Access to artemisinin-based combination therapy (ACT) and quinine in malaria holoendemic regions of western Kenya

Abstract

BackgroundArtemisinin-based combination therapy (ACT) has been adopted as the most effective treatment against malaria in many endemic countries like Kenya while quinine has remained the second line. The objective of the current study was to assess access to Kenya’s policy recommended anti-malarials, ACT and quinine in the public, private and not-for-profit drug outlets in western Kenya.MethodsA cross-sectional survey using purposive sampling of 288 outlets (126 public, 96 private, 66 not-for-profit) was conducted in western Kenya in two regions with varying Plasmodium falciparum endemicities. Information on access (availability, price, affordability) on ACT and quinine was collected using the WHO and Healthcare Associated Infection (HAI) standardized methodologies for availability, prices and affordability of drugs. From a Ministry of Health database, the following were included in the analyses: one (1) main public hospital, followed by random selection of five hospitals under this main facility. Eight other public outlets under each of the hospitals were selected, to a total of 96. Matching number of private outlets (n = 96), all (66) not-for-profit outlets and additional 30 public health facilities were sampled to get the required sample size of 288.ResultsMore public 111 (88.1%) and not-for-profit 27 (40.9%) outlets stocked subsidized ACT (artemether-lumefantrine, AL). Other artemisinin-based combinations were widely available for both children 93 (96.9%) and adults 82 (85.0%) in private outlets. Frequent stock-outs were in public in 106 (84%), reporting three times or more stock-outs in three months. Subsidized ACT (AL) was sold at median price of USD 0.94 and 0.75 in private and not-for-profit outlets respectively. The costs was higher than recommended price of USD 0.5 and requiring up to 0.20-0.25 days of disposable income for households in lowest economic status.ConclusionThere is low availability of subsidized ACT (AL) and higher frequency of stock-outs in government facilities, while private sector sells AL at higher prices, thus making it less affordable to many households. These factors determine the adherence to the dosing schedules during the treatment course and thus the evaluation of the subsidy policy, its implementation and role in malaria burden in this region is compulsory.

Application of geographically-weighted regression analysis to assess risk factors for malaria hotspots in Keur Soce health and demographic surveillance site

“…A multitude of other factors may have an impact in these mostly rural settings, creating a context in which the impact of geographical factors and social behaviours on malaria prevalence and incidence may be particularly relevant. The results from the study support the fact that Distance to the nearest breeding site [ 7 , 12 , 14 , 19 – 22 ], walling material [ 13 ], and household size [ 7 ] were independent predictors of living in a hotspot of malaria transmission. Proximity to breeding sites has been shown to increase the likelihood of exposure opportunities to mosquitoes and the results confirm that households closer to rivers are at increased risk of Plasmodium infection [ 23 – 27 ].…”

Perceptions of malaria and acceptance of rapid diagnostic tests and related treatment practises among community members and health care providers in Greater Garissa, North Eastern Province, Kenya

“…The availability of sufficient supplies of ACT is highly pertinent to this point as the use of RDTs is only logical should ACT then be available for prescription to positive cases. In many public and private HFs in Kenya the availability of affordable ACT cannot be relied upon and has been shown to have been a significant factor in influencing patterns of anti-malarial use [ 42 – 45 ]. Securing and backing up the supply chains of both RDTs and ACT should be a priority in any national programme in order to sustain the trust and proper use of RDTs and ACT amongst CHWs and patients alike.…”

Effective Coverage and Systems Effectiveness for Malaria Case Management in Sub-Saharan African Countries

“…Focusing on public sector and ACT therapy these analyses represent only a fraction of malaria case management services delivered in SSA countries. Frequent stock-outs of ACTs[ 24 ], presence of non-ACT antimalarials[ 16 , 25 ], heavy reliance on informal care providers[ 4 ] as well as concerns about the quality of antimalarial drugs[ 26 , 27 ] in the region call for a more comprehensive measure of effective coverage for the sector.…”