Transcript Slide 1

The Impact of Retail Sector Delivery
of Artemether-Lumefantrine on
Effective Malaria Treatment of
Children Under Five in Kenya
Sarah V. Kedenge
Beth Kangwana; Abdisalan M. Noor; Victor A. Alegana ; Andrew J
Nyandigisi ; Jayesh Pandit ; Greg W Fegan ; Simon Brooker; Robert W
Snow; Catherine A. Goodman
KEMRI-Wellcome Trust Research Programme
General Study Design
• Design: pre-post randomized cluster controlled
trial to compare intervention and control areas
Teso
Busia
Butere
Mumias
Survey Activities
Household and retail censuses, household, provider and
mystery shopper surveys and FGDs
Description of Under 5 Population Surveyed
•3,288 households surveyed at baseline and 3,182 at follow up
•Total Under 5 population surveyed was 2,749 and 2,662 at baseline and follow
up respectively
•Fever prevalence in children 3-59 months (in past 2 weeks) averaged at 28%
at baseline and 30% at follow up
Fever treatment actions taken by caregivers
•86% of fevers experienced within 2 weeks of the interview had some action
taken by caregiver
•Majority of actions were visits made to government facilities (31%) and
specialized drug stores (33%)
• Also frequently used were general stores (18%)
Anti-malarials Received
RECEIVED AN ANTI MALARIAL
Control
Mean (SD )
Intervention
Mean (SD )
Baseline
39% (7.8)
46% (9.4)
Follow up
50%(11.8)
64%(10.5)
P value
Unadjusted
Adjusted
0.0192
0.0074
RECEIVED AN ANTI- MALARIAL MONOTHERAPY
Control
Mean (SD )
Intervention
Mean (SD )
Baseline
30% (11.1)
39% (7.7)
Follow up
23% (7.8)
12% (4.8)
P value
Unadjusted
Adjusted
0.0036
0.0518
Children 3-59 months who received AL on the same
day or following day of fever developing
80%
70%
60%
P-value= 0.0001
50%
45%
40%
BASELINE
FOLLOW UP
30%
20%
20%
10%
5%
5%
0%
CONTROL
INTERVENTION
Adherence
ADHERED TO THE RIGHT DOSE
Control
Mean (SD )
Intervention
Mean (SD )
Baseline
40% (23.3)
53% (40.2)
Follow up
49% (24.8)
67% (8.5)
P value
Unadjusted
Adjusted
0.0606
0.1095
ADHERED TO THE RIGHT PRICE
•95% of those purchasing Tibamal reported paying the
recommended retail price of 20KSH ($0.25)
Study Limitations
• Distribution of AL
• Study limited to children 3-59 months
• Studies limited to one province which is malaria
endemic and at the Kenyan-Ugandan border
• Difficult to determine future changes in treatment
seeking behavior
Policy Implications & Lessons learnt
• Subsidizing ACTs in the retail sector can lead to a
substantial increase in coverage in prompt and effective
treatment
• Although the design of the intervention differs with that
of AMF-m, the findings can be cautiously interpreted to
demonstrate how crowding out anti-malarial
monotherapies and increasing access to AL by increasing
its distribution at decreased costs could work
• Further research required to:
- assess feasibility of introducing diagnosis at retail
outlets to improve targeting of ACT.
- come up with innovative and practical strategies to
improve drug adherence both in the public and private
sector.
Acknowledgements
• Division of Malaria Control: Dr Juma, Dr
Akhwale, Dr Memusi, Dr Nyandigisi and the
team
• Pharmacy and Poisons Board: Dr Pandit
• Population Services International : Manya
Andrews and Mbogo Bunyi and the rest of the
team
• DFID, USAID and the Wellcome Trust
• DHMTs and DOs in Teso, Butere Mumias and
Busia
• Field workers, shopkeepers and care givers