Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets

Jane Chuma,Elizabeth Juma,Timothy Abuya,Janet Ntwiga,Abdinasir Amin,Rima Shretta,Willis Akhwale,Dorothy Memusi,Andrew Nyandigisi,Gladys Tetteh

doi:10.1186/1475-2875-8-243

Jane Chuma, Elizabeth Juma + Show 8 more

Open Access

https://doi.org/10.1186/1475-2875-8-243

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Abstract

BackgroundEffective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment.In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet. This review aimed to document evidence on access to effective malaria treatment in Kenya, identify factors that influence access, and make recommendations on how to improve prompt access to effective malaria treatment. Since treatment-seeking patterns for malaria are similar in many settings in sub-Saharan Africa, the findings presented in this review have important lessons for other malaria endemic countries.MethodsInternet searches were conducted in PUBMED (MEDLINE) and HINARI databases using specific search terms and strategies. Grey literature was obtained by soliciting reports from individual researchers working in the treatment-seeking field, from websites of major organizations involved in malaria control and from international reports.ResultsThe review indicated that malaria treatment-seeking occurs mostly in the informal sector; that most fevers are treated, but treatment is often ineffective. Irrational drug use was identified as a problem in most studies, but determinants of this behaviour were not documented. Availability of non-recommended medicines over-the-counter and the presence of substandard anti-malarials in the market are well documented. Demand side determinants of access include perception of illness causes, severity and timing of treatment, perceptions of treatment efficacy, simplicity of regimens and ability to pay. Supply side determinants include distance to health facilities, availability of medicines, prescribing and dispensing practices and quality of medicines. Policy level factors are around the complexity and unclear messages regarding drug policy changes.ConclusionKenya, like many other African countries, is still far from achieving the Abuja targets. The government, with support from donors, should invest adequately in mechanisms that promote access to effective treatment. Such approaches should focus on factors influencing multiple dimensions of access and will require the cooperation of all stakeholders working in malaria control.

Highlights

IntroductionEffective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment
Effective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment.In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet
In the Abuja declaration of 2000, African heads of state committed themselves to ensure that 60 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of symptom onset, a target that has since been increased to 80 percent by 2010 [1]

Summary

Introduction

Effective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment. In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet. Effective case management is central to reducing malaria mortality and morbidity worldwide. In the Abuja declaration of 2000, African heads of state committed themselves to ensure that 60 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of symptom onset, a target that has since been increased to 80 percent by 2010 [1]. Detailed guidelines for malaria case management were developed following the policy change from sulphadoxinepyrimethamine (SP) to artemether-lumefantrine (AL)

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