . . . . . . .


Rural. 170. 35. 6. 211. 70. 0. 216. 286. 497.Census. 83. 35. 6. 124. 70. 0. 216. 286. 410.








Booster.. 87. 0. 0. 87. 0. 0. 0. 0. 87.TOTAL. 264. 35. 21. 320. 146. 7. 563. 716. 1,036.

Number%of%outlets%eligible%but%not%interviewed%(interview%nonEparticipation)%%

. . . . . . . . .

Katanga. . . . . . . . . .Urban. 0. 0. 1. 1. 0. 0. 0. 0. 1.

Census. 0. 0. 1. 1. 0. 0. 0. 0. 1.Booster. 0. 0. 0. 0. 0. 0. 0. 0. 0.


TOTAL. 0. 0. 1. 1. 0. 0. 0. 0. 1.Kinshasa. . . . . . . . . .



TOTAL. 0. 0. 0. 0. 0. 0. 0. 0. 0.Number%of%interviewed%outlets%with%at%least%one%antimalarial%in%stock%on%the%day%of%the%survey%(Figure%2,%Box%D1)%

. . . . . . . . .

Katanga. . . . . . . . . .Urban. 90. 0. 13. 103. 68. 7. 345. 420. 523.

Census. 26. 0. 13. 39. 68. 6. 345. 419. 458.Booster. 64. 0. 0. 64. 0. 1. 0. 1. 65.


TOTAL. 258. 34. 19. 311. 121. 7. 554. 682. 993.Kinshasa. . . . . . . . . .


Rural. 76. 5. 43. 124. 63. 0. 167. 230. 354.








Census. 22. 5. 43. 70. 63. 0. 167. 230. 300.Booster.. 54. 0. 0. 54. 0. 0. 0. 0. 54.

TOTAL. 201. 5. 63. 269. 163. 61. 563. 787. 1,056.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%2%sum%of%Box%1%and%Box%2)%%

. . . . . . . . .

Katanga. . . . . . . . . .Urban. 91. 0. 14. 105. 73. 7. 347. 427. 532.

Census. 26. 0. 14. 40. 73. 6. 347. 426. 466.Booster. 65. 0. 0. 65. 0. 1. 0. 1. 66.


TOTAL. 261. 35. 20. 316. 141. 7. 563. 711. 1,027.Kinshasa. . . . . . . . . .



TOTAL. 204. 5. 66. 275. 177. 61. 565. 803. 1,078.Number%of%interviewed%outlets%that%provide%malaria%blood%testing,%but%do%not%stock%antimalarial%medicines%(Figure%1%Box%D3)%

. . . . . . . . .

Katanga. . . . . . . . . .Urban. 3. 0. 1. 4. 3. 0. 0. 3. 7.

Census. 0. 0. 1. 1. 3. 0. 0. 3. 4.Booster. 3. 0. 0. 3. 0. 0. 0. 0. 3.


TOTAL. 3. 0. 1. 4. 5. 0. 0. 5. 9.








Kinshasa. . . . . . . . . .Urban. 1. 0. 4. 5. 37. 0. 0. 37. 42.

Census. 0. 0. 4. 4. 37. 0. 0. 37. 41.Booster. 1. 0. 0. 1. 0. 0. 0. 0. 1.


TOTAL. 1. 0. 9. 10. 50. 0. 0. 50. 60.Proportion%of%eligible%and%interviewed%antimalarialEstocking%outlets%with%at%least%one%provider%with%a%healthErelated%qualification*%

. . . . . . . . .

Katanga. . . . . . . . . .Urban. 100.0. A. 100.0. 100.0. 100.0. 100.0. 85.8. 88.3. 90.6.

Census. 100.0. A. 100.0. 100.0. 100.0. 100.0. 85.8. 88.3. 89.3.Booster. 100.0. A. A. 100.0. A. 100.0. A. 100.0. 100.0.

Rural. 97.0. 91.2. 100.0. 96.2. 88.7. A. 42.6. 51.9. 71.5.Census. 95.2. 91.2. 100.0. 94.3. 88.7. A. 42.6. 51.9. 65.5.Booster.. 98.8. A. A. 98.8. A. A. A. A. A.

TOTAL. 98.1. 91.2. 100.0. 97.4. 95.0. 100.0. 69.5. 74.3. 81.6.Kinshasa. . . . . . . . . .

Urban. 100.0. A. 100.0. 100.0. 100.0. 98.4. 79.6. 85.3. 88.3.Census. 100.0. A. 100.0. 100.0. 100.0. 100.0. 79.6. 83.7. 85.3.Booster. 100.0. A. A. 100.0. A. 100.0. A. 98.3. 99.3.

Rural. 100.0. 80.0. 100.0. 99.2. 98.4. A. 77.8. 83.5. 89.0.Census. 100.0. 80.0. 100.0. 98.6. 98.4. A. 77.8. 83.5. 87.0.Booster.. 100.0. A. A. 100.0. A. A. A. A. 100.0.

TOTAL. 100.0. 80.00. 100.0. 99.6. 99.4. 98.4. 79.0. 84.8. 88.5.*...HealthArelated.qualifications.include.medical.doctor,.clinical.officer,.pharmacists,.pharmacy.technician,.pharmacy.assistant,.nurse,.nursing.officer,.medical.assistant,.nursing.assistant,.nursing.aid,.midwife,.and.community.health.worker..Source:.ACTwatch.Outlet.Survey,.DRC.2015..


Annex%6:%Questionnaire%Annex%SELECTION%Section%1:%Information%du%recensement%

%%%ID%PDV%Enquêteur.–.Province.–.Zone.de.Santé.–.Aire.de.Santé.–.Code.PDV. .

.... [___|___]F[___]F[___|___]F[___|___|___|___]F[___|___|___].S1..Date.d’aujourd’hui..(jj/mm/aaaa).

... [___|___]F[___|___]F[_2_|_0_|_1_|_5_].S2..Nom.de.l’enquêteur.[__________________________________________________________________].

S2a..Code.de.l’enquêteur.. [___|___].

S3..Province.[__________________________________________________________________].

S3a..Code.de.la.province.. [___].

S4..Zone.de.santé.[__________________________________________________________________].

S4a..Code.de.la.zone.de.santé.. [___|___].

S5..Aire.de.santé...[__________________________________________________________________].

S5a..Code.de.l’aire.de.santé..

. [___|___|___|___].S6..Village/Rue.[__________________________________________________________________].

.

S7..Nom.de.PDV.[__________________________________________________________________].

S7a..Code.PDV.. [___|___|___].

.S8..Type.de.point.de.vente..

%%%Formation%sanitaire%publique%....01. Hôpital.universitaire.....02. Hôpital.provincial.de.référence.....03. Hôpital.général.de.référence.....04. Bureau.central.de.zone.de.santé.....05. Centre.hospitalier.....06. Centre.de.santé.de.référence.....07. Centre.de.santé......08......Poste.de.santé.....09. Relais.communautaire.

.

Formation%sanitaire%privée%but$lucrative%10. Hôpital.général.de.référence..11. Centre.hospitalier..12. Centre.de.santé.de.référence..13.. Centre.de.santé.!14. Poste.de.santé...

FS%privée%but$non.lucrative%15. Hôpital.général.de.référence..16. Centre.hospitalier..17. Centre.de.santé.de.référence..18.. Centre.de.santé.!

...19.....Poste.de.santé.

.

20. Laboratoire.privé.but.lucratif.21. Laboratoire.privé.but.nonFlucratif..

22.. Pharmacie.formelle.ou.officine.23. Dépôt.pharmaceutique..24. Pharmacie.informelle...

96. Autres.(précisez)$%

[___________________________].

20 Laboratoire privé but lucratif 21 Laboratoire priv

[___|___].

S9..EstFce.que.cette.aire.de.santé.fait.partie.de.l’échantillon.d’appoint.(booster).?! 1..=..Oui. 0=Non. . [___].S10..EstFce.le.centre.de.santé.principale.pour.l’aire.de.santé.qui.représente.le.gouvernement.(qu’il.soit.privé.ou..

public).?.................... . 1..=..Oui. 0=Non. [___].

Allez$à$la$SELECTION$Section$2!%

Écrivez$les$initiales$pour$ce$qui$est$complet$ou$N/A$pour$non$éligible$

Paquet%de%sélection%(TOUTES%LES%SECTIONS)% Paquet%Paludisme% Paquet%PF%

Intervieweur. % % %Superviseur. % % %

FIN%DE%L’ENTRETIEN%(TOUS$les$points$de$vente):%Remplissez$ce$résultat$pour$tous$les$points$de$vente$après$avoir$complété$toutes$les$sections$de$sélection$et$tous$les$paquets.$$

S11..Adresse.physique.ou.lieu.pour.identifier.le.point.de.vente.(Faites$une$description$détaillée$qui$aidera$le$superviseur$à$trouver$le$point$de$vente.$PAS$DE$BOITE$POSTALE)$.S12..Contact.principal.pour.Paludisme..Nom%[__________________________________________].

.

.Téléphone%[___|___|___|___|___|___|___|___|___|___].

S13..Contact.principal.pour.Planification.familiale..Nom%[__________________________________________].

.

.Téléphone.[___|___|___|___|___|___|___|___|___|___].

S14..Latitude.[.S.]F[___|___|___]F[___|___|___|___|___]. S15..Longitude:. [.E.]F[___|___|___]F[___|___|___|___|___].S16..Observations%supplémentaires%de%l’intervieweur%(s’il%y%en%a)%


SÉLECTION%Section%2%(TOUS$les$points$de$vente)%: Bonjour,. je. m’appelle. __________.. Je. travaille. pour. l’Ecole. de. Santé. Public. de. Kinshasa. pour. le. compte. de.l’Association. de. Santé. Familiale.. L’Association. de. Santé. Familiale. est. une. organisation. nonFgouvernementale.œuvrant.dans.les.secteurs.public.et.privé.pour.adopter.le.marketing.social.et.la.communication.pour.le.changement.de.comportement.afin.d’améliorer.l’accès.à.l’information.de.santé,.aux.services.et.aux.produits.essentiels.en.vue.de.motiver. l’adoption. de. comportements. sains.. Nous. effectuons. une. étude. sur. la. disponibilité. des. médicaments.antipaludiques,.des.services.de.test.de.diagnostic.du.paludisme.et.des.produits.et.services.de.planification.familiale..Les. résultats. seront. utilisés. pour. améliorer. la. disponibilité. d’un. traitement. approprié. pour. le. paludisme,. et. des.méthodes. de. planification. familiale. en.RDC.. Je. voudrais. vous. poser. quelques. questions. pour. voir. si. vous. pouvez.faire.partie.de.l’enquête...Nous.ne.sommes.pas.ici.pour.inspecter.votre.entreprise.et.aucune.information.concernant.ce.point.de.vente.précis.ne.sera.transmise.aux.autorités.réglementaires..Nous.ne.partagerons.pas.d’information.personnelle.sur.vous.ou.sur.d’autres.participants.avec.personne.d’autre.en.dehors.de.notre.équipe.de.recherche..La.participation.à.cette.étude.est.volontaire..Vous.êtes.libre.de.décider.si.vous.voulez.prendre.part.ou.non..Si.vous.êtes.d’accord,.vous.pouvez.changer.d’avis.à.tout.moment..Vous.pouvez.refuser.de.répondre.à.des.questions.précises,.ou.arrêter.l’entrevue.à.tout.moment..Si.vous.choisissez.de.ne.pas.répondre.à.une.question,.d’arrêter.l’entrevue.ou.même.de.ne.pas.du.tout.participer.à.l’étude,.cela.n’affectera.pas.vos.conditions.de.travail.aujourd’hui.ou.dans.l’avenir....

.

SRO,%Zinc%&%Amoxicilline$Lisez$au$prestataire$:$Je.voudrais.vous.poser.quelques.questions.pour.savoir.si.vous.disposez.de.traitements.pour.la.diarrhée.et.la.pneumonie..

