Exploring Documentation and Reporting Practices in Malaria Tracking: A Mixed-Methods Study Among Formal Drug Retail Shops in Hohoe Municipal, Ghana

Exploring Documentation and Reporting Practices in Malaria Tracking: A Mixed-Methods Study Among Formal Drug Retail Shops in Hohoe Municipal, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Documentation and Reporting Practices in Malaria Tracking: A Mixed-Methods Study Among Formal Drug Retail Shops in Hohoe Municipal, Ghana Victor Loglo, Vincent Uwumboriyhie Gmayinaam, Mary Ampomah, Paul Boateng, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6908084/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Nov, 2025 Read the published version in Malaria Journal → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Ghana still faces prevailing malaria cases despite the progress made in reducing its incidence. The formal private drug retail sector most at times tends to be the first source of healthcare for people with fever. However, there is limited information from this sector with regards to the documentation and reporting of malaria cases and other diseases. This study examined malaria documentation and reporting practices among formal drug retail shops in the Hohoe Municipality as part of efforts to enhance tracking of malaria. Methods: A concurrent mixed-methods approach was employed, comprising a cross-sectional study of 57 formal drug retail facilities (9 from Community Pharmacies and 48 from OTCMS) and an exploration study of 7 of them. Quantitative data was collected via semi-structured questionnaires and analysed using SPSS. Qualitative data from 7 in-depth interviews were thematically analysed using ATLAS.ti to identify key themes. Results: The median age of the participants was 26 years (IQR = 24–42), with 40 (70.2%) qualified as Counter Medicine Assistants, and 38 (66.7%) having 1–5 years of work experience. Of the 57 shops, 51 (89.5%) lacked documentation and reporting tools; only 5 (10.5%) used paper-based methods. Digital reporting was favored by 35 (61.4%) of attendants, prioritizing a user-friendly interface, data security, and real-time data submission. Participants highlighted barriers like stress and resource constraints but suggested solutions such as improved staffing, training, and digital infrastructure. Conclusions: Malaria documentation and reporting were low, with few facilities relying on paper-based methods. Digital reporting was preferred but faces challenges like resource constraints and inadequate training. Addressing these barriers through infrastructure investments and comprehensive training with collaborations between the National Malaria Elimination Programme (NMEP) and the Ghana Pharmaceuticals Council (GPC) will improve data accuracy and reporting, even in low-connectivity areas. Malaria tracking Documentation and reporting Private drug retail shops Digital reporting Health Information Management Systems (HIMS) Figures Figure 1 Figure 2 Background Malaria remains a major global health threat despite decades of control efforts. Recent reports show a resurgence of cases: in 2022 an estimated 249 million cases and 608,000 deaths occurred worldwide [1]. In 2021, malaria caused approximately 619,000 deaths worldwide, a slight reduction from 625,000 in 2020, but still higher than the 568,000 deaths recorded pre-pandemic in 2019 [2]. Sub-Saharan Affrica (SSA) bears the highest burden, accounting for 95% of global malaria cases and 96% of related deaths in 2020, with children under five constituting 80% of fatalities [2]. Interventions in the past decade (bed nets, indoor spraying, new drugs, vaccines, etc.) did avert millions of cases and cut mortality by about 36% from 2010–2020 [1]. However, progress has recently stalled, and many endemic regions continue to struggle, with Africa bearing by far the heaviest burden [1], [3]. Partly in response to the malaria burden, the WHO launched the "Test, Treat, Track" (T3) strategy in 2012, emphasizing accurate diagnosis, appropriate treatment, and systematic tracking of cases. This strategy highlights the importance of quality diagnostic tools, trained personnel, and comprehensive disease monitoring to enhance the quality of care and optimize antimalarial drug use [4]. The "track" component focuses on documenting and reporting cases to health authorities, enabling better disease surveillance, outbreak identification, and strategic intervention planning [5]. Ghana is among the highest-burden countries in West Africa, though recent data show encouraging declines. By 2022 Ghana recorded about 5.2 million confirmed malaria cases and 151 malaria-related deaths [6]. These figures mark a substantial improvement: nationwide malaria prevalence (e.g. among children under five) has fallen from roughly 27.5% in 2011 to 8.6% in 2022 [6]. This decline coincides with expanded control measures (universal ITN coverage, seasonal chemoprevention, introduction of the malaria vaccine, etc.). Building on these gains, Ghana’s new National Malaria Elimination Strategic Plan (NMESP 2024–2028) sets ambitious targets of 90% reduction in malaria mortality and 50% reduction in case incidence by 2028 [6]. Achieving elimination will require not only continued prevention but robust surveillance and case tracking across all sectors. In Ghana’s health system, the private retail sector plays a critical first-line role in malaria case management. Licensed community pharmacies and over-the-counter medicine shops (OTCMS or “chemical sellers”) are often the first point of care for patients with fever [7]. Studies show that 33.8% of children under five with fever initially seek care from private retail shops, and OTCMS are the first point of care for over 90% of patients visiting these shops [8], [9]. However, limited data on malaria documentation and reporting practices within the private sector hinders effective integration into the national Health Information Management System (HIMS). These formal drug outlets dispense antimalarial treatments (e.g. artemisinin-based combination therapies) and frequently provide malaria rapid diagnostic tests. The importance of this sector is now recognized in policy: Ghana’s NMESP explicitly includes “surveillance in pharmacies and OTCMS” as a new intervention for malaria elimination [10]. In other words, the elimination plan acknowledges that pharmacies and drug shops are an integral part of the malaria treatment chain, whose data must be captured for effective tracking. Despite their key role in treatment, private drug shops have historically been excluded from routine malaria reporting. Ghana’s health information system (DHIMS2) is used to capture case data from public health facilities [11], but there is no formal mechanism for pharmacies or OTCMS to feed their data into DHIMS2. In practice, most private outlets use their own registers or none, and there is no standardized documentation forms mandated for these shops. This gap has been noted in strategic reviews: the NMESP 2024–2028 highlights the need to introduce surveillance in pharmacies/OTCMS [10], implying that such data were not previously integrated. In fact, even in public clinics malaria data quality can be poor, underscoring the need to improve reporting systems overall [11]. Without clear guidelines and tools for documentation and reporting at private outlets, national surveillance remains incomplete. In Hohoe, malaria remains among the top three causes of outpatient visits, though case rates have declined from 44.1% in 2022 to 39.1% by mid-2023 (Hohoe Municipal Health Directorate [HMHD], 2023). Hohoe Municipality in Ghana’s Volta Region illustrates these challenges at the local level. With a population of about 115,000, Hohoe lies in a high-transmission zone with year-round malaria and seasonal peaks. Malaria remains hyper-endemic there: facility data show malaria is the leading cause of outpatient visits (28% of OPD cases) and the leading cause of deaths (19.4%) in Hohoe [12]. Community surveys in Hohoe report extraordinarily high infection rates – for example, one study found 56.9% of children in low-altitude communities were positive for malaria by rapid test [12]. Given this heavy burden, the Volta Region (including Hohoe) is targeted for intensified malaria control and surveillance under Ghana’s elimination strategy. In this context, understanding how Hohoe’s private pharmacies and chemical sellers document and report malaria is particularly important for closing surveillance gaps. This study aims to explore the current documentation and reporting practices among formal drug retail outlets in Hohoe Municipal, Ghana. Using a concurrent mixed-methods design, we will assess how licensed pharmacies and OTCMS record malaria cases and treatments and identify barriers and facilitators to routine case reporting. We will also evaluate outlets’ digital readiness – for example, their capacity to use Ghana’s DHIMS2 platform or other electronic tools for reporting. By illuminating these practices and needs, the study will inform strategies to better integrate private-sector data into national malaria surveillance. In turn, strengthening documentation and reporting in the private sector can improve case tracking and support Ghana’s efforts towards malaria elimination. Materials and Methods Study Design, Site, and Population A concurrent mixed-methods approach was employed, combining a cross-sectional study (quantitative) with an exploratory study (qualitative). Quantitative data collection involved face-to-face interviews with providers using a semi-structured questionnaire. Qualitative data collection included in-depth interviews with attendants or frontline staff at community pharmacies and Over-The-Counter Medicine Sellers (OTCMS). The combination of these approaches ensured a well-rounded analysis, providing both statistical insights and in-depth perspectives on disease documentation practices. The study was conducted in the Hohoe Municipality , located in the Volta Region of Ghana. The municipality covers 1,172 km² and has an estimated population of 95,729 [13]. It is bordered by Togo to the east and several districts in Ghana. The area includes 9 community pharmacies , 63 OTCMS , 2 private hospitals , and several Community-Based Health Planning and Services (CHPS) compounds. The municipality is divided into four sub-municipalities: Alavanyo, Agumatsa, Gbi-South, and Hohoe Sub-Municipality . Healthcare facilities include 14 health centers , 9 CHPS compounds , 23 demarcated CHPS zones , 2 private hospitals , and the Volta Regional Hospital (formerly the municipal hospital) [13]. The study focused on 72 formal private drug retail shops , including 9 community pharmacies and 63 OTCMS . The Volta Regional Hospital serves as the tertiary health center in the municipality. The study involved attendants working in formal private drug retail shops in Hohoe, specifically in community pharmacies and OTCMS. These service providers were responsible for dispensing medications, offering healthcare advice, and managing disease documentation and reporting systems. Service providers who were 18 years or older, actively involved in healthcare services, and had worked for at least six months.Service providers who were unable to participate due to reasons such as scheduling conflicts or health issues. Sample Size and Sampling Techniques The sample size was calculated using the formula by Degu and Tessema , with a reliability coefficient (z-score) of 1.96 at a 95% confidence level and a margin of error (e) of 0.05 [14] . Based on this formula, the required sample size was 65 shops (9 community pharmacies and 56 OTCMS). Ultimately, 57 shops participated in the study: 48 OTCMs and 9 Community Pharmacies. Nine (9) OTCMs were not operational at the time of the study so 6 were excluded from the expected sample from the list of OTCMs. With the Qualitative sampling data collection continued until 7 participants were reached or selected from the retail sector. The seven participants were below the expected saturation. We experienced a decline in participation from shop attendants despite permission from their Volta Pharmaceutical council. Convenience sampling was used for OTCMS ( 48 selected ), and all community pharmacies were included. Random selection of attendants within each shop ensured diverse representation. Purposeful sampling with a maximum variability strategy was used to select 7 participants across both types of facilities. Data collection Tool and Techniques Face-to-face interviews were conducted using a semi-structured questionnaire, supplemented by on-site inspections using a checklist . The structured questionnaire was divided into four sections to systematically gather relevant information. The first section focused on background details of the health facility, including its type, location, total number of service providers, and the qualification of the facility owner. The second section aimed to gather individual-level information about service providers, covering aspects such as age, gender, educational level, qualification, and years of experience in the formal drug retail shop. The third section delved into the tools and methods currently utilized for documenting and reporting cases of malaria and other diseases in the retail shop. Healthcare providers were asked about the types of tools or methods they used, their satisfaction levels with these tools, and any encountered challenges or limitations. Finally, the fourth section sought the opinion of healthcare providers on the most effective reporting tool for tracking malaria cases into the District Health Information Management System (DHIMS). Participants were encouraged to specify the features they deemed essential in their preferred reporting tool and share any additional comments or insights related to malaria tracking and reporting To complement the quantitative data collection, the study included an in-depth interview guide. This guide explored the views of healthcare providers regarding the importance of documenting and reporting malaria cases. It touched on topics like the Malaria Control Strategy, the significance of accurate documentation and reporting, and the role of their retail shop in the broader healthcare system's efforts to eliminate malaria. Follow-up questions were asked where necessary to obtain additional insight, and the in-depth interviews were audio recorded to ensure accuracy of the collected data. Notes were also taken for crosschecking. Permission was sought from participants with an informed consent form to record their responses. The interviews were then conducted in quiet and peaceful environments. Pens, notebooks, and an audio recorder were used to collect data from each interview. To ensure that quality data was collected, individuals with experience in data collection were utilized. Each interview was expected to take at most an hour with each participant. Interviews were audiotaped, transcribed, and