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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

Using Medications Sales from Retail Pharmacies for
Syndromic Surveillance in Rural China
Weirong Yan*1, 2, Liwei Cheng2, Li Tan2, Miao Yu3, Shaofa Nie2, Biao Xu3, Lars Palm4 and
Vinod Diwan1

1Karolinska Institutet, Stockholm, Sweden; 2Huazhong University of Science and Technology, Wuhan, China; 3Fudan University,
Shanghai, China; 4Future Position X, Gavle, Sweden

Objective
To use an unconventional data - pharmaceutical sales surveillance

for the early detection of respiratory and gastrointestinal epidemics in
rural China.

Introduction
Drug sales data as an early indicator in syndromic surveillance has

attracted particular interest in recent years (1, 2), however previous
studies were mostly conducted in developed countries or areas. In
China, many people (around 60%) choose self-medication as their
first option when they encounter a health problem (3), and electronic
sales information system is gradually used by retail pharmacies,
which makes drug sales data become a promising data source for syn-
dromic surveillance in China.

Methods
This experimental study was conducted in four rural counties in

central China. From Apr. 1st 2012, there are 56 retail pharmacies
joined the study, including 21 county pharmacies and 35 township
pharmacies. 123 drugs were selected under surveillance based on the
analysis of local historical sales volume and consultation with local
pharmacists, including 19 antibiotics, 15 antidiarrheal medications, 9
antipyretics, 41 compound cold medicine, and 39 cough suppressants.
Daily sales volume of the selected drugs was recorded into the data-
base by pharmacy staff at each participating unit via electronic file
importing or manual entering. Figure 1 showed the user interface for
data viewing, query and export. Field training and supervision were
regularly conducted to ensure the data quality.

Results
From Apr. 1st to Jun. 30th 2012, there were 103814 sales records

reported in the system, including 44464 (42.83%) records from
county pharmacies and 59350 (57.17%) from township pharmacies.
Among all surveillance drugs, the sales of compound cold medicine
accounted for the largest proportion (43.42%), followed by antibi-
otics (22.52 %), cough suppressants (18.50%), antidiarrheal drugs
(9.49%) and antipyretics (6.06 %). More than 80% data were reported
into the system within 24 hours after the sales date, and the reporting
timeliness of county pharmacies improved with time (table 1). Miss-
ing report rate was less than 5% for all surveillance units. Several re-
porting mistakes were found during the first three-month
implementation, which might be due to system bugs, data provider
unfamiliar with the system especially when manual reporting, data
providers’ carelessness, and some pharmacies reluctant to share sales
data amongst others.

Conclusions
Although the current reporting timeliness and completeness are

satisfying, it is noteworthy the quality of data is not stable during the

beginning phase of the implementation. Further validation of the data
will be required. To ensure the accuracy of data and the effective and
sustainable deployment of the system, it is imperative to establish a
data sharing policy between pharmacies and public health agencies,
and achieve automated data collection to avoid additional human
labor involvement.

Table 1: Timeliness of reporting records from various pharmacies, Apr. 1st -
Jun. 30th, 2012

Figure 1 User interface in the system for data viewing, query and export

Keywords
Syndromic surveillance; Medication sales; Developing settings

Acknowledgments

The study is financially supported by a grant under the European Union
Framework Program 7 (project no: 241900).

References

1. Magruder S. Evaluation of over - the - counter pharmaceutical sales as
a possible early warning indicator of human disease. Johns Hopkins
APL technical digest 2003;24(4):349-53.

2.Das D, Metzger K, Heffernan R, Balter S, Weiss D, Mostashari F. Mon-
itoring over-the-counter medication sales for early detection of dis-
ease outbreaks—New York City. MMWR 2005;54 Suppl:41-6.

3. Wen Y, Lieber E, Wan D, Hong Y; NIMH Collaborative HIV/STD Pre-
vention Trial Group. A qualitative study about self-medication in the
community among market vendors in Fuzhou, China. Health Soc Care
Community. 2011;19(5):504-13.

*Weirong Yan
E-mail: weirongy@gmail.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e145, 2013