S17..AvezFvous.en.stock.aujourd’hui.des.sels.de.réhydratation.orale,.aussi.connus.comme.SRO.(ORS).$Vérifiez$avec$une$fiche$illustrative.

.1.=.Oui. . .0.=.Non.

[___].

S18..AvezFvous.en.stock.aujourd’hui.des.comprimés.de.zinc.pour.le.traitement.de.la.diarrhée.chez.les.enfants.?...Vérifiez$avec$une$fiche$illustrative.

1.=.Oui. . .................0.=.Non........Allez$à$S20.

[___].

S19..Quel.dosage.de.comprimés.de.zinc.pour.le.traitement.de.la.diarrhée.chez.les.enfants.avezFvous.en.stock..aujourd’hui.?.Lisez$la$liste,$encerclez$TOUT$ceux$qui$s’applique$

A.=.10mg.B.=.20mg.Z.=.Autre.(à.préciser):.[______________________________________]$

.A.B.Z.

S20...AvezFvous.en.stock.aujourd’hui.des.SRO.qui.sont.emballés.avec.un.traitement.de.zinc.pour.la.diarrhée.chez..les.enfants.?.Vérifiez$avec$une$fiche$illustrative.

1.=.Oui. . $0.=.Non..................$

[___].

S21..AvezFvous.des.antibiotiques.en.stock.aujourd’hui.?.1.=.Oui. . .0.=.Non.

[___].

S22..AvezFvous.des.comprimés.d’amoxicilline.dispersible,.aussi.connus.comme.Amox.DT.?...Montrez$la$fiche$illustrative.$Intervieweur:$demandez$à$voir$le$produit$et$vérifiez$qu’il$s’agit$d’amoxicilline$dispersible$

1.=.Oui. .0.=.Non.....Allez$à$la$page$suivante$(Section$3).

[___].

S23..Quel.dosage.de.comprimés.d’amoxicilline.dispersible,.aussi.connus.comme.Amox.DT,.avezFvous.en.stock..aujourd’hui.?.Lisez$la$liste,$encerclez$TOUT$ce$qui$s’applique$

A.=.125mg.B.=.250mg.Z.=.Autre.(à.préciser):.[_________________________________________]........$.

.

.A.B.Z.

%. %


RÉSULTAT%(TOUS$les$points$de$vente):%Remplissez$ce$résultat$pour$tous$les$points$de$vente.$!S43..Résultat.de.visite(s).pour.compléter.tous%les%modules...

Date..(jj/mm/aa).

Visite1% Visite%2% Visite%3%

[___|___]F[___|___]F[.1|.5.]. [___|___]F[___|___]F[.1|.5.]. [___|___]F[___|___]F[.1|.5.].

Heure%du%début%(en$24hrs)% [___|___]:[___|___]% [___|___]:[___|___]% [___|___]:[___|___]%

Heure%de%fin%(en$24hrs)% [___|___]:[___|___] [___|___]:[___|___] [___|___]:[___|___]

%%RESULTAT%PALUDISME%

%

[___|___]% [___|___]% [___|___]%01.=.PDV.éligible.pour.le.paludisme.&.questionnaire.rempli...................................Allez$à.

Paquet$PF$ou$FIN.02.=.PDV.non.éligible.pour.le.paludisme.:.ne.remplit.aucun.critère.de.sélection....Allez$à.

Paquet$PF$ou$FIN.03.=.Interview.interrompue. ....Allez$à$S45.04.=.Personne.interrogée.non.disponible/le.moment.ne.convient.pas......................Allez$à$S45.05.=.PDV.non.ouvert.à.ce.moment....................................................................................Allez$à$S45.06.=.PDV.fermé.définitivement..........................................................................................Allez$à$FIN.96.=.Autre.(à%préciser):.

[________________________________________________________].97.=.A.refusé. ..............................................................Allez%à%S44.

S44..Si.le.prestataire.a.refusé,.pourquoi.?..

1=.Charge.de.clients....................Demandez$à$l’interviewé$le$moment$qu’il$préfère$et$notez$dans$S45%2.=.Pense.que.c’est.une.inspection/nerveux.au.sujet.de.la.licence............Allez$au$Paquet$PF$ou$FIN%3.=.Pas.intéressé. .....................Allez$au$Paquet$PF$ou$FIN..6.=.Autre.(à%préciser):.[______________________________________]..Allez$au$Paquet$PF$ou$FIN.7.=.Refuse.de.donner.la.raison. .....................Allez$au$Paquet$PF$ou$FIN$$

[___].

S45..Utilisez$cet$espace$pour$écrire$les$détails$du$rendez.vous$«$rappel$».$S’il$n’est$pas$possible$de$compléter$l’interview$à$un$autre$moment,$allez$à$FIN.$

.

Allez$au$PAQUET$PF$si$ce$n’est$pas$rempli.$Si$le$PAQUET$PF$est$rempli$ou$non$éligible$pour$PF,$allez$à$FIN$DE$L’ENTRETIEN$sur$la$Page$1.

%. %


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!&

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Procédez&à&l’audit&des&antipaludiques.&Différentes&fiches&d’audit&de&médicaments&seront&utilisées,&pour&décrire&les&

informations&des&antipaludiques&selon&la&forme&sous&laquelle&ils&se&présentent.&&

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&

Dans&tous&les&points&de&vente&(PDV),&remplissez&le&code&sous-PDV&(ainsi&que&le&numéro&de&produit)&pour&chaque&médicament&vérifié.&Ces&codes&sont&énumérés&ciPdessous.&

Codes&sousPPDV!X Tous!les!lieux!de!prestation!ayant!une!seule!unité!de!vente!ou!de!distribution!de!médicaments/moyens!de!

diagnostics!!!A Service!/!Dispensaire!de!consultation!externe/!pharmacie!principale!(si!utilisé!pour!tous!les!patients),!B Service!/!Dispensaire!/!Clinique!pour!consultation!externe!des!adultes!C Service!/!Dispensaire!/!Clinique!pour!consultation!externe!pédiatrique!!D Consultation!prénatale!/!Maternité!E Clinique!de!traitement!ARV!/!prise!en!charge!des!PVV!G Clinique!privée!dans!un!hôpital!public!L Laboratoire!(pour!audit!de!diagnostic)&Z Autre!(Spécifier&le&type&dans&l’espace&dédié&aux&commentaires&de&la&feuille&d’audit)!&

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Code!sous<PdV!![_____]$_______$No!de!produit!![__|__]$

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3.!Présentation!$1$=$Comprimé$

2$=$Suppositoire$

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[___]$!!

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5.!Fabricant! 6.!Pays!de!fabrication!

7.!Taille!de!l’emballage!!Il$y$a$un$total$de$$[___|___|___|___]$comprimés$/$suppositoires$/$sachets$de$granules$dans$chaque:$$1$=$Plaquette/Paquet$2$=$Boîte/Bocal$

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Non1applicable#=#9995#;#Refus#=#9997#;#NSP#=#9998!

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12.!Commentaires$

Gratuit#=#000000#;#Refus#=#999997#;#Ne#sait#pas#=#999998!

$

$$$$Fiche$d’Audit$des$Médicament$en$Comprimé$[___|___]$de$[___|___]$#

!FICHE!D’AUDIT!DU!MEDICAMENT!NON!COMPRIME!(NC)!(sirops,$suspensions,$injectables$&$autres)


!Code!sous<PdV!![_____]$_______$!No!de!produit!![__|__]$

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3.!Présentation!!$1$=$Sirop$2$=$Suspension$3$=$Liquide$injectable$$4$=$Poudre$injectable$$5$=$Gouttes$6$=$Autre$(préciser)##

[___]$$$

[_____________________]!

4.!Nom!de!marque!(Inclure!l’information!comme!le!poids!et!l’âge)#

5.!Fabricant! 6.!Pays!de!fabrication!

7.!Taille!de!l’emballage!!Il$y$a$un$total$de$$[___|___|___|___],[__]$mL$(ou$mg$la$poudre$injectable)$dans$chaque:$$$

1$=$Bouteille/flacon$2$=$Ampoule/petit$flacon$

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9.!Ce!produit!y<a<t<il!le!logo!AMFm!?!!1$=$Oui$$0$=$Non$8$=$Ne$sait$pas$$!!!

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10.!Quantité!vendue/distribuée!au!cours!des!7!derniers!jours!à!des!clients!individuels!$Ce$PDV$a$vendu/distribué$$$$[___|___|___|___]!bouteilles,!ampoules,!ou!flacons/petit!flacon!au$cours$des$7$derniers$$ jours.$ $!!

Non1applicable#=#9995#Refus#=#9997##

#Ne#sait#pas#=#9998!

11.!Prix!de!vente!en!détail!$[___|___|___]$bouteilles,!ampoules!ou!flacons/petit!flacon$$coûtent$au$client$individuel$$[___|___|___|___|___]!$FC$$

12.!Commentaires!

Gratuit#=#000000#Refus#=#999997##

Ne#sait#pas#=#999998!$

!!Fiche!d’Audit!des!Non<comprimés![____|____]!de![____|____]


Les$ruptures$de$stock$des$antipaludiques$$$P1.$Y$a't'il$des$antipaludiques$qui$sont$en$rupture$de$stock$aujourd’hui,$mais$que$vous$avez$eus$en$stock$ces$3$derniers$mois$?$$

1$=$Oui$0$=$Non$ $ Aller%à%l’Audit%de%diagnostiques%de%paludisme$8$=$Ne$sait$pas$ Aller%à%l’Audit%de%diagnostiques%de%paludisme$

$

[___]$

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$

1$$=$$Oui,$préciser%;%%

0$$=$$Non,$le$prestataire$ne$peut$pas$s’en$souvenir$

$

[_______________________________________]$$$$$$[_______________________________________]$

[_______________________________________]$$$$$$[_______________________________________]$

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[___]$

Enquêteur:%Aller%à%la%page%suivante%%(Audit%de%diagnostiques%de%paludisme).%

% %


Audit$de$diagnostiques$de$paludisme$Cette$section$est$dédiée$à$la$disponibilité$de$test$sanguin$de$paludisme.$Le$remplissage$des$questions$peut$nécessiter$de$parler$avec$un$ou$plusieurs$membres$de$staff$du$lieu$de$service.$Si$le$répondant$ne$connait$pas$la$réponse$sur$cette$section,$demandez$de$parler$au$membre$de$staff$qui$peut$fournir$l’information.$$P3.$Le$dépistage$par$microscopie$du$paludisme$est'il$disponible$ici$aujourd’hui?$$

1=$Oui$0=$Non$ $ Aller$à%P7%$

[___]$

P4.$Combien$de$tests$à$la$microscopie$du$paludisme$avez'vous$réalisés$au$cours$des$7$derniers$jours$$

997$=$Refus;$$998$=$Ne$sait$pas$$

[___|___|___]$$

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1$=$Oui$ $ %0$=$Non$$$$$$$$$$$$$$$$$$Aller$à$P9%8$=$Ne$sait$pas$$$$$$Demander%à%parler%à%la%personne%qui%connait%cette%information%$

[___]$

P8.$Pourriez'vous$nous$montrer$toute$la$variété$des$tests$que$vous$avez$actuellement$en$stock.$Avez'vous$présentement$un$des$tests$suivant$?$Lire$la$liste$entière;$pas$de$réponse$à$enregistrer.%

•! Standard$Diagnostics$/$SD$Bioline$•! ParaCheck$•! Parasight$•! Care$star$malaria$•! First$reponse$malaria$•! Star$combo$

$$

%Procéder%à%l’audit%de%tests%de%diagnostic%rapide.%%Si%vous%utilisez%des%fiches%supplémentaires,%joignez%des%fiches%additionnelles%et%agrafez%au%bon%endroit%à%l’intérieur%du%questionnaire.%Vérifiez%que%toutes%les%pages%sont%au%bon%endroit%avant%que%vous%allez%au%prochain%PDV.%%%Assigner%à%chaque%TDR%un%Numéro%de%Produit%(chronologique).%%Numéroter%chaque%feuille%d’audit%utilisée%au%bas%de%la%page.%%Dans%les%formations%sanitaires,%remplir%le%Code%sousUPDV%ainsi%que%le%Numéro%de%Produit.%%Trouver%les%Codes%sousUPDV%sur%la%page%1.

