PMID- 22984555
OWN - NLM
STAT- MEDLINE
DCOM- 20130312
LR  - 20211021
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 7
IP  - 9
DP  - 2012
TI  - Are patent medicine vendors effective agents in malaria control? Using lot 
      quality assurance sampling to assess quality of practice in Jigawa, Nigeria.
PG  - e44775
LID - 10.1371/journal.pone.0044775 [doi]
LID - e44775
AB  - BACKGROUND: Patent medicine vendors (PMV) provide antimalarial treatment and care 
      throughout Sub-Saharan Africa, and can play an important role in the fight 
      against malaria. Their close-to-client infrastructure could enable lifesaving 
      artemisinin-based combination therapy (ACT) to reach patients in time. However, 
      systematic assessments of drug sellers' performance quality are crucial if their 
      role is to be managed within the health system. Lot quality assurance sampling 
      (LQAS) could be an efficient method to monitor and evaluate PMV practice, but has 
      so far never been used for this purpose. METHODS: In support of the Nigeria 
      Malaria Booster Program we assessed PMV practices in three Senatorial Districts 
      (SDs) of Jigawa, Nigeria. A two-stage LQAS assessed whether at least 80% of PMV 
      stores in SDs used national treatment guidelines. Acceptable sampling errors were 
      set in consultation with government officials (alpha and beta <0.10). The 
      hypergeometric formula determined sample sizes and cut-off values for SDs. A 
      structured assessment tool identified high and low performing SDs for quality of 
      care indicators. FINDINGS: Drug vendors performed poorly in all SDs of Jigawa for 
      all indicators. For example, all SDs failed for stocking and selling first-line 
      antimalarials. PMV sold no longer recommended antimalarials, such as Chloroquine, 
      Sulfadoxine-Pyrimethamine and oral Artesunate monotherapy. Most PMV were ignorant 
      of and lacked training about new treatment guidelines that had endorsed ACTs as 
      first-line treatment for uncomplicated malaria. CONCLUSION: There is urgent need 
      to regularly monitor and improve the availability and quality of malaria 
      treatment provided by medicine sellers in Nigeria; the irrational use of 
      antimalarials in the ACT era revealed in this study bears a high risk of economic 
      loss, death and development of drug resistance. LQAS has been shown to be a 
      suitable method for monitoring malaria-related indicators among PMV, and should 
      be applied in Nigeria and elsewhere to improve service delivery.
FAU - Berendes, Sima
AU  - Berendes S
AD  - Liverpool School of Tropical Medicine, Liverpool, United Kingdom. 
      berendes@liverpool.ac.uk
FAU - Adeyemi, Olusegun
AU  - Adeyemi O
FAU - Oladele, Edward Adekola
AU  - Oladele EA
FAU - Oresanya, Olusola Bukola
AU  - Oresanya OB
FAU - Okoh, Festus
AU  - Okoh F
FAU - Valadez, Joseph J
AU  - Valadez JJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120912
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antimalarials)
RN  - 0 (Artemisinins)
RN  - 9RMU91N5K2 (artemisinin)
SB  - IM
MH  - Antimalarials/standards/*therapeutic use
MH  - Artemisinins/pharmacology
MH  - Commerce/methods
MH  - Drug Resistance
MH  - Guidelines as Topic
MH  - Health Services Accessibility
MH  - Humans
MH  - Malaria/*drug therapy/*prevention & control
MH  - Nigeria
MH  - Pharmacies
MH  - Quality Assurance, Health Care
MH  - Quality of Health Care
PMC - PMC3440361
COIS- Competing Interests: The authors have declared the following competing interests 
      exist: This work was partly financed by a grant from the ExxonMobil Foundation to 
      the World Bank to support the Malaria Control Booster Project for Africa, which 
      does not alter the authors' adherence to all the PLOS ONE policies on sharing 
      data and materials.
EDAT- 2012/09/18 06:00
MHDA- 2013/03/13 06:00
PMCR- 2012/09/12
CRDT- 2012/09/18 06:00
PHST- 2012/03/30 00:00 [received]
PHST- 2012/08/07 00:00 [accepted]
PHST- 2012/09/18 06:00 [entrez]
PHST- 2012/09/18 06:00 [pubmed]
PHST- 2013/03/13 06:00 [medline]
PHST- 2012/09/12 00:00 [pmc-release]
AID - PONE-D-12-09509 [pii]
AID - 10.1371/journal.pone.0044775 [doi]
PST - ppublish
SO  - PLoS One. 2012;7(9):e44775. doi: 10.1371/journal.pone.0044775. Epub 2012 Sep 12.