reviewed to ensure accuracy. Reliability and validity were ensured through pre-testing at 10 randomly selected formal private drug retail service providers in the Afadzato South District of the Volta Region. Trustworthiness was established through pre-testing , random selection, and iterative questioning with probes. Data Analysis Quantitative Data was analysed using STATA version 17. Descriptive statistics such as frequencies, percentages, tables, and charts were used to present the data. Data cleaning and validation were conducted to ensure data quality before analysis. Graphs, tables, and bar charts were used for data presentation. Frequency distribution was employed to compute quantitative data such as age, gender, educational level, qualification of service providers, total number of service providers, availability of reporting tools, and reporting systems that could be adopted for reporting malaria cases into the District Health Information Management System 2 (DHIMS2). Chi-square test was performed to measure differences between groups (Community Pharmacies and OTCMS). Statistical Significance was measured at 0.05 level of significance. Qualitative Thematic Analysis (TA) was used to analyze qualitative data. TA is a method of analyzing qualitative data [15]. TA was chosen for its simplicity and convenience, allowing flexibility in the researchers' approach. Unlike other theories limited to specific frameworks, TA can be used with any theoretical perspective, making it highly versatile [15]. Additionally, TA permits rich, detailed, and complex descriptions of data. Data collected were transcribed into word files, from which themes and statements were developed using ATLAS.ti software version V7.5.7. Data was coded and assigned into various categories, with similar categories merged into broader headings. Coding involved segmenting textual data, examining similarities and differences, and grouping conceptually similar data into respective nodes. Result Background characteristics of participants The Table 1 and Table 2 provides demographic information about the quantitative and qualitative study participants respectively. A total of 57 attendants from formal private drug retail shops participated in the quantitative study: 9 from Community Pharmacies and 48 from Over-the-Counter Medicine Sellers (OTCMS). The median age was 26 years (IQR = 24–42), with the majority, 40 (70.2%), qualified as Counter Medicine Assistants. Most attendants, 38 (66.7%), reported having 1–5 years of work experience. Among the qualitative participants, demographic details are provided for 7 individuals: 2 were pharmacists, 3 were Medicine Counter Assistants, 1 was a drug seller, and another was the shop owner. Ages ranged from 20 to 23 years, though four participants chose not to disclose their age. Educational backgrounds varied, with three completing secondary school, one holding a Higher National Diploma (HND), and another being a university graduate. Two participants did not provide educational details. In terms of experience, two had been working for one year, two had two years of experience, and two had over five years in their fields, while one participant did not specify their duration of experience. Table 1 Background characteristics of attendants in Formal Private Drug Retail Shops in the Hohoe Municipality, Ghana; April 2024 Variable Community Pharmacy (n = 9, 15.8) OTCM (n = 48, 84.2) Total (N = 57) ꭓ 2 (P-value) n (%) n (%) n (%) Age median (IQR) 32 (26–38) 26 (24-47.5) 26 (24–42) 0.5609 Age (in years) 1.73 (0.277) 16–25 2(22.2) 22(45.8) 34(42.1) 26+ 7(77.8) 26(54.2) 33 (57.9) Sex 3.08 (0.137) Female 3(33.3) 31(64.6) 34 (59.7) Male 6(66.7) 17(35.4) 23 (40.4) Educational level 3.42 (0.241) Middle school/JHS 0(0.0) 5(10.4) 5 (8.8) Technical/Vocation/SH 3(33.3) 26(54.2) 29 (50.9) Tertiary 6(66.7) 17(35.4) 23 (40.4) Qualification 4.51 (0.079) Counter medicine assistant 4(44.4) 36(75.0) 40 (70.2) Nurse/PA 4(44.4) 7(14.6) 11(19.3) Others 1(11.1) 5(10.4) 6 (10.5) Years of Experience 0.69 (0.463) 1–5 5(55.6) 33(68.8) 38 (66.7) 6+ 4(44.4) 15(31.25) 19 (33.3) Table 2 Detailed background characteristics of participants interviewed Pseudonyms Age Sex Educational Qualification Occupation Duration of work 1.OTCMS 1 24 Female HND Holder Counter medicine assistant One year 2. OTCMS 2 37 Male University graduate Pharmacist Twenty-four years 3. OTCMS 3 23 Female University graduate Pharmacist One year 4. OTCMS 4 20 Female Secondary School graduate Counter medicine assistant Two years 5. OTCMS 5 22 Male Secondary School graduate Pharmacist Seven years 6. Community Pharmacy 1 23 Male Senior High School graduate Counter medicine assistant Two years 7. Community pharmacy 2 25 Female Senior High School graduate Counter medicine assistant Six years Existing methods of documentation and reporting tools About 51 (89.5%) of the facilities did not have existing methods of documentation and reporting tools with only 6 (10.5%) indicating there were existing methods of documentation and reporting tools. Five out of the six of facilities documented and reported using paper-based forms (Table 3 ). Table 3 Existing methods of documentation and reporting tools used by formal drug retail shops in the Hohoe Municipality, Ghana; April 2024 Variable Community Pharmacy (n = 9, 15.8) Over the counter (n = 48, 84.2) Total (N = 57) ꭓ 2 (P-value) n (%) n (%) n (%) Documentation 13.05 (0.004) No 5(55.6) 46(95.8) 51 (89.5) Yes 4(44.4) 2(4.2) 6 (10.5) Existing Tools (n = 6) * 0.60 (1.000) Digital software/app 1(25.0) 0(0.0) 1(16.7) Paper-based 3(75.0) 2(100.0) 5(83.3) Disease condition (n = 6) 0.75 (1.000) All 1(25.0) 1(50.0) 2 (33.3) Dangerous drugs 1(25.0) 0(16.7) 1 (16.7) Skin disease, malaria 2(50.0) 1(50) 3 (50.0) Satisfaction with tools (n = 6) 0.60 (1.000) Not satisfied 1(25.0) 0(0.0) 1 (16.7) Satisfied 3(75.0) 2(100.0) 5 (50.0) Ever experienced Challenges (n = 6) 0.38 (1.000) No 3(75.0) 1(50.0) 4 (66.7) Yes 1(25.0) 1(50.0) 2 (33.3) Challenges (n = 2) 2.0(0.157) Calling 1(100.0) 0(0.0) 50.0 Insufficient airtime/bundle 0(0.0) 1(100.0) 50.0 Preferred reporting tool for tracking malaria cases and reporting into the DHIMS The Fig. 1 below presents data on the preferred methods of reporting among attendants of formal retail drug shops, categorized by establishment type: Community Pharmacy (n = 9) and OTCMS (Over-The-Counter Medicine Shops) (n = 48), with a total of 57 respondents. The findings reveal that digital reporting using computer-based software applications was the most favored method overall, selected by 61.4% of respondents (n = 35). Specifically, 60.4% (n = 29) of OTCMS attendants and 66.7% (n = 6) of Community Pharmacy attendants prefer digital methods. The Fig. 2 below presents preferred features or characteristics that attendants of formal retail drug shops consider essential for a reporting tool. Majority of the attendants of formal prioritized a user-friendly interface (36, 64.3%) and data security measures (31, 55.4%) for a reporting tool, with real-time data submission (29, 51.8%) also being mentioned, particularly by OTCMS attendants. While few chose integration with DHIMS (2, 3.6%) and offline functionality (5, 8.9%). Views of the attendants at the formal drug retail shops on the importance of documenting and reporting malaria cases Table 4 summarizes the perspectives gathered from the attendants at formal drug retail shops regarding the documentation and reporting of malaria cases in the Hohoe Municipality. Five main themes emerged. These included: Understanding of Test Treat and Track (T3) strategy, documentation, accurate reporting, roles and future improvement. (see Table 4 ) Table 4 Views of formal retail drug shop attendants in the Hohoe Municipality; April, 2024 Main Themes Sub-themes Codes Understanding of 3T strategy Awareness of T3 Only test Don't know Testing Treatment Sleeping under-treated net Using insecticide (coils and spray) Documentation Importance Creation of awareness For easy tracking Reference Follow up Check up on patient Enter patient details Make enquiries from house Tools Pen Logbook Paper Name Telephone number Location Barriers Stress None Light Technological problems Benefit of Documentation More education Easy elimination of malaria Reduce rate of malaria Prevent complication Refer to clinic Reducing cases of malaria Recommendations for improvement in Malaria documentation. Recommendation Research Test before treatment Education Training Technology Phone Tablet Laptop Computers Mobile app Digital form Training and capacity building Enhance work Increase the number of staff Makes documentation easier Improve knowledge Understanding of 3T Strategy Participants showed varied levels of understanding regarding malaria control strategies, particularly the 3T (Test, Treat, Track). Their narrations revealed that some were familiar with aspects like testing for malaria, but they had limited knowledge about the comprehensive strategy, especially regarding the tracking component of the T3. This was how some participants expressed their views. "I know only testing." - (OTCMS 3) "I have not heard of it before." - (Community pharmacy 1) "I actually do not have any training, so I do not know." - (Community pharmacy 2) Figure 3: Participants’ understanding of 3Ts strategy Documentation This theme described generally participants’ views and current documentation practices. Seven subthemes emerged from were explored with regards to Documentation. These were tools, resources for improvement, details, processes, barriers, facilitators and importance. Participants recounted their views around this theme. Importance of documentation Importance of documentation was the first significant subtheme to emerge from the main theme. Participants recounted the lack of current documentation practices, although they acknowledged importance of documenting malaria cases. They highlighted benefits such as providing quality healthcare, tracking community health issues, and educating patients on prevention methods. “It is important because in case there are other complications afterwards, you can refer to the documentation." - (OTCMS 5) "It will help you know the condition of the people. It will help you to know their health issues so after you know that, then you can provide the healthcare that is needed." - (Community Pharmacy 2) "It is good to document in order to know whether the cases are becoming more or it is becoming less." - (Community Pharmacy 1) Most drug retail shops lacked established documentation practices for malaria cases, primarily due to over-the-counter operations or insufficient training. “No, I do not keep records of them”. – (OTCMS 2) Two participants mentioned what they do as part of the documentation process. “We have a logbook so we enter the patient’s name, telephone number then we put in our suspected diagnoses and the drug we served.” -(OTCMS 3) “If you know the house of the customer, you can make that enquiry. We do not record them.” -(OTCMS 4) Existing Tools Existing tool describes the materials used for documentation. Most participants did not take any records from their clients with the exception of one attendant who indicated that records of their clients were documented. Pens, logbooks, and papers were observed as these tools only served the purpose of accountability to their superiors mentioned as tools for recording information. This was how the attendant expressed herself, “We have a logbook, so we enter the patient’s name, telephone number then we put in our suspected diagnoses and the drug we served”. -(OTCMS 3) Two participants mentioned that name, telephone number and residence of customers were some contact information taken during the process of documentation. “We have a logbook, so we enter the patient’s name, telephone number then we put in our suspected diagnoses and the drug we served.” - (OTCM 3) Barriers Attendants anticipated that there would be some barriers in documenting and reporting malaria cases. These included electricity, and technological problems. This was how some participants expressed themselves, "With technology also, if the light goes off and you do not have light so you can be able to charge it, you will have to first put it on paper so that when the light is on, you will now transfer it to the device you are using. It is going to be a lot of stress." - (Community Pharmacy 2) Some attendants revealed that there were no barriers since they were not documenting. “First of all, we do not document so since we do not document, there will not be any challenge”. – (Community Pharmacy 1) “I do not see any barrier. I do not think there will be any barrier to documentation. If I have to keep records; I do not see why I cannot keep records”. – (OTCMS 2) Benefits of documentation Participants highlighted that detailed reporting of cases leads to creation of awareness, enables easy tracking of cases, provides references for follow-ups, and ensures patients receive timely check-ups. The benefit of documentation identified by participants was accurate reporting. Participants mentioned the advantages of accurate reporting of malaria cases. They emphasized that records help in easy checking and tracking of malaria patients. Additionally, some indicated that maintaining records helps in referring patients and accumulating data. This was how they expressed themselves, “So that we can do follow up checks if the need arises.” – (OTCMS 3) “It can be used in the future to make comparison of the past and current cases to see whether there is an improvement or not.” - (OTCMS 4) “Maybe when you document it and the person comes with the same complain, you can refer the person to the hospital.” -(OTCMS 5) “It provides basic data for referencing. “- (Community Pharmacy 1) The critical role of retail shops was highlighted by participants. They emphasized that retail shops made treatment accessible, potentially limiting the spread of malaria. This was how they expressed themselves, “As we are here, we are also limiting the malaria pandemic or endemic. Some of the people find it difficult to go to the hospital and some are also scared that when they go to the hospital something else will happen so as we are here, they come to us and we attend to them. If it is a malaria case, we treat them and the go which is better than they going to line up at the hospital and waste their time. That is why they normally come to us here.” - (Community Pharmacy 1) “For easy tracking. To make it easy to track any malaria case.” -(OTCMS 4) “It is a way pf providing primary care to the healthcare.” - (OTCMS 2) Recommendations for Improvement in documentation Participants made various recommendations for improving documentation practices, including providing training, supplying necessary resources, and addressing infrastructure challenges. These were recommendations, technology and training and capacity building. Participants mentioned that facilitators such as booking, increasing the number of staff, and well-designed forms can improve documentation practices. This was how they expressed themselves, “With the booking, you will have all the details of the patient in there, including where the person stays and others so booking can help you track the malaria cases”. - (OTCMS 4) “In my view, the number of staff here can be increased so that we can be either 2 or 3 people working here”. - (Community Pharmacy 2) “For instance, when we have a designed form that we are to fill in your records, it will make things easier for us”. -(OTCMS 2) Participants further highlighted the need for technological advancements, such as the use of phones, tablets, laptops, computers, mobile apps, and digital forms, as vital tools to support future improvements. This was how participants expressed themselves. “a mobile phone where you can keep record or keeping the records on a computer.” - (OTCMS 5) “Because we are currently in a modern system, we need laptop and other things to use for the documentation.” - (Community Pharmacy 6) . Participants indicated that, there was a clear need for improved resources such as printed sheets, cards, recording guides, and small laptops to enhance accuracy and efficiency. This was how some attendants expressed their views. “Maybe they can give us some printed sheets so that we know where to put some things so that we will not be writing unnecessary things”. -(OTCMS 1) “If we are provided with the record guide or book, it will help”. – (OTCM 2) “With the booking, you will have all the details of the patient in there, including where the person stays and others so booking can help you track the malaria cases”. (Community pharmacy 2) For future improvements, attendants recommended enhanced research, ensuring testing before treatment, ongoing education, and regular training. This was how some participants expressed themselves, “I do not know the current documentation tools and since I started working, it was only once they came to educate us on how to treat it. So, if they will be coming yearly to show us how to go about it, it will help.”