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Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?
  1. Eleanor Hutchinson1,
  2. Coll Hutchison2,
  3. Sham Lal3,
  4. Kristian Hansen4,
  5. Miriam Kayendeke5,
  6. Christine Nabirye6,
  7. Pascal Magnussen7,
  8. Siân E Clarke8,
  9. Anthony Mbonye9,
  10. Clare I R Chandler4
  1. 1Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  5. 5The Act 2 Project, Kampala, Uganda
  6. 6Infectious Disease Research Collaboration, Kampala, Uganda
  7. 7Department of International Health, Immunology and Microbiology, Centre for Medical Parasitology & Institute for Veterinary Disease Biology, Section for Parasitology and Aquatic Diseases, University of Copenhagen, Kobenhavn, Denmark
  8. 8Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  9. 9Ministry of Health, Kampala, Uganda
  1. Correspondence to Dr Eleanor Hutchinson; eleanor.hutchinson{at}lshtm.ac.uk

Abstract

The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the quality of care provided in these settings. The potential to support the introduction of rapid diagnostic tests for malaria (mRDTs) into drug shops is coming under increased scrutiny. Those in favour argue that it enables the harmonisation of policy around testing and treatment for malaria and maintains a focus on market-based solutions to healthcare. Despite the enthusiasm among many global health actors for this policy option, there is a limited understanding of the consequences of the introduction of mRDTs in the retail sector. We undertook an interpretive, mixed methods study with drug shop vendors (DSVs), their clients and local health workers to explore the uses and interpretations of mRDTs as they became part of daily practice in drug shops during a trial in Mukono District, Uganda. This paper reports the unintended consequences of their introduction. It describes how the test engendered trust in the professional competence of DSVs; was misconstrued by clients and providers as enabling a more definitive diagnosis of disease in general rather than malaria alone; that blood testing made drug shops more attractive places to seek care than they had previously been; was described as shifting treatment-seeking behaviour away from formal health centres and into drug shops; and influenced an increase in sales of medications, particularly antibiotics.

Trial registration number NCT01194557; Results.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Handling editor Valery Ridde

  • Contributors EH supervised the field research, drafted the paper, wrote the theoretical background, supervised the coding of the FGD data and provided the main analysis; CH wrote the theoretical background and analysed the quantitative results; SL gave substantial comments on the paper and the interpretation of the quantitative results; KH designed the questionnaire and gave substantial comments on the interpretation of the quantitative results; MK collected and coded the FGD data and provided comments on the interpretation of the FGD data; PM, SEC and AM provided substantial comments on the paper and the overall interpretation of findings; CIRC supervised the field research and provided substantial comments on the paper. AM, SEC, PM and KH were involved in the design of the intervention. AM, SEC, PM and SL were involved in the implementation of the intervention.

  • Funding Wellcome Trust (084933 (career development fellowship (SEC)); Institutional Strategic Support Fund (CIRC).

  • Competing interests None declared.

  • Ethics approval LSHTM Ethics Committee, Uganda National Council for Science and Technology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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