GUARD study report: Good Use of Antimalarials and Rapid Diagnostic Tests in Cambodia study report

Using a mixed methods approach that included quality assessments, a mystery client study and qualitative research, we conducted a comprehensive evaluation of malaria Rapid Diagnostic Tests and in the private sector in 12 health centre catchment areas across Cambodia. In summary, we found that the RDTs collected from drug shops had maintained good quality and that storage and transport conditions were on the whole satisfactory. Uptake of RDTs appeared to highest in the most highly trained providers i.e. “cabinets”, and lowest in grocery shops, with pharmacies and drugs shops having some ambiguity around their role. Findings from the focus group discussions and the mystery client study suggest that some of the problems in uptake and interpretation relate to RDTs being on the margins of practice for these providers who see themselves as either providing a diagnosis and cure (pinit pchier bal) or simply selling drugs for symptomatic relief (lout tnam). Several problems with RDTs were identified in terms of their actual use, in particular relating to interpretation of results, blood safety, and problems related to the buffer and the blood collecting device. In summary this study provides a comprehensive assessment of malaria RDTs in one of the first countries to implement them in the private sector

Quality of antimalarials at the epicenter of antimalarial drug resistance: results from an overt and mystery client survey in Cambodia.

Widespread availability of monotherapies and falsified antimalarials is thought to have contributed to the historical development of multidrug-resistant malaria in Cambodia. This study aimed to document the quality of artemisinin-containing antimalarials (ACAs) and to compare two methods of collecting antimalarials from drug outlets: through open surveyors and mystery clients (MCs). Few oral artemisinin-based monotherapies and no suspected falsified medicines were found. All 291 samples contained the stated active pharmaceutical ingredient (API) of which 69% were considered good quality by chemical analysis. Overall, medicine quality did not differ by collection method, although open surveyors were less likely to obtain oral artemisinin-based monotherapies than MCs. The results are an encouraging indication of the positive impact of the country's efforts to tackle falsified antimalarials and artemisinin-based monotherapies. However, poor-quality medicines remain an ongoing challenge that demands sustained political will and investment of human and financial resources