- (OTCMS 1) “I think we can do more than we are doing in terms of research. Quite often, they distribute mosquito nets as a way of preventing it and it is helping so much. We still record high cases of the disease, so we have to do more in terms of research.” – (OTCMS 2) Participants indicated that Training and capacity building would help enhance work efficiency, ease documentation processes, and improve overall knowledge among attendants. “It is not everybody that knows how to test so if there will be a yearly training on how to test, even the training we attended, they did not do any practical. They just showed us how to go about it. So, they can show us how to do it practically and give us the questionnaire on how to do the testing. – (OTCMS 1) “By training, you are opening the person’s mind to a lot of information so documentation will be quite easier, and you will get a lot of information on how to document.” -(OTCMS 3) Discussion Almost none of the shops maintained formal written logs of suspected cases, and very few had ever reported cases into the public health system. Shop attendants overwhelmingly expressed a preference for smartphone or computer-based record-keeping rather than paper registers. Awareness of Ghana’s Test-Treat-Track (T3) policy was uniformly low, and participants cited chronic understaffing and lack of formal training in malaria diagnostics or reporting as key obstacles. These observations align with findings from several studies. Ghana’s T3 implementation report explicitly notes that “private facilities, especially pharmacies and chemical shops, do not submit data on malaria” to the health directorate [ 16 ], and that the existing legal framework “does not empower” regulators to require testing or reporting at these outlets [ 16 ]. Likewise, Ghanaian health system reviews have highlighted staffing shortages and insufficient training resources as major barriers to T3 adherence in peripheral settings [ 16 ]. Studies by Mbonye et al. and Ansah et al. also identified similar limitations in Uganda and Ghana respectively, where inadequate documentation hindered effective malaria management and the tracking of diagnostic tool usage [ 17 ], [ 18 ]. On the other hand, the shops’ openness to digital recording is consistent with a broader digital health interest in Ghana: recent qualitative research finds that community pharmacists view e-pharmacy initiatives as having “transformative potential” for health access, provided necessary infrastructure and support are in place [ 19 ]. In short, our findings of inadequate paper-based tracking and keen interest in electronic solutions reflect both the known structural challenges in Ghana’s informal sector and the growing momentum around mobile health technologies. These results mirror patterns documented in Ghana and across sub-Saharan Africa. For example, a survey of rural communities in Ghana found that only 10.5% of febrile children seen at OTC medicine sellers were tested for malaria, compared to nearly 95% in formal clinics [ 20 ]. Similarly, a study in Greater Accra observed that 66.1% of anti-malarial dispensed in pharmacies were given without any diagnostic test [ 21 ]. Our findings show that drug shops rarely document, or report cases fit in this context: unregulated retail outlets in the region routinely operate outside routine surveillance systems. Indeed, a global review of malaria elimination contexts notes that “unregulated private providers often do not report into [national] HMIS,” impeding timely case detection [ 22 ]. In Ghana, regulatory surveys corroborate the lack of record-keeping: fewer than half of licensed medicine sellers retain supplier invoices or other documentation on-site [ 23 ]. At the district level, program evaluations have similarly underscored that private clinics and shops contribute little case data, and they have called for extending the DHIMS2 reporting platform down to every facility, public and private [ 24 ]. Together, these studies indicate that our observations in Hohoe are not unique but are part of a well-recognized surveillance gap in the private sector. Several factors likely explain the weak documentation we observed. Foremost is the fragmented regulatory environment. Ghana’s malaria control guidelines do not mandate reporting by retail pharmacies or chemical sellers, and these outlets generally are not integrated into the health information system [ 16 ]. In practice, this means shopkeepers feel no obligation (and have little incentive) to record cases for official purposes. Staffing and training issues exacerbate the problem: as one Ghanaian evaluation summarized, “staffing shortages, infrastructure/logistics problems, and a lack of funding for staff training” persistently undermine T3 implementation [ 16 ]. Shop owners in our study echoed these points, noting that they juggle multiple tasks with minimal support and that they have rarely received formal instruction on malaria testing or data entry. The relative enthusiasm for digital tools can be interpreted in light of these constraints: mobile or web-based reporting could simplify record-keeping for busy retailers. However, the literature also warns of potential pitfalls. In Ghana, pharmacists caution that without reliable internet, electricity, and user-friendly training, e-health initiatives can exacerbate inequities [ 19 ]. In other words, the shops’ readiness to go digital is promising, but successful adoption would require addressing the underlying infrastructure and literacy challenges. The implications of these findings are far-reaching for Ghana’s malaria elimination strategy. The new National Malaria Elimination Strategic Plan (2024–2028) explicitly identifies private sector engagement as “key” to achieving zero malaria [ 25 ]. Our data underscores because: many febrile patients first seek care in formal drug shops, so missing those cases could leave blind spots in surveillance. Elimination settings demand that “all malaria cases must be identified, documented and investigated” [ 22 ]. Therefore, Ghana must take concrete steps to bring retail outlets into the system. Policy efforts could include revising regulations or issuing new guidelines to require case reporting from licensed outlets. Because malaria is already a notifiable disease in Ghana, one option is to explicitly designate pharmacies and OTCMS as reporting entities, as was done for diseases like tuberculosis [ 16 ], [ 22 ]. Meanwhile, capacity-building is essential: the Pharmacy Council and NMCP should collaborate to train shop staff on the T3 protocol, use of rapid diagnostics, and routine data recording. Technological solutions also have great potential. Given our finding that most participants preferred electronic recording, Ghana might pilot a mobile app or SMS-based reporting tool for malaria cases. Such platforms could integrate directly with DHIMS2, addressing the Ayawaso study’s recommendation to “extend DHIMS2 to the facility level” [ 24 ]. Lessons from Ghana’s burgeoning e-pharmacy sector suggest that apps which are tailored to low-bandwidth environments and include in-app training could overcome some barriers [ 19 ]. International examples are encouraging for instance, Madagascar has successfully begun feeding private-sector clinic and pharmacy data into its DHIS2 system [ 26 ]. With adequate investment in devices, connectivity, and ongoing support, a similar approach could be scaled in Ghana. Limitation This study had several limitations, including reliance on self-reported data, which may have introduced reporting bias. Some participants were excluded due to temporary shop closures, resulting in incomplete sample size. The study also did not assess the feasibility of implementing digital systems or the specific infrastructure and training required. Future research should address these gaps by exploring digital system feasibility, assessing infrastructure needs, and incorporating follow-up visits or virtual interviews to ensure more representative participation and better understanding of implementation challenges. Conclusions and Recommendations This study highlights the lack of standardized documentation and reporting tools in formal drug retail shops, with digital reporting being the most favored method among attendants. Most attendants prioritized user-friendly interfaces, data security, and real-time data submission for reporting malaria cases. However, challenges such as technological barriers and resource shortages were identified, with participants proposing solutions like improved training, increased staffing, and investments in digital infrastructure. We therefore recommend that the NMEP implements policies for standardized documentation, integrates digital tools into drug retail shops, and ensures offline functionality for areas with limited internet access. Comprehensive training for drug shop attendants and sustained investments in digital infrastructure is critical for improving data accuracy and supporting effective malaria management Abbreviations Health Information Management System -HIMS National Malaria Elimination Program -NMEP over-the-counter medicine sellers -OTCMS World Health Organization -WHO Ghana Health Service -GHS National Malaria Elimination and Strategic Plan -NMESP Community-Based Health Planning and Services -CHPS Rapid Diagnostic Test- RDT Declarations Ethics approval and consent to participate. The study was conducted in conformity to the declaration of Helsinki. Ethical approval was given by the University of Health & Allied Sciences, Research Ethics Committee with protocol ID: UHAS-REC A.3 [68] 23-24. Permission was sought from the Volta Regional Pharmacy council before commencement of study. A written consent was received from the Shop attendants prior to questionnaire administration. Consent for publication Not applicable. Availability of data and materials The dataset used for this study is available from the corresponding author on request. Competing interests The authors declare that they have no competing interests. Funding There was no specific funding for this study. Authors' contributions VL and EKA conceived and implemented the study. MA and VUG contributed to the study design. VUG analysed and interpreted the data. VUG and PB and wrote the first draft of the manuscript All authors revised the first and subsequent drafts. All authors read and approved of the final manuscript. Acknowledgements Not applicable. Authors' information (optional) References CDC. Malaria’s Impact Worldwide. Accessed: Jun. 03, 2025. [Online]. Available: https://www.cdc.gov/malaria/php/impact/index.html WHO. WHO guidelines for malaria. Accessed: Jun. 04, 2025. [Online]. Available: https://iris.who.int/handle/10665/352687 WHO Regional Office for Africa. Malaria. Accessed: Jun. 04, 2025. [Online]. Available: https://www.afro.who.int/health-topics/malaria Akanteele Agandaa S, et al. Implementation and challenges of test, treat and track (T3) strategy for malaria case management in children under five years in the Bongo District, Ghana. Clin Res Trials. 2016;2(6). 10.15761/CRT.1000154 . Kolekang AS, Challenges with adherence to the ‘test, treat, and track’ malaria case management guideline among prescribers in Ghana, Malar J et al. vol. 21, no. 1, pp. 1–12, Dec. 2022, 10.1186/S12936-022-04365-6/TABLES/1 Alliance for Science. Ghana sees falling malaria burden, targets elimination -. Accessed: Jun. 04, 2025. [Online]. Available: https://allianceforscience.org/blog/2024/04/ghana-sees-falling-malaria-burden-targets-elimination/ Amankwah S, Anto F. Factors Associated with Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy: A Cross-Sectional Study in Private Health Facilities in Tema Metropolis, Ghana, J Trop Med, vol. 2019, 2019. 10.1155/2019/9278432 . Soniran OT, Mensah BA, Cheng NI, Abuaku B, Ahorlu CS. Improved adherence to test, treat, and track (T3) malaria strategy among Over-the-Counter Medicine Sellers (OTCMS) through interventions implemented in selected rural communities of Fanteakwa North district, Ghana, Malar J, vol. 21, no. 1, pp. 1–10, Dec. 2022, 10.1186/S12936-022-04338-9/TABLES/8 Ansah EK, Gyapong M, Narh-Bana S, Bart-Plange C, Whitty CJM. Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: A study using case-control methodology. Malar J. May 2016;15(1):1–9. 10.1186/S12936-016-1351-1/TABLES/3 . Malm K, Mohammed W. Update on Malaria Elimination in Ghana : Cross-border collaboration and surveillanc, 2023. Accessed: Jun. 04, 2025. [Online]. Available: https://endmalaria.org/sites/default/files/1.%20Wahjib%20and%20Keziah%20.pdf Ayisah C, Kpenu TW, Dzantor EK, Narh CT. Quality of routine malaria data captured at primary health facilities in the Hohoe Municipality, Ghana. Sci Rep. Dec. 2025;15(1):4293. 