FICHE&D’AUDIT&DES&TESTS&DE&DIAGNOSTIC&RAPIDE&&(TDR)


!Fiche&d’Audit&des&TdR&[___|___]&de&[___|___]

Code&sous5PdV&&&[_____]!&&&No&de&produit&&&[__|__]!

1.&Nom&de&marque&!

2.&Test&d’antigène&

(Encercler!tous!ceux!qui!s’appliquent)&

HRP2&&&&&A&

pLDH&&&&B&

!!!!!!Aldolase&&&&C&

Pas!indiqué&&&&&Z&

&

3.&&Type&de&parasites&(Encercler!tous!ceux!qui!s’appliquent)&

Pf&&&&&&&&&&&&A&Pv&&&&&&&&&&&B&Po&&&&&&&&&&&C&pm!!!!!!!!!!!D!pan&&&&&&&&&&&E&

vom/Pvom!!!!F&Other&&&&&&&&&&&G&

Préciser&[____________________]!

Pas!indiqué&&&&&&&Z&&

4.&&Fabricant&&

5.&&Pays&de&fabrication&&&&&

6a.&Numéro&de&catalogue&du&produit&&&!!

6b.&&&No.&du&lot&

7.&Est5ce&un&kit&de&test&pour&auto5administration&avec&son&tampon,&sa&pipette&et&sa&lancette&?&&1!!=!!Oui!0!!=!!Non! !8!!=!!Ne!sait!pas!!!!!!!

[___]&[___|___|___]&

8.&&Quantité&vendue,&distribuée&ou&utilisée&au&cours&des&7&derniers&jours&à&des&clients&individuels&(Ecrivez!le!nombre!total!de!TDR)!!Ce!!point!de!vente!a!vendu!ou!distribué!![___|___|___|___]!&tests!au!cours!des!7!derniers!jours!!Refus!=!9997;!!Ne!sait!pas=9998&

9.&Rupture&de&stock&de&ce&TDR&au&cours&des&3&derniers&mois?&!1!=!Oui!0!=!Non!8!=!Ne!sait!pas!!

[___]&

10a.&&Est5ce&que&vous&ou&les&autres&employés&&utilisent&cette&marque&de&TDR&pour&tester&des&clients&dans&ce&centre/point&de&vente?&&&

1!=!Oui!0!=!Non!!!!!!!!!!!!Aller!à!11a!8!=!Ne!sait!pas!Aller!à!11a!

!

[___]!!&

10b.&Quel&est&le&coût&total&d’un&TDR&pour&un&adulte&(y&compris&le&coût&du&TDR&et&les&frais&de&services)&?&![___|___|___|___|___]&FC! !!

10c.&Quel&est&le&coût&total&d’un&TDR&pour&un&enfant&de&moins&de&5&ans&(y&compris&le&coût&du&TDR&et&les&frais&de&services)&?&&&

[___|___|___|___|___]&FC!!

11a.&&Est5ce&que&ce&centre/point&de&vente&fournit&cette&marque&de&TDR&à&des&clients&qui&l’emportent&pour&faire&des&tests&ailleurs?&&!

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[___]!!

&11b.&Quel&est&le&coût&spécifique&du&test&pour&un&adulte?&!!

[___|___|___|___|___]&FC! !&

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12.&&Prix&d’achat&en&gros&Pour!l’achat!le!plus!récent!:!!!

[___|___|___|___]!tests!!!

coût!!![___|___|___|___|___|___]&FC!&

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!Refus!=!99997;!!Ne!sait!pas!=!99998&

13.&Pourquoi&vous&avez&ce&TdR&en&stock&?&[Montrer&le&TdR]&Ne!lisez!pas!la!liste! !Encercler!toutes!les!réponses!données!!!Prestation!gratuite! !!!!!!!!!!!!!!!!!!!!!A!!

!Profitable!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!B!! !

Recommandé!par!le!gouvernement!!!!!C!!

Prix!bas!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!D!!

Préférence!du!client!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!E!!

Réputation!positive!de!la!marque!!!!!!!!!!F!

Don!de!BCZS! ! ! !!!!!!G!

Don!d’une!organisation!(ONG)! !!!!!!H!!

Ne!sait!pas! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!X!!

Autre! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Z!préciser!!![_______________________________]!

14.&Commentaires&

Gratuit!=!00000;!Non;applicable!=!99995;!Refus!=!99997;!Ne!sait!pas!=!99998!


Rupture'de'Stock'des'TDR'!P9.!Y!a't'il!des!kits!de!Test!de!Diagnostic!Rapide!(TDR)!du!paludisme!qui!sont!en!rupture!de!stock!aujourd’hui,!mais!que!vous!avez!eu!en!stock!ces!3'derniers'mois!?!!

1!=!Oui!0!=!Non! !!!!!!!!!!!!!!!!Aller%au%Module%pour%prestataire%d’antipaludiques%(P11)!8!=!Ne!sait!pas!!!!!!!!!Aller%au%Module%pour%prestataire%d’antipaludiques%(P11)!

!

[___]!

P10.!Connaissez'vous!le!nom!de!marque!de!ces!tests!de!paludisme!qui!sont!en!rupture!de!stock!?!Enregistrer%une%marque%par%ligne.%!

!

1!=!Oui,!préciser%;%

0!=!Non,!le!prestataire!ne!peut!pas!s’en!souvenir'

[____________________________________________________________________________]!

[____________________________________________________________________________]!

[____________________________________________________________________________]!!!!!!!!!!!!!!!

[___]!

!%! !


Module'pour'le'prestataire''Cette%section%est%pour%les%responsables%ayant%en%charge%la%prescription%des%ordonnances,%la%fourniture%des%soins%ou%médicaments%aux%clients/patients.%C’est%le%prestataire%qui%prend%la%décision%concernant%le%traitement%reçu%par%le%patient.!P11.!Vos!responsabilités!dans!ce!centre/point!de!vente!incluent:!la!prescription!des!ordonnances,!la!!!!!!!!!!!!fourniture!des!soins!ou!médicaments!aux!clients/patients!?!

!1!=!Oui!0!=!Non!!!Demander%à%parler%à%la%personne%responsable%d’un%ou%plusieurs%de%ces%

responsabilités.%%

[___]!

P12.!Avez'vous!déjà!participé!à!une!formation!dans!le!domaine!du!diagnostic!du!paludisme!!!!!!!!!!incluant!le!diagnostic!microscopique!ou!le!test!de!diagnostic!rapide!au!cours!des!12!derniers!

mois?!%%%%%%%Y%compris%stage%et%atelier.%!

1!=!Oui!0!=!Non!8!=!Ne!sait!pas!

[___]!

P13.!Avez'vous!déjà!participé!au!cours!des!12!derniers!mois!à!une!formation!sur!le!protocole!utilisé!au!plan!national!sur!le!traitement!du!paludisme!?!!

%%%%%%Y%compris%stage%et%atelier.%!

1!=!Oui!0!=!Non!8!=!Ne!sait!pas!

[___]!

'Enquêteur':'Pour'les'prochaines'questions,'enregistrez'le'nom'de'marque'ou'le'nom'générique,'et'la'présentation.''Demandez'au'prestataire'de'vous'montrer'les'médicaments's’ils'sont'en'stock'pour'vérifier'le'nom'et'la'présentation.''P14.!A!votre!avis,!quel!est!le!médicament!antipaludique!le!plus!efficace!pour!le!paludisme!simple!chez!les!adultes?!

Demandez%au%prestataire%de%vous%montrer%les%médicaments%s’ils%sont%en%stock%Nom'générique'ou'nom'de'marque''

Présentation''

'01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!

05!=!Suspension!06!=!Liquide!inj.!/!perfusion!07!=!Poudre!inj.!08!=!Gouttes!

95!=!Pas!de!préférence!

96!=!Autre!(préciser)!98!=!Ne!sait!pas!

[______________________________________]!!Ne%sait%pas%=%98!

[___|___]!!

Si%autre,%préciser![__________________________________]!!

!

!!P15.!A!votre!avis,!quel!est!le!médicament!antipaludique!le!plus!efficace!pour!le!paludisme!simple!chez!les!enfants!de!

moins!de!cinq!ans!?!Demandez%au%prestataire%de%vous%montrer%les%médicaments%s’ils%sont%en%stock.%Nom'de'la'marque'ou'nom'générique'' Présentation''

01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!!



96!=!Autre!(préciser)!

98!=!Ne!sait!pas![_______________________________________]!!Ne%sait%pas%=%98!

![___|___]!

!Si%autre,%préciser![__________________________________]!!

!

!


P16.!A!votre!avis,!quel!est!le!médicament!antipaludique!le!plus!efficace!pour!le!paludisme!grave!des!enfants!de!moins!de!cinq!ans?%Demandez%au%prestataire%de%vous%montrer%les%médicaments%s’ils%sont%en%stock.%Nom'de'la'marque'ou'nom'générique'' Présentation''

!01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!!



96!=!Autre!(préciser)!98!=!Ne!sait!pas!

[_____________________________________]!!Ne%sait%pas%=%98!

![___|___]!

!

Si%autre,%préciser![__________________________________]!!

!

!!P17.!Veuillez!citer!le!médicament!de!première!intention!recommandé!par!le!gouvernement!pour!traiter!le!paludisme!simple.!Ne'pas'lire'la'liste.'Enregistrer'seulement'une'réponse.'!

01!=!Artésunate'amodiaquine!(Sunat'A,!Coarsucam,!Arsuamoon,!Falcimon)! Aller%à%P18!02!=!Artemether'lumefantrine!(Coartem,!Luther,!L'Artem,!Lonart)!! Aller%à%P18!03!=!ACT..................................................................................................................! Aller%à%P18!04!=!ACTm...............................................................................................................! Aller%à%P18!05!=!Dihydroartemisinin!Piperaquine!06!=!Amodiaquine!07!=!Artémether!08!=!Artémisinin!09!=!Artésunate!10!=!Chloroquine!11!=!Quinine!12!=!Sulfadoxine!Pyrimethamine!(Fansidar,!SP)!96!=!Autre!préciser:![___________________________________________]!98!=!Ne!sait!pas!

[___|___]!

Aller%à%P20%


P18.Veuillez!spécifier!le!schéma!de!traitement!de!première!intention!recommandé!par!le!gouvernement!pour!un!adulte!(60!kg)!pour!ce!médicament.!%Quelle%est%la%présentation?%%

01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!


95!=!Pas!de!préférence!96!=!Autre!(préciser)!98!=!Ne!sait!pas!

Si%le%prestataire%répond%une%présentation%qui%n’est%pas%comprimé,%allez%a%la%question%P19%

%Lire%les%3%questions%qui%suivent%:%%

I.! Combien!des!comprimés!par!prise!?!!

II.! Combien!de!fois!par!jour!?!!

III.! Pendant!combien!de!jours!?!!

Si%le%médicament%est%disponible,%utiliser%l’emballage%pour%remplir%le%tableau%ciXdessous.%Si%le%médicament%n’est%pas%disponible,%demander%au%répondant%de%l’identifier%de%la%fiche%illustrative.%Si%l’identification%n’est%pas%possible,%demander%au%répondant%de%se%rappeler%des%détails%du%médicament.%%%

' Nom'générique'' Dosage' Nom'de'la'marque'

[__|__]!'

______________________________!'

______________________________!'

______________________________!

!

[__|__|__],[__]mg!!![__|__|__],[__]mg!![__|__|__],[__]mg!

!!!!!!!!!

![__|__]!!

[__|__]''

![___|___]! Ne%sait%pas%=%999,8%

Fabricant!!!!!!!

! ! %Ne'sait'pas'='98%

Le!médicament!est'il!une!combinaison'à'dose'fixe'?!

