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BackgroundPoor access to prompt and effective treatment for malaria contributes to high mortality and severe morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine retailer as an important distribution point for malaria medicines has been recognized and several different strategies have been used to improve the services that these retailers provide. Despite these efforts, many mothers still purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT). One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010.MethodsIn December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered).ResultsThe average distance from a home to the nearest public health facility is 2 km, but the average distance to the nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers). More medicine retailers stocked sulphadoxine-pyramethamine (SP; 57%) than ACT (44%). Eleven percent of retailers stocked AMFm subsidized artemether-lumefantrine (AL). No retailers had chloroquine in stock and only five were selling artemisinin monotherapy. The mean price of any brand of AL, the recommended first-line drug in Kenya, was $2.7 USD. Brands purchased under the AMFm programme cost 40% less than non-AMFm brands. Artemisinin monotherapies cost on average more than twice as much as AMFm-brand AL. SP cost only $0.5, a fraction of the price of ACT.ConclusionsAMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price difference between effective and ineffective therapies is still large.

Objective To describe the distribution of cardiovascular risk factors in western Kenya using a Health and Demographic Surveillance System (HDSS). Design Population-based survey of residents in an HDSS Setting Webuye Division in Bungoma East District, Western Province of Kenya Patients 4037 adults ≥18 years of age Interventions Home-based survey using the World Health Organization STEPwise approach to chronic disease risk factor surveillance Main outcome measures Self-report of high blood pressure, high blood sugar, tobacco use, alcohol use, physical activity and fruit/vegetable intake Results The median age of the population was 35 years (IQR: 26–50). Less than 6% of the population reported high blood pressure or blood sugar. Tobacco and alcohol use were reported in 7% and 16% of the population, respectively. The majority of the population (93%) was physically active. The average number of days per week that participants reported intake of fruits (3.1 +/− 0.1) or vegetables (1.6 +/− 0.1) was low. In multiple logistic regression analyses, women were more likely to report a history of high blood pressure (OR 2.72, 95% CI 1.9–3.9), less likely to report using tobacco (OR 0.08, 95% CI 0.06–0.11), less likely to report alcohol use (OR 0.18, 95% CI 0.15–0.21) or eat ≥5 servings per day of fruits or vegetables (OR 0.87, 95% CI 0.76–0.99) compared to men. Conclusions The most common cardiovascular risk factors in peri-urban western Kenya are tobacco use, alcohol use and inadequate intake of fruits and vegetables. Our data reveal locally-relevant sub-group differences that could inform future prevention efforts.

BackgroundMaternal health service coverage in Kenya remains low, especially in rural areas where 63% of women deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the present study were to (1) determine the association between the place of delivery and the distance of a household from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a demographic surveillance system (DSS).MethodsCensus sampling was conducted for 13,333 households in the Webuye health and demographic surveillance system area in 2008–2009. Information was collected on deliveries that had occurred during the previous 12 months. Digital coordinates of households and sentinel locations such as health facilities were collected. Data were analyzed using STATA version 11. The Euclidean distance from households to health facilities was calculated using WinGRASS version 6.4. Hotspot analysis was conducted in ArcGIS to detect clustering of delivery facilities. Unadjusted and adjusted odds ratios were estimated using logistic regression models. P-values less than 0.05 were considered significant.ResultsOf the 13,333 households in the study area, 3255 (24%) reported a birth, with 77% of deliveries being at home. The percentage of home deliveries increased from 30% to 80% of women living within 2km from a health facility. Beyond 2km, distance had no effect on place of delivery (OR 1.29, CI 1.06–1.57, p = 0.011). Heads of households where women delivered at home were less likely to be employed (OR 0.598, CI 0.43–0.82, p = 0.002), and were less likely to have secondary education (OR 0.50, CI 0.41–0.61, p < 0.0001). Hotspot analysis showed households having facility deliveries were clustered around facilities offering comprehensive emergency obstetric care services.ConclusionHouseholds where the nearest facility was offering emergency obstetric care were more likely to have a facility delivery, but only if the facility was within 2km of the home. Beyond the 2-km threshold, households were equally as likely to have home and facility deliveries. There is need for further research on other factors that affect the choice of place of delivery, and their relationships with maternal mortality.