10.1038/S41598-024-78886-2 . ;SUBJMETA=228,478,692,700;KWRD=HEALTH+CARE,HEALTH+SERVICES,PUBLIC+HEALTH. Kweku M et al. Prevalence and risk factors of malaria among children under five years in High and Low altitude rural communities in the Hohoe Municipality of Ghana,., 2017, Accessed: Jun. 04, 2025. [Online]. Available: http://ir.ucc.edu.gh/jspui/handle/123456789/5433 Service GS, GHANA 2021 POPULATION AND HOUSING CENSUS., 2021. Accessed: Mar. 25, 2025. [Online]. Available: https://statsghana.gov.gh/gssmain/fileUpload/pressrelease/2021%20PHC%20General%20Report%20Vol%203A_Population%20of%20Regions%20and%20Districts_181121.pdf Getu Degu FT, Biostatistics LECTURE NOTES For Health Science Students. Jan.,, 2005, Accessed: Jun. 04, 2025. [Online]. Available: http://localhost:8080/xmlui/handle/123456789/1624 Ahmed SK, et al. Using thematic analysis in qualitative research. J Med Surg Public Health. Aug. 2025;6:100198. 10.1016/J.GLMEDI.2025.100198 . Ankonu A-SN et al. Ghana’s Implementation of the Test, Treat and Track Policy for Malaria: an assessment of malaria management and control in selected districts in Ghana. Sep. 2020. Mbonye AK, et al. Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: Lessons learned and policy implications. Malar J. Nov. 2015;14(1):1–8. 10.1186/S12936-015-0979-6/TABLES/2 . Ansah EK et al. Mar., The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: A cluster randomized trial, BMJ (Online), vol. 350, 2015, 10.1136/BMJ.H1019 . Khan S, Eab-Aggrey N. A double-edged sword? Digitalization, health disparities, and the paradoxical case of e-pharmacy in Ghana. Digit Health. Jan. 2025;11:20552076251326224. 10.1177/20552076251326224 . Soniran OT, Abuaku B, Anang A, Opoku-Afriyie P, Ahorlu C. Factors impacting test-based management of suspected malaria among caregivers of febrile children and private medicine retailers within rural communities of Fanteakwa North District, Ghana. BMC Public Health. Dec. 2021;21(1):1899. 10.1186/S12889-021-11960-W . Amankwa CE, Bonful HA, Agyabeng K, Nortey PA, Malar J. Jul., 18, 1, pp. 1–11, 2019, 10.1186/S12936-019-2897-5/FIGURES/2 Bennett A, Avanceña ALV, Wegbreit J, Cotter C, Roberts K, Gosling R. Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings, Malaria Journal 2017 16:1, vol. 16, no. 1, pp. 1–19, Jun. 2017, 10.1186/S12936-017-1901-1 Frempong BK, Amalba A, Donkor N, Akuffo KO. Regulatory compliance among over-the-counter medicine sellers facilities within the Upper East Region of Ghana, J Pharm Policy Pract, vol. 14, no. 1, pp. 1–14, Dec. 2021, 10.1186/S40545-021-00363-2/TABLES/4 Hakorimana YL. Tracking Of Malaria Indicators Reporting System and Data Usage on Malaria Management in Ayawaso District, 2016. Accessed: Jun. 04, 2025. [Online]. Available: http://197.255.68.203/handle/123456789/21186. WHO Regional Office for Africa. Private sector support key in achieving Zero Malaria in Ghana. Accessed: Jun. 04, 2025. [Online]. Available: https://www.afro.who.int/news/private-sector-support-key-achieving-zero-malaria-ghana Malaria PMIM, Increasing Access to Comprehensive Health Information with the Integration of Private Sector Data in the DHIS2 National Health Information System.. Accessed: Jun. 04, 2025. [Online]. Available: https://measuremalaria.cpc.unc.edu/publications/increasing-access-to-comprehensive-health-information-with-the-integration-of-private-sector-data-in-the-dhis2-national-health-information-system/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Nov, 2025 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 20 Jul, 2025 Reviews received at journal 17 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviews received at journal 01 Jul, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviewers agreed at journal 28 Jun, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 17 Jun, 2025 Submission checks completed at journal 17 Jun, 2025 First submitted to journal 16 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6908084","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477979825,"identity":"4aa2e61f-c06f-4bfa-b2ab-692802d86907","order_by":0,"name":"Victor Loglo","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Victor","middleName":"","lastName":"Loglo","suffix":""},{"id":477979826,"identity":"ee0fe80e-5413-472e-b73b-62928af5c343","order_by":1,"name":"Vincent Uwumboriyhie Gmayinaam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYPACCRDB+ICxAcwzAOIDRGlhNiBFCxiwSRClxeBG+tUNP9ss8vjbT6dV8+6ws2dgb94mwfDrDh4tOWU3e9skiiXO5G67zXsmObGB51iZBGPfM5xaJGfkpN3gbZNIbDgA0tLGnMAgkWMmwdhzGK+Wm3+BWuaff7utmLet3p5B/g1+LfwS6cdug2zZcCN3GzNv22HGBgkeMwmGH3i08Lxhuy1zTiJx4423myXnth1PbONJK7ZIbMCthY09/dnNN2V1ifPO52788Lat2p6f/fDGGx/+4NbCwMBjwMDIhmwIiEhsw6ODgf0BA8MfDFFMkVEwCkbBKBi5AAB95FyRu+EkbAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Vincent","middleName":"Uwumboriyhie","lastName":"Gmayinaam","suffix":""},{"id":477979827,"identity":"b31efb72-899e-4814-823d-c4138b44cb90","order_by":2,"name":"Mary Ampomah","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"","lastName":"Ampomah","suffix":""},{"id":477979828,"identity":"0047e064-7d94-4406-b970-fb4917c344c0","order_by":3,"name":"Paul Boateng","email":"","orcid":"","institution":"Ghana Health Service","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Boateng","suffix":""},{"id":477979829,"identity":"f244cc7c-1e2c-4007-8859-17dd4c711297","order_by":4,"name":"Evelyn Kokor Ansah","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"Kokor","lastName":"Ansah","suffix":""}],"badges":[],"createdAt":"2025-06-16 18:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6908084/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6908084/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-025-05645-7","type":"published","date":"2025-11-14T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85743410,"identity":"3d008f6f-40b9-4187-8a68-4a2f7fc0c9ee","added_by":"auto","created_at":"2025-07-01 09:09:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30025,"visible":true,"origin":"","legend":"\u003cp\u003ePreferred reporting tool for tracking malaria cases and reporting in the Hohoe Municipality, Ghana\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6908084/v1/4829d82df172d076ca1d7718.png"},{"id":85743412,"identity":"850878ce-6892-44d1-9424-8c4bfb2a8224","added_by":"auto","created_at":"2025-07-01 09:09:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71640,"visible":true,"origin":"","legend":"\u003cp\u003ePreferred features or characteristics that attendants of formal retail drug shops consider essential for a reporting tool; Hohoe, Ghana; April 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6908084/v1/105b144f034e93cd64de8a6f.png"},{"id":96105340,"identity":"aa50c3cc-d0fc-40d0-adc7-3ebb17f88706","added_by":"auto","created_at":"2025-11-17 16:11:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1946494,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6908084/v1/69212b1e-abe2-4789-af52-3450acca39cb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Documentation and Reporting Practices in Malaria Tracking: A Mixed-Methods Study Among Formal Drug Retail Shops in Hohoe Municipal, Ghana","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria remains a major global health threat despite decades of control efforts. Recent reports show a resurgence of cases: in 2022 an estimated 249 million cases and 608,000 deaths occurred worldwide [1]. In 2021, malaria \u003cstrong\u003ecaused\u003c/strong\u003e approximately 619,000 deaths worldwide, a slight reduction from 625,000 in 2020, but still higher than the 568,000 deaths \u003cstrong\u003erecorded\u003c/strong\u003e pre-pandemic in 2019 [2]. Sub-Saharan Affrica (SSA) \u003cstrong\u003ebears\u003c/strong\u003e the highest burden, accounting for 95% of global malaria cases and 96% of related deaths in 2020, with children under five constituting 80% of fatalities [2]. Interventions in the past decade (bed nets, indoor spraying, new drugs, vaccines, etc.) did avert millions of cases and cut mortality by about 36% from 2010–2020 \u0026nbsp; [1].\u0026nbsp;However, progress has recently stalled, and many endemic regions continue to struggle, with Africa bearing by far the heaviest burden [1], [3].\u003c/p\u003e\n\u003cp\u003ePartly in response to the malaria burden, the WHO \u003cstrong\u003elaunched\u003c/strong\u003e the \"Test, Treat, Track\" (T3) strategy in 2012, emphasizing accurate diagnosis, appropriate treatment, and systematic tracking of cases. This strategy \u003cstrong\u003ehighlights\u003c/strong\u003e the importance of quality diagnostic tools, trained personnel, and comprehensive disease monitoring to enhance the quality of care and optimize antimalarial drug use [4]. The \"track\" component \u003cstrong\u003efocuses\u003c/strong\u003e on documenting and reporting cases to health authorities, enabling better disease surveillance, outbreak identification, and strategic intervention planning [5].\u003c/p\u003e\n\u003cp\u003eGhana is among the highest-burden countries in West Africa, though recent data show encouraging declines. By 2022 Ghana recorded about 5.2 million confirmed malaria cases and 151 malaria-related deaths\u0026nbsp;[6]. These figures mark a substantial improvement: nationwide malaria prevalence (e.g. among children under five) has fallen from roughly 27.5% in 2011 to 8.6% in 2022\u0026nbsp;[6]. This decline coincides with expanded control measures (universal ITN coverage, seasonal chemoprevention, introduction of the malaria vaccine, etc.). Building on these gains, Ghana’s new National Malaria Elimination Strategic Plan (NMESP 2024–2028) sets ambitious targets of 90% reduction in malaria mortality and 50% reduction in case incidence by 2028\u0026nbsp;[6]. Achieving elimination will require not only continued prevention but\u0026nbsp;robust surveillance and case tracking\u0026nbsp;across all sectors.\u003c/p\u003e\n\u003cp\u003eIn Ghana’s health system, the private retail sector plays a critical first-line role in malaria case management. Licensed community pharmacies and over-the-counter medicine shops (OTCMS or “chemical sellers”) are often the first point of care for patients with fever\u0026nbsp;[7].\u0026nbsp;Studies \u003cstrong\u003eshow\u003c/strong\u003e that 33.8% of children under five with fever initially seek care from private retail shops, and OTCMS \u003cstrong\u003eare\u003c/strong\u003e the first point of care for over 90% of patients visiting these shops [8], [9]. However, limited data on malaria documentation and reporting practices within the private sector \u003cstrong\u003ehinders\u003c/strong\u003e effective integration into the national Health Information Management System (HIMS). These formal drug outlets dispense antimalarial treatments (e.g. artemisinin-based combination therapies) and frequently provide malaria rapid diagnostic tests. The importance of this sector is now recognized in policy: Ghana’s NMESP explicitly includes “surveillance in pharmacies and OTCMS” as a new intervention for malaria elimination [10]. In other words, the elimination plan acknowledges that pharmacies and drug shops are an integral part of the malaria treatment chain, whose data must be captured for effective tracking.\u003c/p\u003e\n\u003cp\u003eDespite their key role in treatment, private drug shops have historically been excluded from routine malaria reporting. Ghana’s health information system (DHIMS2) is used to capture case data from public health facilities\u0026nbsp;[11], but there is no formal mechanism for pharmacies or OTCMS to feed their data into DHIMS2. In practice, most private outlets use their own registers or none, and there is no standardized documentation forms mandated for these shops. This gap has been noted in strategic reviews: the NMESP 2024–2028 highlights the need to introduce surveillance in pharmacies/OTCMS\u0026nbsp;[10], implying that such data were not previously integrated. In fact, even in public clinics malaria data quality can be poor, underscoring the need to improve reporting systems overall\u0026nbsp;[11]. Without clear guidelines and tools for documentation and reporting at private outlets, national surveillance remains incomplete.\u003c/p\u003e\n\u003cp\u003eIn Hohoe, malaria remains among the top three causes of outpatient visits, though case rates have declined from 44.1% in 2022 to 39.1% by mid-2023 (Hohoe Municipal Health Directorate [HMHD], 2023). Hohoe Municipality in Ghana’s Volta Region illustrates these challenges at the local level. With a population of about 115,000, Hohoe lies in a high-transmission zone with year-round malaria and seasonal peaks. Malaria remains hyper-endemic there: facility data show malaria is the leading cause of outpatient visits (28% of OPD cases) and the leading cause of deaths (19.4%) in Hohoe\u0026nbsp;[12]. Community surveys in Hohoe report extraordinarily high infection rates – for example, one study found 56.9% of children in low-altitude communities were positive for malaria by rapid test\u0026nbsp;[12]. Given this heavy burden, the Volta Region (including Hohoe) is targeted for intensified malaria control and surveillance under Ghana’s elimination strategy. In this context, understanding how Hohoe’s private pharmacies and chemical sellers document and report malaria is particularly important for closing surveillance gaps.\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the current documentation and reporting practices among formal drug retail outlets in Hohoe Municipal, Ghana. Using a concurrent mixed-methods design, we will assess how licensed pharmacies and OTCMS record malaria cases and treatments and identify barriers and facilitators to routine case reporting. We will also evaluate outlets’ digital readiness – for example, their capacity to use Ghana’s DHIMS2 platform or other electronic tools for reporting. By illuminating these practices and needs, the study will inform strategies to better integrate private-sector data into national malaria surveillance. In turn, strengthening documentation and reporting in the private sector can improve case tracking and support Ghana’s efforts towards malaria elimination.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch3\u003eStudy Design, Site, and Population\u003c/h3\u003e\n\u003cp\u003eA \u003cstrong\u003econcurrent mixed-methods approach\u003c/strong\u003e was employed, combining a \u003cstrong\u003ecross-sectional study\u003c/strong\u003e (quantitative) with an \u003cstrong\u003eexploratory study\u003c/strong\u003e (qualitative).\u003cstrong\u003e\u0026nbsp;Quantitative data collection\u003c/strong\u003e involved face-to-face interviews with providers using a semi-structured questionnaire.