! 1!=!Oui!! 0!=!Non!! ! [___]!! 8!=!Ne!sait!pas!

!

%

%%%%%

[___|___]!

%%%%%!

!

[___|___],[___|___]!

[___|___]!

[___|___]!

Ne%sait%pas%=%98%

'%%%%%%%%%%%%%%

! !


P19.!!Veuillez!spécifier!le!schéma!de!traitement!de!première!intention!recommandé!par!le!gouvernement!pour!un!enfant'de'deux'ans!(10!kg)!pour!le!paludisme!simple!pour!ce!médicament.+%

%%%%%%%%Quelle%est%la%présentation%?%%

01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!



Si%le%prestataire%répond%une%présentation%qui%n’est%pas%comprimé,%allez%a%la%question%P20%Lire%les%3%questions%qui%suivent%:!

I.! !Combien!des!comprimés!par!prise!?!!

II.!!Combien!de!fois!par!jour!?!!

III.!!Pendant!combien!de!jours!?!!

Si%le%médicament%est%disponible,%utiliser%l’emballage%pour%remplir%le%tableau%ciXdessous.%Si%le%médicament%n’est%pas%disponible,%demander%au%répondant%de%l’identifier%de%la%fiche%illustrative.%Si%l’identification%n’est%pas%possible,%demander%au%répondant%de%se%rappeler%des%détails%du%médicament.%%

' Nom'générique'' Dosage' Nom'de'la'marque'

[__|__]!'

______________________________!'

______________________________!'

______________________________!

!

[__|__|__],[__]mg!!![__|__|__],[__]mg!![__|__|__],[__]mg!

!!!!!!!

![__|__]!!

[__|__]!'

! [___|___]! Ne%sait%pas%=%999,8%Fabricant!

!%%%! %Ne'sait'pas'='98%

Le!médicament!est'il!une!combinaison'à'dose'fixe'?!

1!=!Oui!0!=!Non!! ! [___]!8!=!Ne!sait!pas!

!

!!!!!!

[___|___]!

%%%%%[___|___],[___|___]!

[___|___]!

[___|___]!

Ne%sait%pas%=%98%

!

!!P20.!Veuillez!citer!le!médicament!de!première!intention!recommandé!par!le!gouvernement!pour!traiter!!!!!!!!!!!!le!paludisme!grave.!! Ne'pas'lire'la'liste.'Enregistrer'seulement'une'réponse'!

01!=!Artesunate!(Artesun,+Larinate,+Plasmotrim)!………………………………………………………………!!Aller%à%P21!%02!=!Artemether!(Artenam,+Paluther,+Artesiane,+Larither)!....................................................!Aller%à%P21!+03!=!Quinine............................................................................................................................!Aller%à%P21%04!=!ACT/ACTm!05!=!Artemether!Lumefantrine!(Lonart,+Artefan,+Lumartem,+Coartem)!06!=!Artesunate!Amodiaquine!(DUAC,+Coarsucam,+Winthrop)++%07!=!Dihydroartemisinin!Piperaquine!(Duo=cotecxin,+P=alaxin)++++++++++++++++++++++++++++++++++++++ +++++++Aller%à%P22%08!=!Chloroquine!!(Sugarquin)'09!=!Sulfadoxine!Pyrimethamine!(Fansidar,+SP,+Orodar,+Ekelfin,+Metakelfin)!! !96!=!Autre!(préciser):![_________________________________________]!!98!=!Ne!sait!pas!

[___|___]!


P21.!Veuillez!citer!la!présentation!recommandée!par!le!gouvernement!pour!traiter!le!paludisme!grave.!!%%%%%%%%%Ne%pas%lire%la%liste.%Enregistrer%seulement%une%réponse.%!

!

!

[___|___]!01!=!Comprimé!02!=!Suppositoire!03!=!Granules!04!=!Sirop!!



P22.!Un!test!de!diagnostic!rapide!du!paludisme,!aussi!connu!comme!un!TDR,!est!un!petit!test!de!sang,!emballé!individuellement,!qui!diagnostique!rapidement!si!une!personne!a!le!paludisme.!Montrer'les'photos'de'TDR'dans'les'fiches'illustratives'

!En!avez'vous!déjà!vu!ou!entendu!parler!?!!

!

1!=!Oui! ! !!!!%0!=!Non!!!!!!!!!!!!!!!!!!!!!!Aller%à%P26%8!=!Ne!sait!pas!!!!!!!!!!Aller%à%P26%!

[___]!

P23.!Avez'vous!déjà!testé!un!client!pour!le!paludisme!en!utilisant!un!TDR!?!!

1!=!Oui! ! ! %0!=!Non%8!=!Ne!sait!pas%

!!!

[___]!

P24.!Recommanderiez'vous!!à!un!patient/client!de!prendre!un!antipaludique!si!le!test!de!diagnostic!rapide!donne!un!résultat!négatif!pour!le!paludisme?!Lire%la%liste.%Enregistrer%une%seule%réponse!

!

1!=!Oui,!parfois!2!=!Oui,!toujours!3!=!Non,!jamais! ! Aller%à%P26!8!=!Ne!sait!pas! ! Aller%à%P26!

!!!!

[___]!

P25.!Dans!quelles!circonstances!recommanderez'vous!à!un!patient/client!de!prendre!un!antipaludique!après!!un!!!!!!!!!!!test!négatif!avec!le!TDR!du!paludisme?!%%%%%%%%%Ne%pas%lire%la%liste.%Demander%“à%part%ça%?”jusqu’à%ce%que%le%répondant%ne%finisse.%%%%%%%%%%Encercler%TOUTES%les%réponses%données!

!

Quand!ils!ont!des!signes/symptômes!du!paludisme! A!!

Quand!ils!demandent!un!traitement!antipaludique! B!!

Dans!une!zone!sévit!par!le!paludisme!(paludisme!endémique)/!patient!ayant!visité!une!zone!endémique!

C!!

Quand!je!ne!fais!pas!confiance!au!test! D!!

Autre!(spécifier)![_______________________________________________________]! X!!

! !P26.!Depuis!combien!d’années!travaillez'vous!dans!ce!point!de!vente!?!!

(Si%moins%d’un%an,%écrivez%01.)! [___|___]!P27.!Quel!âge!avez'vous!aujourd’hui?!

Ecrire%l’âge%en%année%révolu%% 97%=%Refus%

%98%=%Ne%sait%pas!

[___|___]!

P28.!Observez,%ne%lisez%pas:!Le!répondant!est'il!un!homme!ou!une!femme?!!!

1=!Homme!2=!Femme! ! !

[___]!


!P29.!Quel!niveau!d’instruction!le!plus!élevé!vous!avez!effectué!?!%

01! !=!!N’a!pas!fréquenté!02! !=!!Niveau!primaire!03! !=!!Terminé!le!niveau!primaire!04! !=!!Niveau!secondaire!05! !=!!Terminé!le!niveau!secondaire!06!!!!!=!!Niveau!universitaire!07! !=!!A!terminé!l’université!97!!!!!=!!A!refusé!

[___][___]!

POUR%L’INTERVIEWEUR%SEULEMENT%:%Vérifiez%le%MODULE%DE%PRESTATAIRE%PF%:%Si%le%Paquet%Planification%Familiale%est%complété%et%c’est%le%même%prestataire%interviewé,%allez%la%page%

suivante%(Fiche%de%Suivi%des%Audits)!

P30.!Avez'vous!une!des!qualifications!suivantes!en!santé!?!!Lire%la%liste.%Enregistrer%1%pour%oui,%0%pour%non%

!!

I.! Pharmacien! [___]!II.! Médecin! [___]!

III.! Infirmier!('ère)! [___]!IV.! Infirmière!accoucheuse/Sage'femme! [___]!V.! Laborantin!/!Assistant!en!laboratoire! [___]!

VI.! Technicien!en!pharmacie!/!Assistant!en!pharmacie! [___]!VII.! Assistant!médical! [___]!

VIII.! Conseiller!(ère)!(VIH,!TB,!Planification!familiale,!etc.)! [___]!IX.! Relais!communautaire! [___]!

P31.!En!dehors!de!vous,!!est'ce!qu’il!y!a!des!personnes!qui!travaillent!dans!ce!point!de!vente!et!qui!ont!les!!

types!de!qualifications!suivantes!liées!à!la!santé?!Lire%la%liste.%Enregistrer%1%pour%oui,%0%pour%non,%8%pour%ne%sait%pas%

!

I.! Pharmacien! [___]!II.! Médecin! [___]!

III.! Infirmier!('ère)! [___]!IV.! Infirmière!accoucheuse/Sage'femme! [___]!V.! Laborantin!/!Assistant!en!laboratoire! [___]!

VI.! Technicien!en!pharmacie!/!Assistant!en!pharmacie! [___]!VII.! Assistant!médical! [___]!

VIII.! Conseiller!(ère)!(VIH,!TB,!Planification!familiale,!etc.)! [___]!IX.! Relais!communautaire! [___]!

P32.!COMMENTAIRES!:!MODULE!POUR!LE!PRESTATAIRE!''

%Interviewer:%Aller%à%la%FICHE%DE%SUIVI%DES%AUDITS%

(P33%–%Page%suivant)%%%%


%FICHE'DE'SUIVI'DES'AUDIT'

!P33.!Y!a't'il!des!antipaludiques!COMPRIMES/SUPOSITOIRES/GRANULES!en!stock!dans!ce!point!de!vente!?!

1!=!Oui!!+0!=!Non!!!!!!!!!!!!!!!!!!!Aller%à%P36%8!=!Ne!sait!pas!!!!!!Aller%à%P36!

%

[___]!

P34.!Nombre!total!de!fiches'd’audit!des!médicaments!en!comprimés,'suppositoires'et'granules![___|___]!

P35.!Avez'vous!rempli!des!fiches!d’audits!pour!tous!les!antipaludiques!COMPRIMES/SUPOSITOIRES/GRANULES!disponibles!?%

!1!=!Oui,!audit!complet!0!=!Non,!audit!non!complet!!

!

[___]!

!P36.!Y!a't'il!des!antipaludiques!NON!COMPRIMES!en!stock!dans!ce!point!de!vente!?!!

1!=!Oui!!+0!=!Non!!!!!!!!!!!!!!!!!!!Aller%à%P39%8!=!Ne!sait!pas!!!!!!Aller%à%P39!

%

[___]!

P37.!Nombre!total!de!fiches'd’audit!des!médicaments!non'comprimés![___|___]!

P38.!Avez'vous!rempli!des!fiches!d’audits!pour!tous!les!antipaludiques!NON'COMPRIMES'disponibles?%

!1!=!Oui,!audit!complet!0!=!Non,!audit!non!complet!!

!

[___]!

!P39.!Y!a't'il!des!TDR!en!stock!dans!ce!point!de!vente!?!

1!=!Oui!!+0!=!Non!!!!!!!!!!!!!!!!!!!Aller%au%Résultat%de%Visite%Paludisme%(Sélection%Page%5)%8!=!Ne!sait!pas!!!!!!Aller%au%Résultat%de%Visite%Paludisme%(Sélection%Page%5)!

%

[___]!

P40.!Nombre!total!de!fiches'd’audit'TDR!![___|___]!

P41.!Avez'vous!rempli!des!fiches!d’audits!pour!tous!TDR!disponibles?%!1!=!Oui,!audit!complet!!!!!!!!!Aller%au%Résultat%de%Visite%Paludisme%(Sélection%Page%5)!0!=!Non,!audit!non!complet!!

!

[___]!

%P42.!COMMENTAIRES:!Raison!de!l’audit!incomplet!(si!réponse!est!non!pour!P35,!P38,!ou!P41):!!!++++

%Aller%au%RESULTAT%DE%VISITE%PALUDISME%(Sélection%Page%5)%


Annex%7:%Antimalarial%Reference%%

Table%X3:%Number%of%antimalarials%audited%



Private.Not.ForAProfit.Facility.

