The malaria testing and treatment landscape in Benin

Abstract

BackgroundSince 2004, artemisinin-based combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Benin. In 2016, a medicine outlet survey was implemented to investigate the availability, price, and market share of anti-malarial treatment and malaria diagnostics. Results provide a timely and important benchmark to measure future interventions aimed at increasing access to quality malaria case management services.MethodsBetween July 5th to August 6th 2016, a cross sectional, nationally-representative malaria outlet survey was conducted in Benin. A census of all public and private outlets with potential to distribute malaria testing and/or treatment was implemented among 30 clusters (arrondissements). Outlets were eligible for inclusion in the study if they met at least one of three study criteria: (1) one or more anti-malarials reportedly in stock on the day of the survey; (2) one or more anti-malarials reportedly in stock within the 3 months preceding the survey; and/or (3) provided malaria blood testing. An audit was completed for all anti-malarials, malaria rapid diagnostic tests (RDT) and microscopy.Results7260 outlets with the potential to sell or distribute anti-malarials were included in the census and 2966 were eligible and interviewed. A total of 17,669 anti-malarial and 494 RDT products were audited. Quality-assured ACT was available in 95.0% of all screened public health facilities and 59.4% of community health workers (CHW), and availability of malaria blood testing was 94.7 and 68.4% respectively. Sulfadoxine–pyrimethamine (SP) was available in 73.9% of public health facilities and not found among CHWs. Among private-sector outlets stocking at least one anti-malarial, non-artemisinin therapies were most commonly available (94.0% of outlets) as compared to quality-assured ACT (36.1%). 31.3% of the ACTs were marked with a “green leaf” logo, suggesting leakage of a co-paid ACT into Benin’s unsubsidized ACT market from another country. 78.5% of the anti-malarials distributed were through the private sector, typically through general retailers (47.6% of all anti-malarial distribution). ACT comprised 44% of the private anti-malarial market share. Private-sector price of quality-assured ACT ($1.35) was three times more expensive than SP ($0.42) or chloroquine ($0.41). Non-artemisinin therapies were cited as the most effective treatment for uncomplicated malaria among general retailers and itinerant drug vendors.ConclusionsThe ACTwatch data has shown the importance of the private sector in terms of access to malaria treatment for the majority of the population in Benin. These findings highlight the need for increased engagement with the private sector to improve malaria case management and an immediate need for a national ACT subsidy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1808-x) contains supplementary material, which is available to authorized users.

Monitoring health systems readiness and inpatient malaria case-management at Kenyan county hospitals

“…These encouraging trends should be however balanced against findings in low risk areas where 21% of hospitals had no artesunate and 15% were found without any injectable anti-malarial in stock. Artesunate stock-outs at hospitals have been rarely examined across Africa but they are unlikely to be unique to Kenya [ 29 , 30 ]. While investigations of the supply chain are beyond the scope of this study, the interactions between survey teams and hospital pharmacists do suggest that broad range of the managerial issues related to the integration of commodity orders and delayed financial clearances of the supplies are likely factors constraining access to free artesunate.…”

Malaria Case-Management in Urban Area: Various Challenges in Public and Private Health Facilities in Benin, West Africa

“…The use of non-artemisinin therapy (quinine and anti-malarial monotherapy) remains in malaria case-management behavior. It can be explained by the cost of this non-artemisinin therapy compared to ACT [16].…”

“…A recent study conducted in Benin by ACT watch Group concluded that the public sector is typically well equipped to test and appropriately treat malaria according to national treatment guidelines. However, the private sector is responsible for most of the antimalarial distribution, typically through general retailers, which represent informal channels of ACT distribution [16]. Another national study conducted in six countries (Benin, Madagascar, Uganda, Zambia, DRC and Nigeria) showed a low availability, a low market share and high prices of ACT in the private sector [17].…”

Citrus in Benin Republic: past, present, and future challenges

“…The grafted plants are transferred crop fruit are well known in the country. Malaria, the primary cause of illness and death in the Benin Republic, is locally treated by a mixture of different plant cultivars, including citrus; prepared as decoction or infusion with water or fermented maize water (Hermans et al, 2004;Zinsou & Cherifath, 2017). Indeed, the effect of Tahiti acid lime and Sour orange on the causal agent of malaria (Plasmodium falciparum) has been clinically proved (Addae-Kyereme et al, 2001;Weenen et al, 1990).…”