\u003cstrong\u003e\u0026nbsp;Qualitative data collection\u003c/strong\u003e included in-depth interviews with attendants or frontline staff at community pharmacies and Over-The-Counter Medicine Sellers (OTCMS). The combination of these approaches ensured a well-rounded analysis, providing both statistical insights and in-depth perspectives on disease documentation practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the \u003cstrong\u003eHohoe Municipality\u003c/strong\u003e, located in the Volta Region of Ghana. The municipality covers \u003cstrong\u003e1,172 km²\u003c/strong\u003e and has an estimated population of \u003cstrong\u003e95,729\u003c/strong\u003e [13]. It is bordered by Togo to the east and several districts in Ghana. The area includes \u003cstrong\u003e9 community pharmacies\u003c/strong\u003e, \u003cstrong\u003e63 OTCMS\u003c/strong\u003e, \u003cstrong\u003e2 private hospitals\u003c/strong\u003e, and several Community-Based Health Planning and Services (CHPS) compounds. The municipality is divided into four sub-municipalities: \u003cstrong\u003eAlavanyo, Agumatsa, Gbi-South,\u003c/strong\u003e and \u003cstrong\u003eHohoe Sub-Municipality\u003c/strong\u003e. Healthcare facilities include \u003cstrong\u003e14 health centers\u003c/strong\u003e, \u003cstrong\u003e9 CHPS compounds\u003c/strong\u003e, \u003cstrong\u003e23 demarcated CHPS zones\u003c/strong\u003e, \u003cstrong\u003e2 private hospitals\u003c/strong\u003e, and the \u003cstrong\u003eVolta Regional Hospital\u003c/strong\u003e (formerly the municipal hospital) [13]. The study focused on \u003cstrong\u003e72 formal private drug retail shops\u003c/strong\u003e, including \u003cstrong\u003e9 community pharmacies\u003c/strong\u003e and \u003cstrong\u003e63 OTCMS\u003c/strong\u003e. The \u003cstrong\u003eVolta Regional Hospital\u003c/strong\u003e serves as the tertiary health center in the municipality.\u003c/p\u003e\n\u003cp\u003eThe study involved attendants working in \u003cstrong\u003eformal private drug retail shops\u003c/strong\u003e in Hohoe, specifically in community pharmacies and OTCMS. These service providers were responsible for dispensing medications, offering healthcare advice, and managing disease documentation and reporting systems. Service providers who were 18 years or older, actively involved in healthcare services, and had worked for at least six months.Service providers who were unable to participate due to reasons such as scheduling conflicts or health issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Sampling Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the formula by \u003cstrong\u003eDegu and Tessema\u003c/strong\u003e, with a reliability coefficient (z-score) of \u003cstrong\u003e1.96\u003c/strong\u003e at a \u003cstrong\u003e95% confidence level\u003c/strong\u003e and a margin of error (e) of \u003cstrong\u003e0.05\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cstrong\u003e[14]\u003c/strong\u003e\u003c/strong\u003e. Based on this formula, the required sample size was \u003cstrong\u003e65 shops\u003c/strong\u003e (9 community pharmacies and 56 OTCMS). Ultimately, \u003cstrong\u003e57 shops\u003c/strong\u003e participated in the study: 48 OTCMs and 9 Community Pharmacies. Nine (9) OTCMs were not operational at the time of the study so 6 were excluded from the expected sample from the list of OTCMs. With the Qualitative sampling data collection continued until \u003cstrong\u003e7 participants\u003c/strong\u003e were reached or selected from the retail sector. The seven participants were below the expected saturation. We experienced a decline in participation from shop attendants despite permission from their Volta Pharmaceutical council.\u003c/p\u003e\n\u003cp\u003eConvenience sampling was used for OTCMS (\u003cstrong\u003e48 selected\u003c/strong\u003e), and all community pharmacies were included. Random selection of attendants within each shop ensured diverse representation. Purposeful sampling with a \u003cstrong\u003emaximum variability strategy\u003c/strong\u003e was used to select \u003cstrong\u003e7 participants\u003c/strong\u003e across both types of facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection Tool and Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFace-to-face interviews were conducted using a semi-structured questionnaire, supplemented by on-site inspections using a checklist\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe structured questionnaire was divided into four sections to systematically gather relevant information. The first section focused on background details of the health facility, including its type, location, total number of service providers, and the qualification of the facility owner. The second section aimed to gather individual-level information about service providers, covering aspects such as age, gender, educational level, qualification, and years of experience in the formal drug retail shop. The third section delved into the tools and methods currently utilized for documenting and reporting cases of malaria and other diseases in the retail shop. Healthcare providers were asked about the types of tools or methods they used, their satisfaction levels with these tools, and any encountered challenges or limitations. Finally, the fourth section sought the opinion of healthcare providers on the most effective reporting tool for tracking malaria cases into the District Health Information Management System (DHIMS). Participants were encouraged to specify the features they deemed essential in their preferred reporting tool and share any additional comments or insights related to malaria tracking and reporting\u003c/p\u003e\n\u003cp\u003eTo complement the quantitative data collection, the study included an in-depth interview guide.\u003cbr\u003e\u0026nbsp;This guide explored the views of healthcare providers regarding the importance of\u003cbr\u003e\u0026nbsp;documenting and reporting malaria cases. It touched on topics like the Malaria Control\u003cbr\u003e\u0026nbsp;Strategy, the significance of accurate documentation and reporting, and the role of their retail\u003cbr\u003e\u0026nbsp;shop in the broader healthcare system's efforts to eliminate malaria. Follow-up questions were\u003cbr\u003e\u0026nbsp;asked where necessary to obtain additional insight, and the in-depth interviews were audio recorded to ensure accuracy of the collected data. Notes were also taken for crosschecking.\u003cbr\u003e\u0026nbsp;Permission was sought from participants with an informed consent form to record their\u003cbr\u003e\u0026nbsp;responses. The interviews were then conducted in quiet and peaceful environments. Pens,\u003cbr\u003e\u0026nbsp;notebooks, and an audio recorder were used to collect data from each interview. To ensure that\u003cbr\u003e\u0026nbsp;quality data was collected, individuals with experience in data collection were utilized. Each\u003cbr\u003e\u0026nbsp;interview was expected to take at most an hour with each participant. Interviews were audiotaped, transcribed, and reviewed to ensure accuracy.\u003c/p\u003e\n\u003cp\u003eReliability and validity were ensured through \u003cstrong\u003epre-testing\u003c/strong\u003e at 10 randomly selected formal private drug retail service providers in the Afadzato South District of the Volta Region. Trustworthiness was established through \u003cstrong\u003epre-testing\u003c/strong\u003e, random selection, and iterative questioning with probes.\u003c/p\u003e\n\u003ch3\u003eData Analysis\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuantitative\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003eData was analysed using STATA version 17. Descriptive statistics such as frequencies, percentages, tables, and charts were used to present the data. Data cleaning and validation\u003cbr\u003ewere conducted to ensure data quality before analysis. Graphs, tables, and bar charts were used for data presentation. Frequency distribution was employed to compute quantitative data such as age, gender, educational level, qualification of service providers, total number of service providers, availability of reporting tools, and reporting systems that could be adopted for reporting malaria cases into the District Health Information Management System 2 (DHIMS2). Chi-square test was performed to measure differences between groups (Community Pharmacies and OTCMS). Statistical Significance was measured at 0.05 level of significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQualitative\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic Analysis (TA) was used to analyze qualitative data. TA is a method of analyzing qualitative data [15]. TA was chosen for its simplicity and convenience, allowing flexibility in the researchers' approach. Unlike other theories limited to specific frameworks, TA can be used with any theoretical perspective, making it highly versatile [15]. Additionally, TA permits rich, detailed, and complex descriptions of data. Data collected were transcribed into word files, from which themes and statements were developed using ATLAS.ti software version V7.5.7. Data was coded and assigned into various categories, with similar categories merged into broader headings. Coding involved segmenting textual data, examining similarities and differences, and grouping conceptually similar data into respective nodes.\u0026nbsp;\u003c/p\u003e"},{"header":"Result","content":"\n\u003ch3\u003eBackground characteristics of participants\u003c/h3\u003e\n\u003cp\u003eThe Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides demographic information about the quantitative and qualitative study participants respectively. A total of 57 attendants from formal private drug retail shops participated in the quantitative study: 9 from Community Pharmacies and 48 from Over-the-Counter Medicine Sellers (OTCMS). The median age was 26 years (IQR\u0026thinsp;=\u0026thinsp;24\u0026ndash;42), with the majority, 40 (70.2%), qualified as Counter Medicine Assistants. Most attendants, 38 (66.7%), reported having 1\u0026ndash;5 years of work experience. Among the qualitative participants, demographic details are provided for 7 individuals: 2 were pharmacists, 3 were Medicine Counter Assistants, 1 was a drug seller, and another was the shop owner. Ages ranged from 20 to 23 years, though four participants chose not to disclose their age. Educational backgrounds varied, with three completing secondary school, one holding a Higher National Diploma (HND), and another being a university graduate. Two participants did not provide educational details. In terms of experience, two had been working for one year, two had two years of experience, and two had over five years in their fields, while one participant did not specify their duration of experience.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBackground characteristics of attendants in Formal Private Drug Retail Shops in the Hohoe Municipality, Ghana; April 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunity Pharmacy\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9, 15.8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOTCM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;48, 84.2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eꭓ\u003csup\u003e2\u003c/sup\u003e (P-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (26\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (24-47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (24\u0026ndash;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.5609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.73 (0.277)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34(42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.08 (0.137)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.42 (0.241)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school/JHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnical/Vocation/SH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.51 (0.079)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCounter medicine assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40 (70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse/PA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11(19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.69 (0.463)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(31.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetailed background characteristics of participants interviewed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudonyms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducational Qualification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration of work\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.OTCMS 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHND Holder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCounter medicine assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOne year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. OTCMS 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTwenty-four years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. OTCMS 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOne year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. OTCMS 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary School graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCounter medicine assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTwo years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. OTCMS 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary School graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSeven years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Community Pharmacy 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCounter medicine assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTwo years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Community pharmacy 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCounter medicine assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSix years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eExisting methods of documentation and reporting tools\u003c/h3\u003e\n\u003cp\u003eAbout 51 (89.5%) of the facilities did not have existing methods of documentation and reporting tools with only 6 (10.5%) indicating there were existing methods of documentation and reporting tools. Five out of the six of facilities documented and reported using paper-based forms (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExisting methods of documentation and reporting tools used by formal drug retail shops in the Hohoe Municipality, Ghana; April 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunity Pharmacy (n\u0026thinsp;=\u0026thinsp;9, 15.8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOver the counter (n\u0026thinsp;=\u0026thinsp;48, 84.2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eꭓ\u003csup\u003e2\u003c/sup\u003e (P-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDocumentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.05 (0.004)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExisting Tools (n\u0026thinsp;=\u0026thinsp;6) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60 (1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDigital software/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease condition (n\u0026thinsp;=\u0026thinsp;6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.75 (1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDangerous drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkin disease, malaria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSatisfaction with tools (n\u0026thinsp;=\u0026thinsp;6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60 (1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver experienced Challenges (n\u0026thinsp;=\u0026thinsp;6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.38 (1.