ALL.Public.Private.forAProfit.Facility.

Pharmacy. Drug.Store. Total.Private% ALL%Outlets%

Katanga. . . . . . . . . .

Urban. 715. 0. 90. 805. 403. 108. 4,236. 4,747. 5,552.

Census. 187. 0. 90. 277. 403. 87. 4,236. 4,726. 5,003.

Booster. 528. 0. 0. 528. 0. 21. 0. 21. 549.

Rural. 920. 76. 16. 1,012. 194. 0. 1,292. 1,486. 2,498.

Census. 435. 76. 16. 527. 194. 0. 1,292. 1,486. 2,013.

Booster.. 485. 0. 0. 485. 0. 0. 0. 0. 485.

TOTAL. 1,635. 76. 106. 1,817. 597. 108. 5,528. 6,233. 8,050.

Kinshasa. . . . . . . . . .

Urban. 1,062. 0. 123. 1,185. 507. 2,163. 8,469. 11,139. 12,324.

Census. 256. 0. 123. 379. 507. 60. 8,469. 9,036. 9,415.

Booster. 806. 0. 0. 806. 0. 2,103. 0. 2,103. 2,909.

Rural. 614. 11. 225. 850. 266. 0. 2,847. 3,113. 3,963.

Census. 136. 11. 225. 372. 266. 0. 2,847. 3,113. 3,485.

Booster.. 478. 0. 0. 478. 0. 0. 0. 0. 478.

TOTAL. 1,676. 11. 348. 2,035. 773. 2,163. 11,316. 14,252. 16,287.



Table&X4:&Quality/assured&(QA&ACT)&and&Non/quality&assured&ACTs&Audited&

Quality/assured&ACT&(QA&ACT)&

QA.ACTs.are.ACTs.that.comply.with.the.GFATM’s.Quality.Assurance.Policy..A.QA.ACT.is.any.ACT.that.appeared.on.the.GFATM’s.indicative.list.of.antimalarials.meeting. the. GFATM’s. quality. assurance. policy*. prior. to. data. collection,. or. that. previously. had. CFstatus. in. an. earlier. GFATM.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®..

Artemether&Lumefantrine! Artesunate&Amodiaquine!

Artefan.35+.kg.^#. ArtesunFPlus.>14.years.^#.

Artefan.Dispersible.35+.kg^#. Artesunate.+.Amodiaquine.2F11.months.(IPCA)^#.

Artemether.+.Lumefantrine.5F14.kg.(IPCA)#. Artesunate.+.Amodiaquine.1F6.years.(IPCA)^#.

Artemether.+.Lumefantrine.15F24.kg.(IPCA)#. Artesunate.+.Amodiaquine.6F13.years.(IPCA).^#.

Coartem.20/120.5F15.kg.^#. Artesunate.+.Amodiaquine.13.years.and.above.(IPCA).^#.

Coartem.20/120.15F25.kg.^#. Winthrop.Infant.2F11.months.^#.

Coartem.20/120.25F35.kg.^#. Winthrop.Toddler.1F5.years.^#.

Coartem.20/120.35.kg.and.above.^#. Winthrop.Child.6F13.years.^#.

Coartem.80/480.35.kg.and.above.^#. Winthrop.Adult.14.years.and.above.^#.

Colart.(IPCA).^#. .

Combisunate.35kg.and.above.#. .

Lumartem.5F15.kg.#. .

Lumartem.15F5kg.#. .

Lumartem.35kg.and.above.^#. .

Non/quality&assured&ACT&&ACTs.that.do.not.meet.the.definition.of.being.quality.assured..

Artemether&Lumefantrine&Tablets!Aludoc.40/240.^#. Curamart.DS.#.

Aludoc.80/480.^#. LAFDS.^#.

Arlumetrin.#. LAFForte.^#.

Arlumetrin.DP.#. LFArtem.^#.

Arlumetrin.Forte.#. LFArtem.dispersible.#.

ArluFMS.#. LFArtem.DS.#.

ArluFGranules.#. LFArtem.forte.^#.

Artemether.Lumefantrine.5F14.Kg.(S.Kant.Healthcare).^#. Lonart.Dispersible.for.infant.&.children.only.^#.

Artemether.Lumefantrine.15F24.Kg.(Kant.Healthcare).^#. Lonart.DS.^#.

Artemether.Lumefantrine.25F34.Kg.(S.Kant.Healthcare).^#. Lonart.forte.#.

Artemether.Lumefantrine.35.kg.and.above.(S.Kant.Healthcare).#^. LufametFDS.#.

ArteFPed.Adult.#^. Lumart.DS.#.

Arthefan.40.#^. Lumeart.forte.#.

Arthefan.80.#^. Lumether.(Astra.Lifecar).#.

CetherFL.Adult.#^. Luther.^#.

CoFArlumether.Forte.#^. Luther.DP.^#.

CoFArther.DS.#^. Luther.forte.^#.

CoFArtluf.#^. Mefanther.DS.#.

CoFArtluf.DS.#. Mefanther.forte.^#.

CoFArtluf.Dispersible.#^. Nomal.^#.

CoFArtluf.Forte.#^. Palufin.#.

Cofantrine.Adult.#. Palufin.forte.#.

Cofantrine.Dispersible.Infant.&.Children.#. Riamet.20mg/120mg.#.

CoFRimetar.#^. ShikarthemFL.#.

CoFRimetar.80/480.Adult.&.Child.>35Kg.#^. TLCFEther.forte.^#.

CoFRimetar.dispersible.20/120.enfants.5F14kg.^#. .


Table&X4:&Quality/assured&(QA&ACT)&and&Non/quality&assured&ACTs&Audited&

Non/quality&assured&ACT&Artemether&Lumefantrine&Suspension!ArteFPed.Pediatric.^#. Lonart.pediatric.^#.

CetherFL.pediatric.5F15kg.^#. Lufamet.^#.

CoFArtesiane.^#. Lumeart.pediatric.^#.

CoFArther.^#. Luther.pediatric.^#.

CoFArtluf.^#. MF2.^#.

Cofantrine.^#. MedixinFL.pediatric.#.

CoFRimetar.^#. Mefanther.pediatric.^#.

Curamart.pediatric.#. Nomal.^#.

Gvither.plus.pediatric.^#. Palufin.#.

LFartem.double.action.^#. ShikarthemFL.pediatric.#.

Artemisinin&Naphtoquine&Tablets&ARCO.^.

Artemisinin&Piperaquine&Tablets&Artequick.^#.

Artesunate&Amodiaquine&Tablets!Amonat.junior.^#. ASAQ.Denk.#.

AmonatFA.#. Falcimon.kit.for.adult.#.

Armadoc.adult.^#. SunatFA.^#.

Armadoc.enfant.^#. SunatFA.forte.^#.

Armadoc.junior.^#. .

Artesunate&Mefloquine&Tablets!Artequin.300/375.#. Artequin.Pediatric.#.

Artequin.600/750.#. .

Artesunate&SP&Tablets!ArteFplus.^#. CoFarinate.FDC.junior.^#.

Artesunate.plus.^#. Falcidox.plus.#.

AsuFdenk.#. Fansinat.junior.^#.

Asunate.denk.100.plus.junior.^#. MalacomFA.adult.^#.

Asunate.denk.200.plus.^#. MalacomFE.child.^#.

CoFarinate.FDC.adult.^#. Malafan.forte.enfant.^#.

Dihydroartemsinin&Piperaquine&Tablets&Artepip.40/320mg.adult.#.. Duo.cotecxin.40/320.#.

Artepip.40/320mg.junior.#. Malacur.40/320.#.

Combiquin.#. Palucur.adult.and.children.>25kg.^#.

DFArtepp.^#. Paludose.plus.^#.

DarteFQ.#. PFGvaxin.#.

Diperakine.^#. .

Dihydroartemsinin&Piperaquine&Suspension&Artepip.^#. MalaxinFP.^#.

Combiquin.^#. PFAlaxin.#.

Diperakine.^#. Palucur.#.

Malacur.#. PFGvaxin.^#.

Dihydroartemsinin&Piperaquine&Trimethoprim&Tablets&Artecom.#.

Dihydroartemsinin&Sulfadoxine&Pyrimethamine&Tablets&MalaxinFPlus.#^.

*.http://www.theglobalfund.org/en/procurement/quality/pharmaceutical..^. Product.audited.in.the.public.sector.#. Product.audited.in.the.private.sector.


Table&X5:&Nationally&Registered&ACTs&ACT.registered.with.the.country’s.national.drug.regulatory.authority.and.permitted.for.sale.or.distribution.in.country...

Artemether&Lumefantrine&Tablets& &

Aludoc.20/120.#^& Cofantrine.^.

Aludoc.40/240.#^& Colart.#^.

Aludoc.DS.80/480.#^& LFArtem.#^.

Arlumetrin.^& Lonart.Dispersible.#^.

CoFArlumether.^& Lonart.#^.

CoFArtluf.#^& Lufamet.^.

Coartem.20/120.5F<15Kg.^& Lumartem.5F15.kg.^.

Coartem.20/120.15F25.kg.#^& Lumartem.15F25.kg.^.

Coartem.20/120.25F35.kg.#^& Lumartem.35.kg.and.above.#^.

Coartem.20/120.35.kg.and.above.#^& Lumether.^.

Coartem.80/480.35.kg.and.above.#^& Luther.#^.

Artemether&Lumefantrine&Suspension& &

Aludoc.Pediatric.#^. Lonart.Pediatric.#^.

Arlumetrin.^. Lufamet.#^.

CoFArtesiane.#^. Lumartem.Pediatric.^.

CoFArtluf.#^. Luther.Pediatric.#^.

Cofantrine.#^. MF2.#^.

Gvither.Plus.Pediatric.#^. Mefanther.Pediatric.#^.

Artemisinin&Piperaquine&Tablets& .

Artequick.#^! .

Artesunate&Amodiaquine&Tablets. .

Armadoc.Enfant.#^. Artesunate.Amodiaquine.>35.kg.(IPCA).#^.

Armadoc.Junior.#^. ASAQ.Denk.^.

Armadoc.Adulte.#^. ASAQ.Winthrop.Infant.2F11.Months.#^.

ArtesunFPlus.^. ASAQ.Winthrop.Toddler.1F5.Years.#^.

ArtesunFPlus.Adult.#^. ASAQ.Winthrop.Child.6F13.Years.#^.

Artesunate.Amodiaquine.4.5F8.kg.(IPCA).#^. ASAQ.Winthrop.Adult.+14.Years.#^.

Artesunate.Amodiaquine.9F17.(IPCA).kg. SunatFA.#^.

Artesunate.Amodiaquine.18F35.(IPCA).kg.#^. .

Artesunate&Sulfadoxine&Pyrimethamine&Tablets& .

CoFArinate.Junior.#^. CoFArinate.Adult.#^.

Dihydroartemisinin&Piperaquine&Tablet. .

DFArtepp.#^. Malacur.^.

DarteFQ.^. PFGvaxin.^.

Duo.Cotecxin.^. .

Dihydroartemisinin&Piperaquine&Suspension. .

Malacur.^. PFGvaxin.#^.

MalaxinFP.#^. .

Dihydroartemisinin&Sulfadoxine&Pyrimethamine&Tablets. .

Malaxin.Plus.#! .^. Product.audited.in.the.public/privateFnotFforFprofit.sector.#. Product.audited.in.the.private.sector.


Table&X6:&Severe&Malaria&Treatment&Audited&WHO.recommends.parenteral.artesunate.as.firstFline.treatment.in.the.management.of.severe.falciparum.malaria,.with.artemether.or.quinine.injections. as. acceptable. alternatives. if. parenteral. artesunate. is. not. available*.. If. complete. treatment. for. severe. malaria. is. not. possible,.patients.with.severe.malaria.should.be.given.preFreferral.treatment.and.referred.immediately.to.an.appropriate.facility.for.further.treatment..The.following.are.options.for.preFreferral.treatment:.rectal.artesunate,.injectable.quinine,.injectable.artesunate,.and.injectable.artemether..

