Mystery Shopping in Community Drug shops: Research as Development in Rural Tanzania

Throughout Africa, the private sector plays an important role in malaria treatment complementing formal health\ud services. However this sector is faced by a number of challenges including poor dispensing practices by unqualified staff. The Accredited Drug Dispensing Outlet (ADDO) program was introduced in Tanzania in 2002 to improve\ud the quality of retail services and especially of dispensing practices. The study adapted the often contested mystery\ud shopping methodology and trained local community members to assess practices of ADDO dispensers. The study then compared the assessed dispensers’ practices before and after ADDO interventions. Mystery shoppers were identified in the villages with the assistance of Health Demographic Surveillance System field staff. A total of 865 visits were made to general shops and drug shops between 2004 and 2009. Three case scenarios were developed to assess the quality of treatment; a) child aged 2 - 4 months, with fever/hot body for one day and problems with drinking/breastfeeding, b) child aged 2 - 4 years, with recurring fever/hot body for 3 days problems with drinking, eating, diarrhoea and tiredness/ not playing as usual and c) adult, with recurring fever/hot body for 2 days, headache, dizziness and loss of appetite. Study findings indicate improvements in dispensers’ knowledge and practices in management of fever, especially after the roll out of ADDO program in the study area. A 30 percent increase was noted after ADDO interventions on four assessed indicators developed based on the national malaria control guideline on malaria case management. On the other hand advice on the use of Insecticide Treated Nets as a measure to prevent malaria was not consistent over years even after ADDO interventions.\ud Children aged two to four years and adults were more likely to be provided with anti-malarials than children\ud between two to four months. Despite challenges posed against the methodology, findings reveals how useful\ud the mystery shopping technique can be for community assessments of ADDO interventions in retail outlets.\ud Study findings signify the importance of ADDO interventions in improving malaria case management in drug retail\ud outlets. If ADDOs are closely monitored and strengthened to provide appropriate malaria treatment and the program\ud is rolled throughout the country, a reduction in malaria morbidity and mortality is possible in the country. Innovative community based participatory research approaches and more systematic mystery shopping techniques would allow for comparative community-based assessments of ADDO interventions across regions.\u

Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

BACKGROUND\ud \ud To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.\ud \ud METHODS\ud \ud The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.\ud \ud RESULTS\ud \ud Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)\ud \ud CONCLUSIONS\ud \ud The public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake

Padovan and Perrin generalized quaternions

In this study, we investigate the Padovan (or Cordonnier) and Perrin generalized quaternions. We obtain the new identities for these special quaternions related to matrix forms. We also introduce Binet-like formulae, generating functions, several summation, and binomial properties concerning these quaternions.WOS:0006591192000012-s2.0-8510737562