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChallenges (n\u0026thinsp;=\u0026thinsp;2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0(0.157)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient airtime/bundle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePreferred reporting tool for tracking malaria cases and reporting into the DHIMS\u003c/h2\u003e \u003cp\u003eThe Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below presents data on the preferred methods of reporting among attendants of formal retail drug shops, categorized by establishment type: Community Pharmacy (n\u0026thinsp;=\u0026thinsp;9) and OTCMS (Over-The-Counter Medicine Shops) (n\u0026thinsp;=\u0026thinsp;48), with a total of 57 respondents. The findings reveal that digital reporting using computer-based software applications was the most favored method overall, selected by 61.4% of respondents (n\u0026thinsp;=\u0026thinsp;35). Specifically, 60.4% (n\u0026thinsp;=\u0026thinsp;29) of OTCMS attendants and 66.7% (n\u0026thinsp;=\u0026thinsp;6) of Community Pharmacy attendants prefer digital methods.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below presents preferred features or characteristics that attendants of formal retail drug shops consider essential for a reporting tool. Majority of the attendants of formal prioritized a user-friendly interface (36, 64.3%) and data security measures (31, 55.4%) for a reporting tool, with real-time data submission (29, 51.8%) also being mentioned, particularly by OTCMS attendants. While few chose integration with DHIMS (2, 3.6%) and offline functionality (5, 8.9%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eViews of the attendants at the formal drug retail shops on the importance of documenting and reporting malaria cases\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the perspectives gathered from the attendants at formal drug retail shops regarding the documentation and reporting of malaria cases in the Hohoe Municipality. Five main themes emerged. These included: Understanding of Test Treat and Track (T3) strategy, documentation, accurate reporting, roles and future improvement. (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eViews of formal retail drug shop attendants in the Hohoe Municipality; April, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding of 3T strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness of T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnly test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTesting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSleeping under-treated net\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUsing insecticide (coils and spray)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDocumentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eImportance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCreation of awareness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFor easy tracking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCheck up on patient\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEnter patient details\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMake enquiries from house\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTools\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePen\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLogbook\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTelephone number\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBarriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTechnological problems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBenefit of Documentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEasy elimination of malaria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReduce rate of malaria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevent complication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRefer to clinic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReducing cases of malaria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecommendations for improvement in Malaria documentation.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRecommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTest before treatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraining\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTechnology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTablet\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaptop\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComputers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMobile app\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDigital form\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTraining and capacity building\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEnhance work\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncrease the number of staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMakes documentation easier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImprove knowledge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eUnderstanding of 3T Strategy\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants showed varied levels of understanding regarding malaria control strategies, particularly the 3T (Test, Treat, Track). Their narrations revealed that some were familiar with aspects like testing for malaria, but they had limited knowledge about the comprehensive strategy, especially regarding the tracking component of the T3.\u003c/p\u003e \u003cp\u003eThis was how some participants expressed their views.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"I know only testing.\"\u003c/em\u003e \u003cb\u003e- (OTCMS 3)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\"I have not heard of it before.\"\u003c/em\u003e \u003cb\u003e- (Community pharmacy 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\"I actually do not have any training, so I do not know.\"\u003c/em\u003e \u003cb\u003e- (Community pharmacy 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eFigure 3: Participants\u0026rsquo; understanding of 3Ts strategy\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDocumentation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis theme described generally participants\u0026rsquo; views and current documentation practices. Seven subthemes emerged from were explored with regards to Documentation. These were tools, resources for improvement, details, processes, barriers, facilitators and importance. Participants recounted their views around this theme.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImportance of documentation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eImportance of documentation was the first significant subtheme to emerge from the main theme. Participants recounted the lack of current documentation practices, although they acknowledged importance of documenting malaria cases. They highlighted benefits such as providing quality healthcare, tracking community health issues, and educating patients on prevention methods.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It is important because in case there are other complications afterwards, you can refer to the documentation.\"\u003c/em\u003e \u003cb\u003e- (OTCMS 5)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\"It will help you know the condition of the people. It will help you to know their health issues so after you know that, then you can provide the healthcare that is needed.\"\u003c/em\u003e \u003cb\u003e- (Community Pharmacy 2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\"It is good to document in order to know whether the cases are becoming more or it is becoming less.\"\u003c/em\u003e \u003cb\u003e- (Community Pharmacy 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost drug retail shops lacked established documentation practices for malaria cases, primarily due to over-the-counter operations or insufficient training.\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;No, I do not keep records of them\u0026rdquo;.\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCMS 2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo participants mentioned what they do as part of the documentation process.\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We have a logbook so we enter the patient\u0026rsquo;s name, telephone number then we put in our suspected diagnoses and the drug we served.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-(OTCMS 3)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;If you know the house of the customer, you can make that enquiry. We do not record them.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-(OTCMS 4)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eExisting Tools\u003c/b\u003e \u003c/p\u003e \u003cp\u003eExisting tool describes the materials used for documentation. Most participants did not take any records from their clients with the exception of one attendant who indicated that records of their clients were documented. Pens, logbooks, and papers were observed as these tools only served the purpose of accountability to their superiors mentioned as tools for recording information.\u003c/p\u003e \u003cp\u003eThis was how the attendant expressed herself,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We have a logbook, so we enter the patient\u0026rsquo;s name, telephone number then we put in our suspected diagnoses and the drug we served\u0026rdquo;.\u003c/em\u003e \u003cb\u003e-(OTCMS 3)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Two participants mentioned that name, telephone number and residence of customers were some contact information taken during the process of documentation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We have a logbook, so we enter the patient\u0026rsquo;s name, telephone number then we put in our suspected diagnoses and the drug we served.\u0026rdquo;\u003c/em\u003e\u003cb\u003e- (OTCM 3)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAttendants anticipated that there would be some barriers in documenting and reporting malaria cases. These included electricity, and technological problems.\u003c/p\u003e \u003cp\u003eThis was how some participants expressed themselves,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"With technology also, if the light goes off and you do not have light so you can be able to charge it, you will have to first put it on paper so that when the light is on, you will now transfer it to the device you are using. It is going to be a lot of stress.\"\u003c/em\u003e \u003cb\u003e- (Community Pharmacy 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome attendants revealed that there were no barriers since they were not documenting.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;First of all, we do not document so since we do not document, there will not be any challenge\u0026rdquo;.\u003c/em\u003e \u003cb\u003e\u0026ndash; (Community Pharmacy 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I do not see any barrier. I do not think there will be any barrier to documentation. If\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI have to keep records; I do not see why I cannot keep records\u0026rdquo;.\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCMS 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eBenefits of documentation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants highlighted that detailed reporting of cases leads to creation of awareness, enables easy tracking of cases, provides references for follow-ups, and ensures patients receive timely check-ups. The benefit of documentation identified by participants was accurate reporting.\u003c/p\u003e \u003cp\u003eParticipants mentioned the advantages of accurate reporting of malaria cases. They emphasized that records help in easy checking and tracking of malaria patients. Additionally, some indicated that maintaining records helps in referring patients and accumulating data.\u003c/p\u003e \u003cp\u003eThis was how they expressed themselves,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;So that we can do follow up checks if the need arises.\u0026rdquo;\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCMS 3)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It can be used in the future to make comparison of the past and current cases to see whether there is an improvement or not.\u0026rdquo;\u003c/em\u003e \u003cb\u003e- (OTCMS 4)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Maybe when you document it and the person comes with the same complain, you can refer the person to the hospital.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-(OTCMS 5)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It provides basic data for referencing. \u0026ldquo;-\u003c/em\u003e \u003cb\u003e(Community Pharmacy 1)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe critical role of retail shops was highlighted by participants. They emphasized that retail shops made treatment accessible, potentially limiting the spread of malaria. This was how they expressed themselves,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;As we are here, we are also limiting the malaria pandemic or endemic. Some of the people find it difficult to go to the hospital and some are also scared that when they go to the hospital something else will happen so as we are here, they come to us and we attend to them. If it is a malaria case, we treat them and the go which is better than they going to line up at the hospital and waste their time. That is why they normally come to us here.\u0026rdquo; -\u003c/em\u003e \u003cb\u003e(Community Pharmacy 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;For easy tracking. To make it easy to track any malaria case.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-(OTCMS 4)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It is a way pf providing primary care to the healthcare.\u0026rdquo;\u003c/em\u003e \u003cb\u003e- (OTCMS 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecommendations for Improvement in documentation\u003c/h3\u003e\n\u003cp\u003eParticipants made various recommendations for improving documentation practices, including providing training, supplying necessary resources, and addressing infrastructure challenges. These were recommendations, technology and training and capacity building.