Rectal&artesunate&

ATF200.#. PlasmotrimF200.^#.

ATF50.#. PlasmotrimF50.^#.

Artesunate&powder&injection!

Artesun.^#. ATF120.^#.

Artesunate.120.(Lincoln.Parenteral).#. Delasunate.#.

Artexid.60.^#. Palunate.^#.

Artexid.120.#. Start.60.^#.

ATF60.^#. Start.120.^#.

Arteether&injection!

Aba.junior.^#. Emal.^#.

Aba.forte.^#. LFArtem.#.

Abitar.^#. Malarkit.^#.

Abther.^#. Medither.junior.#.

Albart.^#. Medither.regular.^#.

Alfather.junior.^#. Medither.forte.^#.

Alfather.adult.^#. PalufinFQ.#.

ARH.junior.^#. Parther.junior.#.

ARH.forte.^#. Parther.regular.^#.

Arither.^. Parther.forte.^#.

Arteether.(Shalina.Laboratories).^#. Planether.junior.#.

ArteFped.children.^#. Planether.forte.#.

ArteFped.adult.^#. Rimetar.junior.^#.

ArteFped.forte.^#. Rimetar.adult.^#.

Artesim.^#. Rimetar.forte.^#.

Arther.#. Spanther.junior.#.

BFther.^#. Spanther.forte.^#.

CetherFL.junior.^#. TLCFEther.junior.^#.

CetherFL.adult.^#. TLCFEther.forte.^#.

Curaether.^#. .

Artemether&injection!

Amether.^#. Artesiane.100.#.

Armethar.^#. Artesiane.300.#.

Artem.^#. Arthefan.#.

Artemether.(Jiangsu.Sainty.Pharma).#. Arther.^#.

Artemether.(Shangai.Ruili).^. Gvither.forte.^#.

Artenam.#. Luther.80.^#.

Artesiane.20.pediatric.#. Prither.^#.

Artesiane.40.#. Skapaluartem.^#.

Artesiane.80.^#. .

Quinine&injection!

Quini.pack.^#. Quinine.hydrochloride.injectable.(Anhui.Chengshi).^#.

Quinine.injectable.(Pharmakina).^#. Quinimax.^#.

Quinine.injectable.(Renaudin).^. Quininject.#.

Quinine.dihydrochloride.injectable.(Anhui.Chengshi).^#. .

*.Guidelines)for)the)treatment)of)malaria,)3rd)edition..WHO..Geneva:.2015..^. Product.audited.in.the.public.sector.#. Product.audited.in.the.private.sector.


Annex%8:%RDT%Reference%%%.

Table%X7:%Number%of%RDTs%audited%




Private.forAProfit.Facility.

Pharmacy. Drug.Store. ALL.Private.Private.forAProfit.Facility%

Katanga. . . . . . . . . .Urban. 77. 0. 12. 89. 52. 0. 46. 98. 187.

Census. 22. 0. 12. 34. 52. 0. 46. 98. 132.

Booster. 55. 0. 0. 55. 0. 0. 0. 0. 55.

Rural. 165. 32. 6. 203. 31. 0. 14. 45. 248.

Census. 79. 32. 6. 117. 31. 0. 14. 45. 162.

Booster.. 86. 0. 0. 86. 0. 0. 0. 0. 86.

TOTAL. 242. 32. 18. 292. 83. 0. 60. 143. 435.

Kinshasa. . . . . . . . . .

Urban. 93. 0. 12. 105. 51. 5. 4. 60. 165.

Census. 19. 0. 12. 31. 51. 0. 4. 55. 86.

Booster. 74. 0. 0. 74. 0. 5. 0. 5. 79.

Rural. 51. 2. 20. 73. 27. 0. 2. 29. 102.

Census. 12. 2. 20. 34. 27. 0. 2. 29. 63.

Booster.. 39. 0. 0. 39. 0. 0. 0. 0. 39.

TOTAL. 144. 2. 32. 178. 78. 5. 6. 89. 267.


.


.

Table&X8:&RDT&Brand&Names&and&Manufacturers*&Brand&Name& Manufacturer&

Carestart.^#. Access.Bio.Inc..First.Response.^#. Premier.Medical.Corporation.Ltd.Paracheck.^#. Orchid.Biomedical.Systems.SD.Bioline.^#. Standard.Diagnostics.Inc..UITest.#. Humor.Diagnostica.Vision.#. Vision.Biotech.

*.702.RDTs.were.audited..Two.RDTs.were.missing.brand.name.information.(missing.or.don’t.know).and.4.were.missing.manufacturer.name.(missing.or.don’t.know)..

^. Product.audited.in.the.public/privateInotIforIprofit.sector.#. Product.audited.in.the.private.sector..

.

.


Annex&9.&Sampling&Weights&.Sampling. weights. were. applied. for. analysis. of. the. DRC. 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.domainIspecific.estimates..Urban.and.rural.health.zones.in.Kinshasa.were.defined. with. reference. to. the. Plan% Provincial% de% Developpement% Sanitaire% (PPDS)% de% Kinshasa% 2011:2015..Classifications. for.Katanga.Province.were.primarily.defined. in.consultation.with.key. informants. in.Lubumbashi.who. were. familiar. with. health. service. provision. across. the. Province.. The. classifications. were. independently.crossIchecked.against.the.sampling.frame.used.for.the.2013.Demographic.and.Health.Survey.(DHS),.where.the.latter.included.health.zone.information..A.representative.sample.was.selected.within.each.domain....

2)! OneEstage& cluster& sampling:. Health. areas. were. selected. from. sampling. frames. within. each. domain. with.probability. proportional. to. size..Within. each. health. area,. 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&and&pharmacies:.Within.both.Kinshasa.and.Katanga.provinces,.public.

health.facilities.were.visited. in.50%.of.urban.health.areas.within.health.zones.where.one.or.more.health.area.was.selected. in. the.main.sample..All.public.health. facilities. located.within.the.same.health.zone.as.a.sampled.rural.health.area.were.visited. in.Kinshasa.province,.whereas. in.Katanga.province,.public.health. facilities.were.visited.within.two.randomly.selected.health.areas.within.each.health.zone.that.included.a.sampled.rural.health.area..A.census.of.all.pharmacies.was.conducted.in.Kinshasa.and.Katanga.provinces..

.The.sampling.weights.applied.during.analysis.are.the.inverse.of.the.probability.of.selection:...

!" =1

a&×& ()()

&

.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.applied.to.all.outlets.within.a.given.cluster,.irrespective.of.outlet.type..&Market.share.and.market.composition.were.calculated.using.the.full.census.data.at.the.healthIarea.level.only.(i.e..the.booster.sample.was.not.included.in.market.share.and.market.composition.calculations)..Health.area.sampling.weights.were.created.using.the.sampling.weight.formula.(Wi),.where:..&•! Mα.=. estimated.health.area.population.size.•! ΣMα.=. sum.of.estimated.health.area.population.size.in.the.entire.stratum.•! a.=. number.of.health.areas.selected.within.the.stratum.&The. health. area. sampling.weights.were. applied. to. all. other. indicators. in. the. report. for. all. outlet. types,.with. the.exception. of. pharmacies. and. health. facilities..Where. pharmacies. and.public. health. facilities.were. included. in. the.sample. through. a. health. zoneIwide. census,. the.weights. applied. to. pharmacies. and. public. health. facilities. for. all.indicators,.other.than.market.share,.were.calculated.using.the.sampling.weight.formula,.where:.


.•! Mα.=. estimated.health.zone.population.size.•! ΣMα.=. sum.of.estimated.health.zone.size.in.the.entire.stratum.•! a.=. number.of.health.zones.selected.within.the.stratum..Where. booster. public. health. facilities. were. included. in. the. sample. through. an. approach. of. taking. a. fraction. of.additional.public.health.facilities.or.areas.within.a.given.health.zone,.the.weights.applied.to.public.health.facilities.for.all.indicators.other.than.market.share.were.calculated.using.the.sampling.weight.formula,.where:..

!" =1

a&× *α*α×&&b&× (α

(α

&

.Where:..1st.Stage.of.selection:..•! Dα.=. estimated.health.zone.population.size..•! ΣDα.=. sum.of.estimated.health.zone.population.sizes..•! a.=. number.of.health.zones.selected..

.2nd.Stage.of.selection:..•! Mα.=. estimated.health.area.population.size.•! ΣMα.=. sum.of.estimated.health.area.population.sizes.in.the.stratum.(urban/rural).•! b.=. number.of.health.areas.selected.within.the.health.zone..The.population.estimates.used.to.select.health.areas.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.nonIcompletion.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.antimalarialIstocking.outlets.with.a.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.

the. 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...

Calculation. Numerator.divided.by.denominator....


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.antimalarialIstocking.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.qualityIassured.and.nonIquality.assured.ACTs...Table.3.reports.the.types.of.qualityIassured.(QA).and.nonIquality.assured.(nonIQA).ACTs.audited.in.the.public.and.private.sector,.including.generic.name.and.formulation.....Numerator. By. sector,. the. number. of. QA. and. nonIQA. 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.nonIQA.ACTs.audited...

Calculation. Numerator.divided.by.the.denominator.within.QA.and.nonIQA.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.3.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.the.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.the.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. interIquartile. range. (IQR). is. provided. as. a.measure. of.dispersion....Calculation. Median.antimalarial.AETD.(see.Annex.11).price. in.US.dollars.with. interIquartile. range.(25th.and.

75th.percentiles)....

Handling.missing.values..

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.preIpackaged.QA.ACT.therapies:.pediatric.appropriate.for.a.10kg.

child.(two.years.of.age),.and.adult.appropriate.for.a.60kg.adult..The.interIquartile.range.(IQR). is.provided.as.a.measure.of.dispersion...

.Calculation. Median. preIpackaged. therapy. price. in. US. dollars. with. interIquartile. range. (25th. and. 75th.

percentiles...

Handling.missing.values..

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..

.Table.6:.Availability.of.malaria.blood.testing.among.antimalarialIstocking.outlets......Table. 6. reports. the. proportion. of. antimalarialIstocking. 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. qualityIassured. RDTs.. QualityIassured. RDTs. are. RDTs. that. comply. with. the. GFATM’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...

Calculation. Numerator.divided.by.denominator....


•! AntimalarialIstocking.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/testingIonly.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.the.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.the.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.......A.! Table.8.reports.the.median.price.of.blood.testing.to.consumers. including.any.consultation.or.service.fees..The.

interIquartile.range.(IQR).is.provided.as.a.measure.of.dispersion....Calculation. Median.total.blood.test.price.in.US.dollars.with.interIquartile.range.(25th.and.75th.percentiles)..

.Handling.missing.values.

MicroscopyIstocking.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....


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...

.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..

.




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,.outletItype.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,.outletItype.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.selfIreported.practices.for.managing.clients.who.test.negative.for.malaria...Numerator. A.! Recommends.antimalarials.to.testInegative.clients:.respondents.who.indicated.“yes,.always,”.

or.“yes.sometimes.”.B.! Circumstances.for.recommending.an.antimalarial:.individual.indicators.for.the.most.common.

responses.provided.to.this.openIended.question..Note.this.numerator.excludes.providers.who.did.not.respond.to.the.previous.question.about.recommending.antimalarials.to.testInegative.clients.with.“yes.always”.or.“yes.sometimes.”...

Denominator. A.! Recommends.antimalarials.to.testInegative.clients:.respondents.who.provided.a.response.to.this.question,.including.“don’t.know.”..

B.! Circumstances. for. recommending. an. antimalarial:. respondents. who. provided. at. least. one.response. to. this.question,. including. “don’t. know”. (i.e.. at. least.one.variable. in. this. series. is.nonImissing)..Note.this.denominator.excludes.providers.who.did.not.respond.to.the.previous.question.about.recommending.antimalarials.to.testInegative.clients.with.“yes.always”.or.“yes.sometimes.”.

.Calculation. Numerator.divided.by.denominator..

