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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

The impact of retail sector delivery of artemether-lumefantrine on effective malaria treatment of children under five in Kenya .

LSHTM investigators:
Catherine Goodman, Simon Brooker & Greg Fegan.
External collaborators:
Beth Kangwana, Sarah Kedenge, Abdisalan Noor & Bob Snow (KEMRI-Wellcome Trust Research Programme, Kenya); Andrew Nyandigisi (Division of Malaria Control, Kenya); Jayesh Pandit (Pharmacy and Poisons Board, Kenya).
Funding body:
Wellcome Trust & UK Department for International Development.

In 2006, Kenya introduced artemisinin-based combination therapy (ACT) through the public sector free of charge, but access remains low. The aim of this study was to evaluate to what extent the provision of pre-packed, subsidised ACT, delivered through private sector retailers, will increase the proportion of children under five, with fever, receiving appropriate anti-malarial treatment.

The intervention was implemented by the Division of Malaria Control (DOMC) in collaboration with Population Services International (PSI). The study sites were in three districts in Western Kenya: Teso, Butere-Mumias and Busia. Intervention effectiveness was evaluated through a pre-post cluster randomised controlled trial. Baseline data were collected before the intervention and follow up data 9 months after the start of the intervention from both households and retail outlets. The data were collected using six data collection activities: 1) Retail census 2) Household survey 3) Provider survey 4) Mystery shopper 5) Focus group discussions and 6) Documentation of context.

The intervention led to a substantial increase in ACT access, and in ACT coverage for childhood fevers. The vast majority of sales at the target price and correct dose. However, advice given to caretakers by shopkeepers was often inadequate and ACT adherence remained sub-optimal.