\u003c/p\u003e \u003cp\u003eParticipants mentioned that facilitators such as booking, increasing the number of staff, and well-designed forms can improve documentation practices.\u003c/p\u003e \u003cp\u003eThis was how they expressed themselves,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;With the booking, you will have all the details of the patient in there, including where the person stays and others so booking can help you track the malaria cases\u0026rdquo;.\u003c/em\u003e \u003cb\u003e- (OTCMS 4)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;In my view, the number of staff here can be increased so that we can be either 2 or 3 people working here\u0026rdquo;.\u003c/em\u003e \u003cb\u003e- (Community Pharmacy 2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;For instance, when we have a designed form that we are to fill in your records, it will make things easier for us\u0026rdquo;.\u003c/em\u003e \u003cb\u003e-(OTCMS 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants further highlighted the need for technological advancements, such as the use of phones, tablets, laptops, computers, mobile apps, and digital forms, as vital tools to support future improvements.\u003c/p\u003e \u003cp\u003eThis was how participants expressed themselves.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;a mobile phone where you can keep record or keeping the records on a computer.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-\u003c/b\u003e\u003cem\u003e(OTCMS 5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Because we are currently in a modern system, we need laptop and other things to use for the documentation.\u0026rdquo;\u003c/em\u003e \u003cb\u003e- (Community Pharmacy 6)\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants indicated that, there was a clear need for improved resources such as printed sheets, cards, recording guides, and small laptops to enhance accuracy and efficiency.\u003c/p\u003e \u003cp\u003eThis was how some attendants expressed their views.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Maybe they can give us some printed sheets so that we know where to put some things so that we will not be writing unnecessary things\u0026rdquo;.\u003c/em\u003e \u003cb\u003e-(OTCMS 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;If we are provided with the record guide or book, it will help\u0026rdquo;.\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCM 2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;With the booking, you will have all the details of the patient in there, including where the person stays and others so booking can help you track the malaria cases\u0026rdquo;.\u003c/em\u003e \u003cb\u003e(Community pharmacy 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor future improvements, attendants recommended enhanced research, ensuring testing before treatment, ongoing education, and regular training.\u003c/p\u003e \u003cp\u003eThis was how some participants expressed themselves,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I do not know the current documentation tools and since I started working, it was only once they came to educate us on how to treat it. So, if they will be coming yearly to show us how to go about it, it will help.\u0026rdquo;-\u003c/em\u003e \u003cb\u003e(OTCMS 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I think we can do more than we are doing in terms of research. Quite often, they distribute mosquito nets as a way of preventing it and it is helping so much. We still record high cases of the disease, so we have to do more in terms of research.\u0026rdquo;\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCMS 2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants indicated that Training and capacity building would help enhance work efficiency, ease documentation processes, and improve overall knowledge among attendants.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It is not everybody that knows how to test so if there will be a yearly training on how to test, even the training we attended, they did not do any practical. They just showed us how to go about it. So, they can show us how to do it practically and give us the questionnaire on how to do the testing.\u003c/em\u003e \u003cb\u003e\u0026ndash; (OTCMS 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;By training, you are opening the person\u0026rsquo;s mind to a lot of information so documentation will be quite easier, and you will get a lot of information on how to document.\u0026rdquo;\u003c/em\u003e \u003cb\u003e-(OTCMS 3)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlmost none of the shops maintained formal written logs of suspected cases, and very few had ever reported cases into the public health system. Shop attendants overwhelmingly expressed a preference for smartphone or computer-based record-keeping rather than paper registers. Awareness of Ghana\u0026rsquo;s Test-Treat-Track (T3) policy was uniformly low, and participants cited chronic understaffing and lack of formal training in malaria diagnostics or reporting as key obstacles.\u003c/p\u003e \u003cp\u003eThese observations align with findings from several studies. Ghana\u0026rsquo;s T3 implementation report explicitly notes that \u0026ldquo;private facilities, especially pharmacies and chemical shops, do not submit data on malaria\u0026rdquo; to the health directorate [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and that the existing legal framework \u0026ldquo;does not empower\u0026rdquo; regulators to require testing or reporting at these outlets [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Likewise, Ghanaian health system reviews have highlighted staffing shortages and insufficient training resources as major barriers to T3 adherence in peripheral settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies by Mbonye et al. and Ansah et al. also identified similar limitations in Uganda and Ghana respectively, where inadequate documentation hindered effective malaria management and the tracking of diagnostic tool usage [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, the shops\u0026rsquo; openness to digital recording is consistent with a broader digital health interest in Ghana: recent qualitative research finds that community pharmacists view e-pharmacy initiatives as having \u0026ldquo;transformative potential\u0026rdquo; for health access, provided necessary infrastructure and support are in place [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In short, our findings of inadequate paper-based tracking and keen interest in electronic solutions reflect both the known structural challenges in Ghana\u0026rsquo;s informal sector and the growing momentum around mobile health technologies.\u003c/p\u003e \u003cp\u003eThese results mirror patterns documented in Ghana and across sub-Saharan Africa. For example, a survey of rural communities in Ghana found that only 10.5% of febrile children seen at OTC medicine sellers were tested for malaria, compared to nearly 95% in formal clinics [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, a study in Greater Accra observed that 66.1% of anti-malarial dispensed in pharmacies were given without any diagnostic test [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our findings show that drug shops rarely document, or report cases fit in this context: unregulated retail outlets in the region routinely operate outside routine surveillance systems. Indeed, a global review of malaria elimination contexts notes that \u0026ldquo;unregulated private providers often do not report into [national] HMIS,\u0026rdquo; impeding timely case detection [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In Ghana, regulatory surveys corroborate the lack of record-keeping: fewer than half of licensed medicine sellers retain supplier invoices or other documentation on-site [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. At the district level, program evaluations have similarly underscored that private clinics and shops contribute little case data, and they have called for extending the DHIMS2 reporting platform down to every facility, public and private [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Together, these studies indicate that our observations in Hohoe are not unique but are part of a well-recognized surveillance gap in the private sector.\u003c/p\u003e \u003cp\u003eSeveral factors likely explain the weak documentation we observed. Foremost is the fragmented regulatory environment. Ghana\u0026rsquo;s malaria control guidelines do not mandate reporting by retail pharmacies or chemical sellers, and these outlets generally are not integrated into the health information system [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In practice, this means shopkeepers feel no obligation (and have little incentive) to record cases for official purposes. Staffing and training issues exacerbate the problem: as one Ghanaian evaluation summarized, \u0026ldquo;staffing shortages, infrastructure/logistics problems, and a lack of funding for staff training\u0026rdquo; persistently undermine T3 implementation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Shop owners in our study echoed these points, noting that they juggle multiple tasks with minimal support and that they have rarely received formal instruction on malaria testing or data entry. The relative enthusiasm for digital tools can be interpreted in light of these constraints: mobile or web-based reporting could simplify record-keeping for busy retailers. However, the literature also warns of potential pitfalls. In Ghana, pharmacists caution that without reliable internet, electricity, and user-friendly training, e-health initiatives can exacerbate inequities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In other words, the shops\u0026rsquo; readiness to go digital is promising, but successful adoption would require addressing the underlying infrastructure and literacy challenges.\u003c/p\u003e \u003cp\u003eThe implications of these findings are far-reaching for Ghana\u0026rsquo;s malaria elimination strategy. The new National Malaria Elimination Strategic Plan (2024\u0026ndash;2028) explicitly identifies private sector engagement as \u0026ldquo;key\u0026rdquo; to achieving zero malaria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Our data underscores because: many febrile patients first seek care in formal drug shops, so missing those cases could leave blind spots in surveillance. Elimination settings demand that \u0026ldquo;all malaria cases must be identified, documented and investigated\u0026rdquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, Ghana must take concrete steps to bring retail outlets into the system. Policy efforts could include revising regulations or issuing new guidelines to require case reporting from licensed outlets. Because malaria is already a notifiable disease in Ghana, one option is to explicitly designate pharmacies and OTCMS as reporting entities, as was done for diseases like tuberculosis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Meanwhile, capacity-building is essential: the Pharmacy Council and NMCP should collaborate to train shop staff on the T3 protocol, use of rapid diagnostics, and routine data recording.\u003c/p\u003e \u003cp\u003eTechnological solutions also have great potential. Given our finding that most participants preferred electronic recording, Ghana might pilot a mobile app or SMS-based reporting tool for malaria cases. Such platforms could integrate directly with DHIMS2, addressing the Ayawaso study\u0026rsquo;s recommendation to \u0026ldquo;extend DHIMS2 to the facility level\u0026rdquo; [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Lessons from Ghana\u0026rsquo;s burgeoning e-pharmacy sector suggest that apps which are tailored to low-bandwidth environments and include in-app training could overcome some barriers [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. International examples are encouraging for instance, Madagascar has successfully begun feeding private-sector clinic and pharmacy data into its DHIS2 system [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. With adequate investment in devices, connectivity, and ongoing support, a similar approach could be scaled in Ghana.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eThis study had several limitations, including reliance on self-reported data, which may have introduced reporting bias. Some participants were excluded due to temporary shop closures, resulting in incomplete sample size. The study also did not assess the feasibility of implementing digital systems or the specific infrastructure and training required. Future research should address these gaps by exploring digital system feasibility, assessing infrastructure needs, and incorporating follow-up visits or virtual interviews to ensure more representative participation and better understanding of implementation challenges.\u003c/p\u003e"},{"header":"Conclusions and Recommendations","content":"\u003cp\u003eThis study highlights the lack of standardized documentation and reporting tools in formal drug retail shops, with digital reporting being the most favored method among attendants. Most attendants prioritized user-friendly interfaces, data security, and real-time data submission for reporting malaria cases. However, challenges such as technological barriers and resource shortages were identified, with participants proposing solutions like improved training, increased staffing, and investments in digital infrastructure. We therefore recommend that the NMEP implements policies for standardized documentation, integrates digital tools into drug retail shops, and ensures offline functionality for areas with limited internet access. Comprehensive training for drug shop attendants and sustained investments in digital infrastructure is critical for improving data accuracy and supporting effective malaria management\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eHealth Information Management System -HIMS\u003c/li\u003e\n \u003cli\u003eNational Malaria Elimination Program -NMEP\u003c/li\u003e\n \u003cli\u003eover-the-counter medicine sellers -OTCMS\u003c/li\u003e\n \u003cli\u003eWorld Health Organization -WHO\u003c/li\u003e\n \u003cli\u003eGhana Health Service -GHS\u003c/li\u003e\n \u003cli\u003eNational Malaria Elimination and Strategic Plan -NMESP\u003c/li\u003e\n \u003cli\u003eCommunity-Based Health Planning and Services -CHPS\u003c/li\u003e\n \u003cli\u003eRapid Diagnostic Test- RDT\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in conformity to the declaration of Helsinki. Ethical approval was given by the University of Health \u0026amp; Allied Sciences, Research Ethics Committee with protocol ID: UHAS-REC A.3 [68] 23-24. Permission was sought from the Volta Regional Pharmacy council before commencement of study. A written consent was received from the Shop attendants prior to questionnaire administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used for this study is available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no specific funding for this study.