.



A.! Providers.missing.a.response.to.this.question.will.be.excluded.from.the.indicator...B.! This.indicator.is.assessed.using.an.openIended.multiple.response.option.question..Providers.

with. at. least. one. nonImissing. 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. A. and. B. in. Table. 13),. while. a. different. provider. responsible. for. prescribing. and/or.dispensing. medicines. may. have. responded. to. questions. about. government. recommended.malaria.firstIline.treatment.and.dosing.regimen.(indicators.A.and.B.in.Table.14)..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.firstIline.treatment,.knowledge.of.the.firstIline.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.firstIline:.providers.who.responded.to.p17.with.a.generic.or.brand.name.consistent.

with.a.national.firstIline.treatment,.or.responded.to.p17.with.“ACT,”.or.“ACTm”.and.in.p18.provided.a.generic.or.brand.name.consistent.with.a.national.firstIline.treatment..In.other.words,.providers.must.specifically.name.the.firstIline.treatment.using.generic.or.brand.name.language.in.either.p17.or.p18....

B.! FirstIline.regimen,.adult:.providers.who.correctly.stated.the.firstIline.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.openIended.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.antiIpyretic.(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.firstIline:.All.providers.who.responded.to.p17.–.please.name.the.firstIline.medicine...B.! FirstIline.regimen,.adult:.All.providers.who.responded.to.p17.(starting.the.series.on.firstIline.

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.nonIantimalarial.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...

..


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.peerIreviewed.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. overIsimplify. 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. (coI

formulated.or. coIblistered),. the. strength.of. only. one.principal. ingredient. issued.. The. artemisinin. derivative. is.used.as.the.principal.ingredient.for.ACT.AETD.calculations..

.•! CoIblistered.combinations.are.generally.assumed.to.be.1:1.ratio.of.tablets.unless.otherwise.documented.during.

fieldwork.or.through.manufacturer.websites....•! SulfamethoxpyrazineIpyrimethamine. is. assumed. to. have. the. same. fullIcourse. adult. treatment. dose. as.

sulfadoxineIpyrimethamine...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

45.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...... .

45.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.Note:%this%includes%a%recommended%loading%dose%of%4mg/kg%on%the%first%day%

followed%by%a%six:day%course%of%2mg/kg%once%daily..ArtemetherILumefantrine.[Artemether].

480mg. WHO.Guidelines.for.the.treatment.of.malaria.3rd.edition,.2015.

ArtemisininINaphthoquine.[Artemisinin].

2400mg. WHO.Use.of.Antimalarials,.2001.

ArtemisininIPiperaquine.[Artemisinin].

504mg.

Thanh.NX,.Trung.TN,.Phong.NC,.et.al..2012..The.efficacy.and.tolerability.of.artemisininIpiperaquine.(Artequick®).versus.artesunateIamodiaquine.(Coarsucam™).for.the.treatment.of.uncomplicated.Plasmodium.falciparum.malaria.in.southIcentral.Vietnam..Malaria%Journal,.11:217..

Artesunate. 960mg.WHO.Use.of.Antimalarials,.2001.Note:%this%includes%a%recommended%loading%dose%of%4mg/kg%on%the%first%day%

followed%by%a%six:day%course%of%2mg/kg%once%daily..ArtesunateIAmodiaquine.[Artesunate]..


ArtesunateIMefloquine.[Artesunate].


ArtesunateI.SulfadoxineIPyrimethamine.[Artesunate]..


AtovaquoneIProguanil.[Atovaquone].


Chloroquine. 1500mg. WHO.Guidelines.for.the.treatment.of.malaria.3rd.edition,.2015.

Dihydroartemisinin. 480mg.Manufacturer.Guidelines.(Cotecxin%–%Holleypharm;%MALUether%–%Euromedi).

DihydroartemisininIPiperaquine.[Dihydroartemisinin].

360mg.

WHO.Guidelines.for.the.treatment.of.malaria.3rd.edition,.2015.Note:.the.AETD.under.the.new.2015.guidelines.is.now.480mg.whereas.360mg.was.indicated.in.previous.guidelines..Product.availability.for.adult.preIpackaged.DHA.PPQ.in.2015.was.still.most.commonly.360mg.administered.over.a.3Iday.course.of.a.total.of.9.tablets.(40/320)..

DihydroartemisininIPiperaquineITrimethoprim.[Dihydroartemisinin]..

256mg.Manufacturer.Guidelines.(Artecxin%–%Medicare%Pharma;%Artecom%–%Ctonghe).

DihydroartemisininISulfadoxineIPyrimethamine.[Dihydroartemisinin].

360mg.Manufacturer.Guidelines.(Dalasin%–%Adams%Pharma).

Hydroxychloroquine. 2000mg.Manufacturer.Guidelines.(Plaquenil%–%Sanofi%Aventis).

Mefloquine. 1000mg. WHO.Model.Formulary,.2008.Quinine. 10408mg. WHO.Model.Formulary,.2008.SulfadoxineIPyrimethamine. 1500mg. WHO.Model.Formulary,.2008.

.

. .


Annex%12:%Antimalarial%Volumes%

Table%X10:%Antimalarial%volumes,%by%outlet%type,%Katanga,%2015%

AETDs%sold%or%distributed%in%the%previous%week%by%outlet%type%and%antimalarial:*%


Community.Health.Worker%

Private.Not.For?Profit.Facility%

TOTAL%Public%/%NotKForKProfit%

Private.For?Profit.Facility.

Drug.Store. TOTAL%Private.

ANTIKMALARIAL%TOTAL%

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

1.%Any%ACT%20595.4. 837.3. 1284.9. 22717.7. 7183.2. 41751.8. 50368.5. 73086.2.

(15646.8,%25544.1). (0.0,%1804.7). (0.0,%2715.1). (17663.1,%27772.3). (1169.1,%13197.3). (17696.5,%65807.1). (18634.0,%82103.0). (40999.7,%105172.6).

First.line.ACT.!.20502.7. 837.3. 1227.6. 22567.7. 6811.5. 35747.9. 43372.0. 65939.7.

(15551.2,.25454.3). (0.0,.1804.7). (0.0,.2625.7). (17514.2,.27621.2). (1352.2,.12270.7). (18000.2,.53495.6). (19711.1,.67032.9). (41717.5,.90161.8).

Artesunate.amodiaquine. 19297.2. 837.3. 978.3. 21112.8. 3733.4. 10070.7. 13804.1. 34916.9.(14387.2,.24207.1). (0.0,.1804.7). (0.0,.2464.8). (16140.6,.26085.0). (1042.6,.6424.2). (6905.1,.13236.3). (8870.3,.18738.0). (27718.6,.42115.3).

Artemether.lumefantrine. 1205.6. 0.0. 249.3. 1454.9. 3078.0. 25677.2. 29567.8. 31022.7.(413.6,.1997.5). ?. (0.0,.1024.4). (618.6,.2291.2). (0.0,.8004.2). (9542.9,.41811.5). (7602.4,.51533.2). (8925.4,.53120.0).

Artesunate.sulfadoxine.pyrimethamine. 92.7. 0.0. 0.0. 92.7. 16.1. 2074.0. 2423.7. 2516.4.?. ?. ?. (28.4,.157.0). ?. (0.0,.4929.4). (0.0,.5947.1). (0.0,.5983.6).

Dihydroartemisinin.piperaquine. 0.0. 0.0. 0.0. 0.0. 337.6. 406.5. 858.4. 858.4.?. ?. ?. ?. ?. (0.0,.861.3). (0.0,.2155.4). (0.0,.2155.4).


0.0. 0.0. 57.3. 57.3. 18.1. 3192.9. 3350.7. 3408.0.?. ?. ?. ?. ?. (0.0,.6392.2). (0.0,.6804.2). (0.0,.6855.2).

Quality?assured.ACT.(QA.ACT). 19529.0. 837.3. 1152.4. 21518.7. 4562.8. 17665.9. 22614.7. 44133.4.(14595.2,.24462.8). (0.0,.1804.7). (0.0,.2525.1). (16517.9,.26519.5). (1628.1,.7497.5). (11500.3,.23831.5). (14603.1,.30626.4). (34399.0,.53867.9).

QA.artesunate.amodiaquine. 19161.7. 837.3. 978.3. 20977.3. 3731.9. 9285.3. 13017.1. 33994.5.(14252.4,.24071.0). (0.0,.1804.7). (0.0,.2464.8). (16004.6,.25950.1). (1040.9,.6422.8). (6340.3,.12230.2). (8238.7,.17795.6). (26867.1,.41121.9).

QA.artemether.lumefantrine. 367.2. 0.0. 174.1. 541.4. 831.0. 8380.6. 9597.6. 10139.0.(0.0,.1574.5). ?. (0.0,.654.6). (0.0,.1303.4). (0.0,.2264.9). (4092.4,.12668.8). (4103.3,.15091.9). (4682.6,.15595.3).

Non?quality.assured.ACT.(non?QA.ACT). 1066.5. 0.0. 132.5. 1199.0. 2620.4. 24085.9. 27753.8. 28952.7.(481.2,.1651.8). ?. (0.0,.665.5). (590.9,.1807.0). (0.0,.7049.4). (3458.9,.44712.9). (1193.4,.54314.1). (2308.9,.55596.6).


2.%Any%nonKartemisinin%therapy. 11732.0. 31.2. 2839.8. 14603.0. 7952.9. 40783.7. 49471.0. 64074.0.(5145.1,%18318.9). (0.0,%413.8). (28.2,%5651.4). (7507.6,%21698.5). (2965.2,%12940.6). (28641.5,%52925.9). (33665.4,%65276.5). (45807.6,%82340.4).

Sulfadoxine.pyrimethamine. 9025.8. 31.2. 1769.9. 10826.9. 6086.7. 27401.4. 33802.7. 44629.6.(2905.8,.15145.8). ?. (0.0,.4788.7). (4291.5,.17362.3). (1616.5,.10557.0). (19801.1,.35001.7). (23520.9,.44084.6). (31837.9,.57421.3).

Oral.quinine. 2153.4. 0.0. 979.7. 3133.1. 1555.9. 12478.8. 14423.2. 17556.3.(1285.8,.3021.1). ?. (0.0,.2208.3). (1777.7,.4488.5). (985.8,.2126.0). (7142.1,.17815.5). (8291.7,.20554.6). (11201.5,.23911.1).

Quinine.IV/IM. 535.1. 0.0. 90.2. 625.4. 308.5. 784.6. 1117.2. 1742.6.(265.8,.804.5). ?. (6.7,.173.8). (343.4,.907.4). (142.3,.474.8). (531.9,.1037.4). (740.8,.1493.7). (1174.9,.2310.2).

Other.non?artemisinin.therapy.^. 0.0. 0.0. 0.0. 0.0. 0.0. 50.8. 50.8. 50.8.?. ?. ?. ?. ?. ?. ?. ?.

3.%Oral%artemisinin%monotherapy%0.0. 0.0. 0.0. 0.0. 0.0. 28.6. 28.6. 28.6.K. K. K. K. K. K. K. K.

4.%NonKoral%artemisinin%monotherapy%116.4. 15.3. 84.7. 216.4. 521.5. 3617.0. 4216.1. 4432.4.

(43.2,%189.7). (0.0,%58.5). (0.0,%274.7). (79.2,%353.5). (166.1,%877.0). (651.5,%6582.4). (884.8,%7547.4). (1092.2,%7772.7).

Artesunate.IV/IM.#. 14.7. 0.0. 0.0. 14.7. 53.4. 29.4. 82.8. 97.5.(0.0,.34.1). ?. ?. (0.0,.34.1). (0.0,.192.1). (0.0,.63.9). (0.0,.211.7). (0.0,.221.6).


Table%X10:%Antimalarial%volumes,%by%outlet%type,%Katanga,%2015%

AETDs%sold%or%distributed%in%the%previous%week%by%outlet%type%and%antimalarial:*%


Community.Health.Worker%

Private.Not.For?Profit.Facility%



Drug.Store. TOTAL%Private.


