Abstract
BackgroundMalaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults. Effectively managing malaria is dependent upon appropriate treatment. In Kenya, between 17 to 83 percent of febrile individuals first seek treatment for febrile illness over the counter from medicine retailers. Understanding medicine retailer knowledge and behaviour in treating suspected malaria and dispensing anti-malarials is crucial.MethodsTo investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya.ResultsMost of the medicine retailers surveyed (65%) were able to identify artemether-lumefantrine (AL) as the Kenyan Ministry of Health recommended first-line anti-malarial therapy for uncomplicated malaria. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. However, the proportion of medicine retailers who recommend the correct treatment is disappointingly low. Only 48% would recommend AL to adults, and 37% would recommend it to children. It was discovered that customer demand has an influence on retailer behaviour. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn is correlated with dispensing practices. Medicine retailer behaviour, including patient referral practice and dispensing practices, are also correlated with knowledge of the first-line anti-malarial medication. The Kenya Ministry of Health guidelines were found to influence retailer drug stocking and dispensing behaviours.ConclusionMost medicine retailers could identify the recommended first-line treatment for uncomplicated malaria, but the percentage that could not is still too high. Furthermore, knowing the MOH recommended anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training and education are both areas that could be improved. Considering the influence that patient demand has on retailer behaviour, future interventions focusing on community education may positively influence appropriate dispensing of anti-malarials.
Highlights
Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults
Two individuals were excluded from analysis on the basis that they did not dispense medications and could not comment on antimalarial dispensing practices
The relationship retailers have with their customers positions them well to increase the rate of appropriate treatment for malaria and improve malaria case management
Summary
Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults. In response to the high levels of parasite resistance to sulphadoxine-pyrimethamine (SP), the Kenyan Ministry of Health changed its first-line anti-malarial policy for treating uncomplicated malaria to artemether-lumefantrine, an artemisinin-based combination therapy (ACT), in 2006. With this new treatment recommendation in place, it became vital that development of drug resistance to this new therapy was delayed as long as possible, and that anti-malarial drug providers adhered to the new recommendation, discontinued the use and prescription of ineffective treatments, and that access to ACT was broadened to reach as many infected individuals as possible. To increase access to ACT, efforts are being invested in interventions targeting retail drug locations
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