Acta Tropica 164 (2016) 455–462 Contents lists available at ScienceDirect Acta Tropica jo ur nal home p age: www.elsevier.com/locate/actatropica How unlicensed drug vendors in rural Uganda perceive their role in the management of childhood malaria Eric Liow a , Dr. Rosemin Kassam a,∗ , Richard Sekiwunga b a School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada b Child Health and Development Centre, School of Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda a r t i c l e i n f o Article history: Received 4 July 2016 Received in revised form 6 October 2016 Accepted 18 October 2016 Available online 19 October 2016 Keywords: Unlicensed drug vendors Uganda Malaria management Informal Training a b s t r a c t Background: A large number of caregivers in Uganda rely on the private drug delivery sector to manage childhood illnesses such as malaria. In rural settings where the formal private sector is scarce, unlicensed retail drug outlets are an important initial source of care for households. Despite their abundance, little is known about them. This study explores unlicensed retail drug outlet vendors’ perceptions of their practice and social environment in one rural district of Uganda. Materials and methods: A qualitative design using semi-structured interviews was conducted with ven- dors from unlicensed retail drug outlets across all 10 sub-counties of Butaleja District. The study was conducted over a six-week period in 2011. Open-ended questions were used to gain insight into partici- pants’ perspectives, and data were analyzed using acceptable qualitative research protocols. Results: Interviews were carried out with 75 vendors by trained local research assistants. Most vendors operated out of drug shops, just over half were both owners and shop attendants, and only 14% had qualifications to apply for operating a licensed drug shop. Vendors’ experiences with managing malaria in children aged five and under in their community revealed five major themes, their perceptions of: 1) their role in the community, 2) their ability to manage uncomplicated malaria in young children, 3) the challenges of day-to-day operations, 4) the effect of regulatory policies on their ability to serve their communities, and 5) the prospect of future training programs. While the literature has raised concerns regarding the quality of care provided at such unlicensed outlets, most vendors in this study had a limited awareness of their deficiencies. Conclusions: There was a general sentiment among vendors that the public health system within Butaleja was failing the community and their presence was filling an important vacuum. Given the dominance of unlicensed retail drug outlets over their formal (licensed) counterparts in many rural settings, further deliberations and research is critical to determine how best to fit in and create value from the unlicensed sector within the formal health system. © 2016 Elsevier B.V. All rights reserved. 1. Introduction Malaria is one of the leading causes of morbidity and mortality in Uganda, resulting in significant suffering and economic bur- den (Black et al., 2010; World Health Organization (WHO), 2015b; Yeka et al., 2012). Among the countries of sub-Saharan Africa, Uganda has the third highest malaria rate, following only the Demo- Abbreviations: ACT, Artemisinin-based combination therapy; iCCM, Integrated community case management; CHW, Community Health Workers; DV, Drug ven- dor; AMFm, Affordable Medicines Facility-malaria. ∗ Corresponding author. E-mail addresses: ericliow@alumni.ubc.ca (E. Liow), rosemin.kassam@ubc.ca (R. Kassam), sekiwunga@yahoo.com (R. Sekiwunga). cratic Republic of Congo and Nigeria (World Health Organization (WHO), 2015b). The disease is endemic in 95% of the country, with intense year-round transmission giving rise to a large num- ber of cases (Okello et al., 2006). In 2014, there were 19,201,136 suspected malaria cases and 5921 malaria deaths reported for Uganda (World Health Organization (WHO), 2015a, 2015b). Con- firmatory diagnostic testing followed by prompt treatment with an artemisinin-based combination therapy (ACT) has been the main- stay for managing acute uncomplicated malaria for over a decade. How quickly caregivers of young children can access appropri- ate malaria care remains an important determinant of morbidity and mortality (Cohen et al., 2012). Accordingly, over the past few decades, there has been a concerted effort by the Ugandan gov- ernment to introduce within the public and private formal health system initiatives to improve access to ACTs and parasitological http://dx.doi.org/10.1016/j.actatropica.2016.10.012 0001-706X/© 2016 Elsevier B.V. All rights reserved.