#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

Artemether.IV/IM.. 25.4. 0.0. 64.0. 89.5. 213.9. 888.1. 1102.0. 1191.4.(0.0,.87.6). ?. ?. (0.0,.266.8). ?. (179.3,.1596.9). (362.5,.1841.5). (449.6,.1933.2).

Arteether/Artemotil.IV/IM. 47.9. 0.0. 19.4. 67.3. 254.2. 2543.6. 2875.4. 2942.8.?. ?. ?. (5.8,.128.9). (70.6,.437.8). (0.0,.5135.2). (0.0,.5754.1). (67.7,.5817.8).

Any.severe.malaria.treatment. 651.6. 15.3. 174.9. 841.7. 830.1. 4346.8. 5278.5. 6120.2.(353.5,.949.7). (0.0,.58.5). (13.4,.336.4). (510.6,.1172.8). (327.1,.1333.0). (1334.8,.7358.8). (1746.9,.8810.1). (2474.4,.9766.1).

OUTLET%TYPE%TOTAL%32443.9% 883.8% 4209.4% 37537.1% 15657.6% 86181.0% 104084.1% 141621.2%

(23978.5,%40909.3)% (0.0,%1862.3)% (886.6,%7532.3)% (28631.2,%46443.0)% (5989.2,%25326.0)% (49254.2,%123107.8)% (55596.6,%152571.6)% (91337.8,%191904.6)%

*. A.total.of.16,798.8.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.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first?line.treatments.for.uncomplicated.malaria..^. Other.non?artemisinin.therapies.include.amodiaquine,.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first?line.treatment.for.severe.malaria..A.total.of.7,016.antimalarials.(in.the.census.sample).were.audited..Of.these,.1,172.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.%Source:.ACTwatch.Outlet.Survey,.DRC,.2015.%


Table%X11:%Antimalarial%volumes,%by%outlet%type,%Kinshasa,%2015%

AETDs%sold%or%distributed%in%the%previous%week%by%outlet%type%and%antimalarial%type:*%


Private.Not.For?Profit.Facility.



Pharmacy. Drug.Store. TOTAL%Private.


#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

1.%Any%ACT%10084.4% 1687.4. 12000.6. 4061.3. 80.4. 60221.7. 64363.4. 76364.0.

(2980.3,%17188.5)% (821.1,%2553.7). (4890.4,%19110.8). (2528.0,%5594.6). K. (37670.1,%82773.3). (42002.1,%86724.7). (51678.9,%101049.1).

First.line.ACT.!. 9221.1. 1604.1. 11053.9. 3408.1. 75.9. 42241.7. 45725.7. 56779.6.(3349.9,.15092.4). (808.7,.2399.5). (5190.7,.16917.2). (1978.9,.4837.2). ?. (27280.5,.57202.8). (30728.4,.60722.9). (39228.5,.74330.7).

Artesunate.amodiaquine. 7963.6. 795.7. 8988.0. 1458.6. 0.0. 2265.4. 3724.0. 12712.1.(2949.4,.12977.8). (407.7,.1183.7). (4099.5,.13876.6). (261.7,.2655.6). ?. (1174.1,.3356.7). (2208.8,.5239.2). (7231.6,.18192.5).

Artemether.lumefantrine. 1257.6. 808.4. 2065.9. 1949.4. 75.9. 39976.3. 42001.7. 44067.6.(315.1,.2200.0). (114.9,.1501.8). (712.6,.3419.3). (773.0,.3125.9). ?. (25498.1,.54454.5). (27359.7,.56643.6). (29032.2,.59102.9).

Artesunate.piperaquine. 126.6. 5.1. 131.7. 0.0. 0.0. 604.8. 604.8. 736.5.?. ?. ?. ?. ?. (185.3,.1024.4). (185.3,.1024.4). (252.2,.1220.9).

Artesunate.mefloquine. 0.0. 0.0. 0.0. 0.0. 0.0. 70.7. 70.7. 70.7.?. ?. ?. ?. ?. ?. ?. ?.

Artesunate.sulfadoxine.pyrimethamine. 44.9. 19.3. 64.1! 147.1! 4.5! 8624.5! 8776.1! 8840.2!?. (0.0,.59.1). ?! (0.0,.462.3)! ?! (4164.9,.13084.0)! (4345.9,.13206.2)! (4420.4,.13260.0)!

Dihydroartemisinin.piperaquine. 656.3. 59.0. 715.3! 506.1! 0.0! 5105.6! 5611.7! 6327.0!(0.0,.2350.5). (0.0,.284.2). (0.0,.2075.6)! (0.0,.1073.7)! ?! (3278.2,.6933.1)! (3669.7,.7553.8)! (4193.0,.8461.1)!


0.0. 0.0. 0.0! 0.0! 0.0! 96.7! 96.7! 96.7!?. ?. ?! ?! ?! (0.0,.257.3)! (0.0,.257.3)! (0.0,.257.3)!


23.9. 0.0. 23.9! 0.0! 0.0! 3477.7! 3477.7! 3501.6!?. ?. ?! ?! ?! (1986.2,.4969.2)! (1986.2,.4969.2)! (2010.2,.4993.0)!

Quality?assured.ACT.(QA.ACT). 6659.1. 869.4. 7757.3! 1401.0! 0.0! 1831.3! 3232.3! 10989.5!(3516.5,.9801.7). (511.1,.1227.7). (4742.8,.10771.7)! (284.3,.2517.7)! ?! (649.5,.3013.1)! (1872.7,.4591.9)! (7036.6,.14942.5)!

QA.artesunate.amodiaquine. 6647.3. 795.7. 7671.7! 1401.0! 0.0! 335.1! 1736.1! 9407.8!(3506.7,.9787.9). (418.3,.1173.1). (4644.7,.10698.8)! (284.3,.2517.7)! ?! (0.0,.718.6)! (611.8,.2860.3)! (6119.8,.12695.8)!

QA.artemether.lumefantrine. 11.8. 73.7. 85.5! 0.0! 0.0! 1496.2! 1496.2! 1581.7!?. ?. ?! ?! ?! (537.7,.2454.8)! (537.7,.2454.8)! (593.8,.2569.7)!

Non?quality.assured.ACT. 3425.3. 818.0. 4243.3! 2660.3! 80.4! 58390.4! 61131.1! 65374.4!(0.0,.8341.1). (149.0,.1487.0). (0.0,.9159.3)! (1341.5,.3979.1)! ?! (36584.5,.80196.4)! (39333.8,.82928.4)! (42787.5,.87961.3)!

Nationally.registered.ACT. 8364.1. 1308.4. 9901.3! 2597.4! 32.4! 33216.4! 35846.2! 45747.5!(3166.7,.13561.5). (687.9,.1929.0). (4756.3,.15046.3)! (1329.4,.3865.4)! ?! (20625.2,.45807.6)! (23446.6,.48245.8)! (31236.8,.60258.2)!

2.%Any%nonKartemisinin%therapy. 8839.5% 1391.9. 10317.4! 3164.0! 440.6! 63598.7! 67203.4! 77520.7!(0.0,%20724.3)% (683.7,%2100.1). (0.0,%22094.4)! (1718.6,%4609.4)! (0.0,%1265.4)! (50178.0,%77019.5)! (54097.4,%80309.3)! (56645.5,%98395.9)!

Sulfadoxine.pyrimethamine. 6012.6. 965.3. 7063.9! 1719.1! 374.5! 43501.6! 45595.2! 52659.1!(0.0,.15866.4). (343.5,.1587.2). (0.0,.16633.2)! (1048.2,.2389.9)! (365.8,.383.3)! (34316.5,.52686.8)! (36709.6,.54480.8)! (36894.8,.68423.3)!

Oral.quinine. 2642.7. 365.4. 3008.0! 1287.1! 66.1! 19589.3! 20942.6! 23950.6!(0.0,.5357.0). (205.8,.524.9). (312.3,.5703.7)! (411.4,.2162.9)! ?! (14823.8,.24354.8)! (15995.2,.25890.0)! (17601.8,.30299.3)!

Quinine.IV/IM. 183.5. 61.2. 244.6. 150.7. 0.0. 460.1. 610.8. 855.4.(27.7,.339.2). (24.1,.98.3). (84.3,.404.9). (74.8,.226.6). ?. (257.3,.662.9). (397.1,.824.4). (556.8,.1154.0).

Other.non?artemisinin.therapy.^. 0.0. 0.0. 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!?. ?. ?! ?! ?! ?! ?! ?!

3.%Oral%artemisinin%monotherapy%0.0% 0.0% 0.0! 0.0! 0.0! 0.0! 0.0! 0.0!K% K% K! K! K! K! K! K!

4.%NonKoral%artemisinin%monotherapy%730.5% 495.2. 1225.8! 1447.8! 14.7! 12569.1! 14031.6! 15257.3!

(31.9,%1429.2)% (269.2,%721.3). (399.9,%2051.7)! (845.2,%2050.4)! K! (8116.7,%17021.4)! (9597.5,%18465.6)! (10732.6,%19782.1)!. . . . . . . . .


Table%X11:%Antimalarial%volumes,%by%outlet%type,%Kinshasa,%2015%

AETDs%sold%or%distributed%in%the%previous%week%by%outlet%type%and%antimalarial%type:*%


Private.Not.For?Profit.Facility.



Pharmacy. Drug.Store. TOTAL%Private.


#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

#.AETD.(95%.CI).

Artesunate.IV/IM.#. 89.3. 86.8. 176.1! 19.8! 0.0! 217.1! 236.9! 413.0!(0.0,.183.3). ?. (51.0,.301.2)! (0.2,.39.5)! ?! (80.1,.354.1)! (101.2,.372.7)! (217.5,.608.6)!

Artemether.IV/IM.. 85.1. 15.4. 100.5! 111.3! 0.0! 546.5! 657.9! 758.3!(0.0,.240.4). (0.0,.36.9). (2.1,.198.8)! (56.5,.166.1)! ?! (339.5,.753.6)! (436.2,.879.6)! (461.1,.1055.6)!

Arteether/Artemotil.IV/IM. 556.2. 393.0. 949.2! 1316.7! 14.7! 11723.4! 13054.8! 14004.0!(0.0,.1123.9). (228.8,.557.2). (292.4,.1606.0)! (708.8,.1924.6)! ?! (7511.3,.15935.6)! (8842.0,.17267.6)! (9754.4,.18253.6)!

Any.severe.antimalarial.treatment. 914.0. 556.4. 1470.4! 1598.5! 14.7! 13029.1! 14642.3! 16112.7!(89.2,.1738.8). (294.9,.817.9). (498.2,.2442.6)! (919.9,.2277.1)! ?! (8496.1,.17562.2)! (10141.0,.19143.6)! (11453.8,.20771.7)!

OUTLET%TYPE%TOTAL%19654.5% 3574.5% 23543.7! 8673.1! 535.7! 136389.5! 145598.3! 169142!

(2978.7,%36330.3)% (2124.4,%5024.7)% (6968.1,%40119.3)! (6180.8,%11165.4)! (0.0,%2534.0)! (97796.8,%174982.2)! (107398.7,%183798.0)!

(121601.0,%216683.0)!

*. A.total.of.13,447.5.61.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..

!. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.amodiaquine.and.artemether.lumefantrine.were.the.first?line.treatments.for.uncomplicated.malaria..^. Other.non?artemisinin.therapies.include.amodiaquine,.atovaquone.proguanil,.chloroquine,.hydroxychloroquine.sulphate,.and.mefloquine..#. At.the.time.of.the.2015.DRC.ACTwatch.outlet.survey,.artesunate.IV/IM.was.the.first?line.treatment.for.severe.malaria..A.total.of.12,900.antimalarials.(in.the.census.sample).were.audited..Of.these,.942.audited.antimalarials.were.not.included.in.market.share.calculations.due.to.incomplete.or.inconsistent.information.%Source:.ACTwatch.Outlet.Survey,.DRC,.2015.%


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