the impact of retail sector delivery of artemether-lumefantrine on effective malaria treatment of...
TRANSCRIPT
![Page 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;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/1.jpg)
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
![Page 2: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/2.jpg)
![Page 3: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/3.jpg)
General Study Design • Design: pre-post randomized cluster controlled
trial to compare intervention and control areas
Teso
Butere Mumias
Busia
![Page 4: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/4.jpg)
Survey ActivitiesHousehold and retail censuses, household, provider and
mystery shopper surveys and FGDs
![Page 5: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/5.jpg)
Description of Under 5 Population Surveyed
• 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%)
Fever treatment actions taken by caregivers
• 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
![Page 6: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/6.jpg)
Anti-malarials Received
ControlMean (SD )
InterventionMean (SD )
P valueUnadjustedAdjusted
Baseline 39% (7.8) 46% (9.4)
Follow up 50%(11.8) 64%(10.5) 0.01920.0074
ControlMean (SD )
InterventionMean (SD )
P valueUnadjustedAdjusted
Baseline 30% (11.1) 39% (7.7)
Follow up 23% (7.8) 12% (4.8) 0.00360.0518
RECEIVED AN ANTI MALARIAL
RECEIVED AN ANTI- MALARIAL MONOTHERAPY
![Page 7: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/7.jpg)
Children 3-59 months who received AL on the same day or following day of fever developing
CONTROL INTERVENTION0%
10%
20%
30%
40%
50%
60%
70%
80%
5% 5%
20%
45%
BASELINE
FOLLOW UP
P-value= 0.0001
![Page 8: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/8.jpg)
Adherence
ControlMean (SD )
InterventionMean (SD )
P valueUnadjustedAdjusted
Baseline 40% (23.3) 53% (40.2)
Follow up 49% (24.8) 67% (8.5) 0.06060.1095
ADHERED TO THE RIGHT DOSE
ADHERED TO THE RIGHT PRICE
• 95% of those purchasing Tibamal reported paying the recommended retail price of 20KSH ($0.25)
![Page 9: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/9.jpg)
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
![Page 10: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/10.jpg)
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.
![Page 11: The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya Sarah V. Kedenge Beth Kangwana;](https://reader030.vdocuments.mx/reader030/viewer/2022020417/56649f305503460f94c4a2aa/html5/thumbnails/11.jpg)
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