Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLoS One. 2012;7(9):e44775. doi: 10.1371/journal.pone.0044775. Epub 2012 Sep 12.
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.
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.
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.
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.
专利药品销售商（PMV）在整个撒哈拉以南非洲地区提供抗疟治疗和护理，在抗击疟疾方面可以发挥重要作用。他们贴近客户的基础设施可以使救命的青蒿素为基础的联合治疗（ACT）及时到达患者。然而，如果要在卫生系统内管理他们的作用，对药品销售商的药物供应服务质量进行系统评估至关重要。批量质量保证抽样（LQAS）可能是监测和评估 PMV 实践的有效方法，但迄今为止从未用于此目的。
为支持尼日利亚疟疾强化计划，我们在尼日利亚吉加瓦州的三个参议员选区（SD）评估了 PMV 的实践情况。两阶段 LQAS 评估了 SD 中至少 80%的 PMV 商店是否使用国家治疗指南。可接受的抽样误差是与政府官员协商确定的（α和β<0.10）。超几何公式确定了 SD 的样本量和截止值。一个结构化的评估工具确定了高绩效和低绩效的 SD，以确定护理质量指标。
在吉加瓦州的所有 SD 中，药品供应商在所有指标上的表现都很差。例如，所有 SD 都未能储存和销售一线抗疟药物。PMV 销售不再推荐的抗疟药物，如氯喹、磺胺多辛-乙胺嘧啶和口服青蒿琥酯单药治疗。大多数 PMV 对新的治疗指南一无所知，也缺乏培训，该指南已将 ACT 作为治疗无并发症疟疾的一线药物。
迫切需要定期监测和改善尼日利亚药品销售商提供的疟疾治疗的供应和质量；在 ACT 时代，这项研究揭示了抗疟药物的不合理使用存在很高的经济损失、死亡和耐药风险。LQAS 已被证明是监测 PMV 中与疟疾相关指标的一种合适方法，应在尼日利亚和其他地方应用，以改善服务提供。
