Unregulated drug vendors' knowledge, attitudes, beliefs and practices related to malaria management of children five and under in Butaleja District, Uganda

Background: It has been estimated that there are 4000 licensed drug shops throughout Uganda with approximately 39% being unlicensed and unregulated with the latter being common in rural areas. Unregulated drug vendors play a major role in malaria management for young children (age five and under) since they are often the first points of access for caregivers seeking treatment for their sick children. As a result, their ability to manage malaria has a great influence on malaria outcomes in the rural community. Objective: The study assessed practices of unregulated drug vendors related to case management for children five and under. Knowledge, attitudes and beliefs in other areas of malaria management were also assessed to better understand their practices. Methods: This study employed a descriptive and qualitative design using a semi-structured interview. A district-wide census identified 88 unlicensed, unregulated drug vendors in which 75 participants were recruited into the study through a purposive sampling strategy. Results: The study found that a large proportion of drug vendors were unqualified to operate a drug shop. Several flaws in their practices were identified including vendors dispensing quinine instead of first-line ACT, irrational poly-pharmacy, dispensing oral quinine indiscriminately, providing under-dose treatment and selling ineffective antimalarials. Only 26.7% of vendors stocked ACTs while 90.7% stocked quinine (oral). Only 27.9% reported ACT as the best option to treat malaria, while others believed in less effective medicines. Some vendors also offered responses to questions that indicated incorrect beliefs related to cause, prevention, and effectiveness of different antimalarials. Although many were unqualified and demonstrated poor knowledge, beliefs and practices related to malaria management, many were interested in participating in future programs. About 89.0% expressed preference for short-term training sessions. Conclusion: Small proportion of drug vendors stocking ACTs suggests ...