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eVL and EKA conceived and implemented the study. MA and VUG contributed to the study design. VUG analysed and interpreted the data. VUG and PB and wrote the first draft of the manuscript All authors revised the first and subsequent drafts.\u0026nbsp;All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors' information (optional)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCDC. Malaria\u0026rsquo;s Impact Worldwide. Accessed: Jun. 03, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/malaria/php/impact/index.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/malaria/php/impact/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. WHO guidelines for malaria. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/352687\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/352687\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO Regional Office for Africa. Malaria. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/health-topics/malaria\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/health-topics/malaria\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkanteele Agandaa S, et al. Implementation and challenges of test, treat and track (T3) strategy for malaria case management in children under five years in the Bongo District, Ghana. Clin Res Trials. 2016;2(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15761/CRT.1000154\u003c/span\u003e\u003cspan address=\"10.15761/CRT.1000154\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolekang AS, Challenges with adherence to the \u0026lsquo;test, treat, and track\u0026rsquo; malaria case management guideline among prescribers in Ghana, Malar J et al. vol. 21, no. 1, pp. 1\u0026ndash;12, Dec. 2022, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-022-04365-6/TABLES/1\u003c/span\u003e\u003cspan address=\"10.1186/S12936-022-04365-6/TABLES/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlliance for Science. Ghana sees falling malaria burden, targets elimination -. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://allianceforscience.org/blog/2024/04/ghana-sees-falling-malaria-burden-targets-elimination/\u003c/span\u003e\u003cspan address=\"https://allianceforscience.org/blog/2024/04/ghana-sees-falling-malaria-burden-targets-elimination/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmankwah S, Anto F. Factors Associated with Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy: A Cross-Sectional Study in Private Health Facilities in Tema Metropolis, Ghana, J Trop Med, vol. 2019, 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2019/9278432\u003c/span\u003e\u003cspan address=\"10.1155/2019/9278432\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoniran OT, Mensah BA, Cheng NI, Abuaku B, Ahorlu CS. Improved adherence to test, treat, and track (T3) malaria strategy among Over-the-Counter Medicine Sellers (OTCMS) through interventions implemented in selected rural communities of Fanteakwa North district, Ghana, Malar J, vol. 21, no. 1, pp. 1\u0026ndash;10, Dec. 2022, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-022-04338-9/TABLES/8\u003c/span\u003e\u003cspan address=\"10.1186/S12936-022-04338-9/TABLES/8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsah EK, Gyapong M, Narh-Bana S, Bart-Plange C, Whitty CJM. Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: A study using case-control methodology. Malar J. May 2016;15(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-016-1351-1/TABLES/3\u003c/span\u003e\u003cspan address=\"10.1186/S12936-016-1351-1/TABLES/3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalm K, Mohammed W. Update on Malaria Elimination in Ghana : Cross-border collaboration and surveillanc, 2023. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://endmalaria.org/sites/default/files/1.%20Wahjib%20and%20Keziah%20.pdf\u003c/span\u003e\u003cspan address=\"https://endmalaria.org/sites/default/files/1.%20Wahjib%20and%20Keziah%20.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyisah C, Kpenu TW, Dzantor EK, Narh CT. Quality of routine malaria data captured at primary health facilities in the Hohoe Municipality, Ghana. Sci Rep. Dec. 2025;15(1):4293. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/S41598-024-78886-2\u003c/span\u003e\u003cspan address=\"10.1038/S41598-024-78886-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. ;SUBJMETA=228,478,692,700;KWRD=HEALTH+CARE,HEALTH+SERVICES,PUBLIC+HEALTH.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKweku M et al. Prevalence and risk factors of malaria among children under five years in High and Low altitude rural communities in the Hohoe Municipality of Ghana,., 2017, Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://ir.ucc.edu.gh/jspui/handle/123456789/5433\u003c/span\u003e\u003cspan address=\"http://ir.ucc.edu.gh/jspui/handle/123456789/5433\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eService GS, GHANA 2021 POPULATION AND HOUSING CENSUS., 2021. Accessed: Mar. 25, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://statsghana.gov.gh/gssmain/fileUpload/pressrelease/2021%20PHC%20General%20Report%20Vol%203A_Population%20of%20Regions%20and%20Districts_181121.pdf\u003c/span\u003e\u003cspan address=\"https://statsghana.gov.gh/gssmain/fileUpload/pressrelease/2021%20PHC%20General%20Report%20Vol%203A_Population%20of%20Regions%20and%20Districts_181121.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetu Degu FT, Biostatistics LECTURE NOTES For Health Science Students. Jan.,, 2005, Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://localhost:8080/xmlui/handle/123456789/1624\u003c/span\u003e\u003cspan address=\"http://localhost:8080/xmlui/handle/123456789/1624\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed SK, et al. Using thematic analysis in qualitative research. J Med Surg Public Health. Aug. 2025;6:100198. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.GLMEDI.2025.100198\u003c/span\u003e\u003cspan address=\"10.1016/J.GLMEDI.2025.100198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnkonu A-SN et al. Ghana\u0026rsquo;s Implementation of the Test, Treat and Track Policy for Malaria: an assessment of malaria management and control in selected districts in Ghana. Sep. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbonye AK, et al. Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: Lessons learned and policy implications. Malar J. Nov. 2015;14(1):1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-015-0979-6/TABLES/2\u003c/span\u003e\u003cspan address=\"10.1186/S12936-015-0979-6/TABLES/2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsah EK et al. Mar., The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: A cluster randomized trial, BMJ (Online), vol. 350, 2015, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/BMJ.H1019\u003c/span\u003e\u003cspan address=\"10.1136/BMJ.H1019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan S, Eab-Aggrey N. A double-edged sword? Digitalization, health disparities, and the paradoxical case of e-pharmacy in Ghana. Digit Health. Jan. 2025;11:20552076251326224. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20552076251326224\u003c/span\u003e\u003cspan address=\"10.1177/20552076251326224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoniran OT, Abuaku B, Anang A, Opoku-Afriyie P, Ahorlu C. Factors impacting test-based management of suspected malaria among caregivers of febrile children and private medicine retailers within rural communities of Fanteakwa North District, Ghana. BMC Public Health. Dec. 2021;21(1):1899. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12889-021-11960-W\u003c/span\u003e\u003cspan address=\"10.1186/S12889-021-11960-W\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmankwa CE, Bonful HA, Agyabeng K, Nortey PA, Malar J. Jul., 18, 1, pp. 1\u0026ndash;11, 2019, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-019-2897-5/FIGURES/2\u003c/span\u003e\u003cspan address=\"10.1186/S12936-019-2897-5/FIGURES/2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBennett A, Avance\u0026ntilde;a ALV, Wegbreit J, Cotter C, Roberts K, Gosling R. Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings, Malaria Journal 2017 16:1, vol. 16, no. 1, pp. 1\u0026ndash;19, Jun. 2017, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-017-1901-1\u003c/span\u003e\u003cspan address=\"10.1186/S12936-017-1901-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrempong BK, Amalba A, Donkor N, Akuffo KO. Regulatory compliance among over-the-counter medicine sellers facilities within the Upper East Region of Ghana, J Pharm Policy Pract, vol. 14, no. 1, pp. 1\u0026ndash;14, Dec. 2021, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S40545-021-00363-2/TABLES/4\u003c/span\u003e\u003cspan address=\"10.1186/S40545-021-00363-2/TABLES/4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakorimana YL. Tracking Of Malaria Indicators Reporting System and Data Usage on Malaria Management in Ayawaso District, 2016. Accessed: Jun. 04, 2025. [Online]. Available: http://197.255.68.203/handle/123456789/21186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO Regional Office for Africa. Private sector support key in achieving Zero Malaria in Ghana. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/news/private-sector-support-key-achieving-zero-malaria-ghana\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/news/private-sector-support-key-achieving-zero-malaria-ghana\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalaria PMIM, Increasing Access to Comprehensive Health Information with the Integration of Private Sector Data in the DHIS2 National Health Information System.. Accessed: Jun. 04, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://measuremalaria.cpc.unc.edu/publications/increasing-access-to-comprehensive-health-information-with-the-integration-of-private-sector-data-in-the-dhis2-national-health-information-system/\u003c/span\u003e\u003cspan address=\"https://measuremalaria.cpc.unc.edu/publications/increasing-access-to-comprehensive-health-information-with-the-integration-of-private-sector-data-in-the-dhis2-national-health-information-system/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria tracking, Documentation and reporting, Private drug retail shops, Digital reporting, Health Information Management Systems (HIMS)","lastPublishedDoi":"10.21203/rs.3.rs-6908084/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6908084/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Ghana still faces prevailing malaria cases despite the progress made in reducing its incidence. The formal private drug retail sector most at times tends to be the first source of healthcare for people with fever. However, there is limited information from this sector with regards to the documentation and reporting of malaria cases and other diseases. This study examined malaria documentation and reporting practices among formal drug retail shops in the Hohoe Municipality as part of efforts to enhance tracking of malaria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A concurrent mixed-methods approach was employed, comprising a cross-sectional study of 57 formal drug retail facilities (9 from Community Pharmacies and 48 from OTCMS) and an exploration study of 7 of them. Quantitative data was collected via semi-structured questionnaires and analysed using SPSS. Qualitative data from 7 in-depth interviews were thematically analysed using ATLAS.ti to identify key themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The median age of the participants was 26 years (IQR = 24–42), with 40 (70.2%) qualified as Counter Medicine Assistants, and 38 (66.7%) having 1–5 years of work experience. Of the 57 shops, 51 (89.5%) lacked documentation and reporting tools; only 5 (10.5%) used paper-based methods. Digital reporting was favored by 35 (61.4%) of attendants, prioritizing a user-friendly interface, data security, and real-time data submission. Participants highlighted barriers like stress and resource constraints but suggested solutions such as improved staffing, training, and digital infrastructure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Malaria documentation and reporting were low, with few facilities relying on paper-based methods. Digital reporting was preferred but faces challenges like resource constraints and inadequate training. Addressing these barriers through infrastructure investments and comprehensive training with collaborations between the National Malaria Elimination Programme (NMEP) and the Ghana Pharmaceuticals Council (GPC) will improve data accuracy and reporting, even in low-connectivity areas.\u003c/p\u003e","manuscriptTitle":"Exploring Documentation and Reporting Practices in Malaria Tracking: A Mixed-Methods Study Among Formal Drug Retail Shops in Hohoe Municipal, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:09:30","doi":"10.21203/rs.3.rs-6908084/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-20T09:47:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-17T08:26:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T20:41:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160164715879662034314742354583927426688","date":"2025-07-02T19:42:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-01T08:30:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312109838097374294222744500619965446119","date":"2025-06-29T14:42:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220249606238481587089591057415557219874","date":"2025-06-28T21:07:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7973476327156804151428368305008071593","date":"2025-06-26T19:17:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80874382026801047070736566190424670092","date":"2025-06-25T16:40:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T14:37:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-17T07:54:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-17T07:53:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-06-16T18:47:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c75dd96a-dcc2-4bd0-b92e-adbd151bdbfc","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:07:44+00:00","versionOfRecord":{"articleIdentity":"rs-6908084","link":"https://doi.org/10.1186/s12936-025-05645-7","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-11-14 15:57:51","publishedOnDateReadable":"November 14th, 2025"},"versionCreatedAt":"2025-07-01 09:09:30","video":"","vorDoi":"10.1186/s12936-025-05645-7","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05645-7","workflowStages":[]},"version":"v1","identity":"rs-6908084","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6908084","identity":"rs-6908084","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}