Private pharmacy staff in five main towns in Benin, Burkina Faso, and Mali: knowledge and practices concerning malaria care in 2014.

The Global Fund's involvement in the fight against malaria has led to significant improvements, but mostly through programs supporting public-sector health facilities and personnel. The authors report the results of the preliminary survey preceding their intervention with private pharmacies. A simple random sampling technique was used to select the sample of pharmacies in urban areas in Burkina Faso, Benin, and Mali. A pretested questionnaire was administered to the supervisor present in each pharmacy at the time of the survey. Data were collected by local students in the first quarter of 2014. In all, 94 pharmacies were surveyed, representing 17.6% of all the pharmacies in these 5 cities. Among the participants, 84% knew about the national malaria control program, and 77.7% about artemisinin-based combination therapy (ACT), while 38.8% knew the national protocols. Licensed pharmacists had a better knowledge of ACT than their assistants, and training improved knowledge of treatment for uncomplicated malaria episodes. These pharmacists and assistants would like to be more involved in the fight against malaria. They are ready to advise ACT when appropriate after rapid detection tests. It is necessary to find resources for subsidized inputs in the private sector to make these drugs and tests more accessible for all patients.

Costs of near-miss obstetric complications for women and their families in Benin and Ghana.

This paper estimates the total cost to women and their families associated with a spontaneous vaginal delivery and five types of 'near-miss' obstetric complication in Benin and Ghana, and assesses affordability in relation to household cash expenditure. A retrospective evaluation of costs was carried out among 121 mothers in three hospitals in Ghana. A prospective evaluation of costs was undertaken among 420 pregnant women in two hospitals in Benin. Information was collected on the cost of travel to the facilities and of direct medical and non-medical costs incurred during their stay in hospital. In Benin, costs ranged from an average of 15 US dollars for a spontaneous delivery to 256 US dollars for a near-miss complication caused by dystocia. In Ghana, average costs ranged from 18 US dollars for a spontaneous vaginal delivery to 115 US dollars for a near-miss complication caused by haemorrhage. Medical costs accounted for the largest share of total costs, mainly drugs and medical supplies in Ghana and costs of the delivery and any surgical intervention in Benin. Payments associated with a spontaneous vaginal delivery amounted to at least 2% of annual household cash expenditure in both countries. In the case of severe obstetric complications, costs incurred reached a high of 34% of annual household cash expenditure in Benin. The economic burden of hospital-based delivery care in Ghana and Benin is likely to deter or delay women's use of health services. Should a woman develop severe obstetric complications while in labour, the relatively high costs of hospital care could have a potentially catastrophic impact on the household budget.