Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study

This study investigated unlicensed drug outlets’ practices for the management of malaria in the rural district of Butaleja, Uganda. A
qualitative design using semi structured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using
thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education,
but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While
most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy
(ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria
treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over
a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing
gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed
vendors to improve the management of childhood malaria.