Abstract
BackgroundMany patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidized pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one day training for retail staff on malaria diagnosis and treatment, job aids and community engagement activities.MethodsThe intervention was assessed using a cluster-randomized, controlled design. Provider and mystery-shopper cross-sectional surveys were conducted at baseline and eight months post-intervention to assess provider practices. Data were analysed based on cluster-level summaries, comparing control and intervention arms.ResultsOn average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2% points (confidence interval (CI): 14.8%, 33.6%; adjusted p=0.0001); the percentage of outlets stocking AL by 31.7% points (CI: 22.0%, 41.3%; adjusted p=0.0001); and the percentage of providers prescribing AL for presumptive malaria by 23.6% points (CI: 18.7%, 28.6%; adjusted p=0.0001). Generally outlets that received training and job aids performed better than those receiving one or none of these intervention components.ConclusionOverall, subsidizing ACT and retailer training can significantly increase the percentage of outlets stocking and selling AL for the presumptive treatment of malaria, but further research is needed on strategies to improve the provision of counselling advice to retail customers.
Highlights
Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices
Barriers in the private and public sectors to accessing Artemisinin-based combination therapy (ACT) treatment have contributed to the finding that less than 22% of children with fever were treated with an ACT across six African countries [8]
The intervention The intervention was implemented by the Division of Malaria Control (DOMC) of the Kenyan Ministry of Public Health and Sanitation, Population Services International (PSI), and the Pharmacy and Poisons Board (PPB)
Summary
Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. Barriers in the private and public sectors to accessing ACT treatment have contributed to the finding that less than 22% of children with fever were treated with an ACT across six African countries [8]. It is, important to investigate ways to improve the quality of malaria casemanagement in the private sector. Attention has focused on a range of strategies, including shopkeeper training, pre-packaging of drugs, community education, and most recently, ACT subsidies [9,10,11]
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