| dc.description.abstract | Artemisinin-based Combination Therapy (ACT) was adopted as the most effective treatment
option against malaria in Kenya. Artemether-Lumefantrine (AL) is the first-line ACT drug
for treatment of uncomplicated malaria, while quinine is preferred for complicated and severe
malaria. Information on access and knowledge and practices of providers prior to or during
implementation of ACT and quinine is scanty. Moreover, the evaluation of how these factors
influence the use of these drugs in households is rare. The results could be used as a guideline
to step-up the activities to enhance malaria treatment and as a key bench-mark to evaluate the
success of the implementation of the malaria treatment policy in Kenya and further evaluate
the role of policy implementation in malaria burden in the study region. The study adopted
World Health Organization (WHO) and Health Action International (HAl) standardized
methodologies to evaluate access and provider knowledge and practices and use of these
drugs. A cross-sectional survey using three-stage sampling was conducted in two
Plasmodium falciparum endemic regions. Based on WHO and HAl methodologies, two main
health facilities were selected. This was followed by additional selected of five district
hospitals under each main facility and eight other facilities (health centres and dispensaries)
under each district hospitals to give a total of 96 outlets (including 4% non-response). A
matching number of private outlets were randomly selected. In addition, all (66) not-forprofit
outlets and additional 30 public facilities within the study area were sampled to get the
required sample size of 288. For every outlet targeted, one household was surveyed to give a
total of 288 households. Results revealed that most private outlets, 27 (40.5%) did not stock
the first-line anti-malarial. Quinine was the most available in private 45 (68.8%). AL was
1.88 times more expensive in private outlets relative to the government recommended price.
Private sector had 50 (52.1%) who failed to state the correct anti-malarial for complicated
and severe malaria. Only 15 (15.6%) of providers in private outlets had been trained on the
use of ACT for malaria treatment. Those trained were 2-3 times more likely to provide the
correct treatment regimen for uncomplicated (OR, 2.01; CI, 1.66-3.83; P=0.039) and severe
malaria in children (OR, 2.66; CI; 1.88-5.44; P<O.OOOI) and in adults (OR, 2.01; CI, 1.88-
4.25 P=0.002). Those who had gone through in-service training among the private providers
were almost 4 times unlikely to sell partial packs of ACT (OR, 3.79; CI, 2.77-11.2;
P<O.OOOl), were 3 times likely to request for written prescription (OR, 3.00; CI, 2.45-10.4;
P=O.OOl) Anti-malarial price (OR, 2.88; CI, 1.99-4.31; P<O.OOOl), affordability (OR, 3.01;
CI, 2.45-5.01; P=0.005) and knowledge of dosing regimen (OR, 2.67; CI, 2.02-4.33;
P<O.OOOl), sale of partial packs (OR, 2.78; CI, 2.22-4.45; P<O.OOOI) and advice given by
providers (OR, 1.24; CI, 1.10-2.67; P=0.004) were several folds likely to influence antimalaria
use in households. There is low accessibility to policy recommended anti-malarials
(ACTs and quinine) in outlets. The government should ensure continuous availability of
recommended drugs to the consumers in right package sizes, and at affordable prices in all
outlet types and train stakeholders on new policies. It is essential to educate the consumers on
the need to adhere to the correct treatment regimen and ensure that changes in treatment
guidelines are accompanied by subsequent implementation activities involving all health sector players | en_US |
