Abstract
BackgroundHealth facility stock-outs of artemether-lumefantrine (AL), the common first-line therapy for uncomplicated malaria across Africa, adversely affect effective malaria case-management. They have been previously reported on various scales in time and space, however the magnitude of the problem and trends over time are less clear. Here, 2010-2011 data are reported from public facilities in Kenya where alarming stock-outs were revealed in 2008.MethodsData were collected between January 2010 and June 2011 as part of 18 monthly cross-sectional surveys undertaken at nationally representative samples of public health facilities. The primary monitoring indicator was total stock-out of all four weight-specific AL packs. The secondary indicators were stock-outs of at least one AL pack and individual stock-outs for each AL pack. Monthly proportions and summary means of the proportions over the monitoring period were measured for each indicator. Stock-out trends were assessed using linear regression.ResultsThe number of surveyed facilities across 18 time points ranged between 162 and 176 facilities. The stock-out means of the proportion of health facilities were 11.6% for total AL stock-out, 40.6% for stock-out of at least one AL pack, and between 20.5% and 27.4% for stock-outs of individual AL packs. Monthly decrease of the total AL stock-out was 0.005% (95% CI: -0.5 to +0.5; p = 0.983). Monthly decrease in the stock-out of at least one AL pack was 0.7% (95% CI: -1.5 to +0.3; p = 0.058) while stock-outs of individual AL packs decreased monthly between 0.2% for AL 24-pack and 0.7% for AL six-pack without statistical significance for any of the weight-specific packs.ConclusionsDespite lower levels of AL stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular worry for the most detrimental:- simultaneous absence of any AL pack. Only minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified.
Highlights
Health facility stock-outs of artemether-lumefantrine (AL), the common first-line therapy for uncomplicated malaria across Africa, adversely affect effective malaria case-management
In most African countries, information on the artemisininbased combination therapy (ACT) availability at peripheral facilities is either absent or collected periodically during the cross-sectional surveys undertaken on various scales in time and space [2,3,4,5]
In 2008, a cross-sectional survey undertaken at public facilities in seven Kenyan districts revealed that a total AL stock-out of all four weight-specific packs was present at 26% of facilities while 75% of facilities were stocked out of at least one AL pack [8]
Summary
Health facility stock-outs of artemether-lumefantrine (AL), the common first-line therapy for uncomplicated malaria across Africa, adversely affect effective malaria case-management They have been previously reported on various scales in time and space, the magnitude of the problem and trends over time are less clear. In most African countries, information on the ACT availability at peripheral facilities is either absent or collected periodically during the cross-sectional surveys undertaken on various scales in time and space [2,3,4,5] This limited information suggests that ACT stock-outs are common, its. From 2010 onwards, monthly monitoring of AL availability on the nationally representative sample of facilities was initiated In this brief report, the national findings in the period between January 2010 and June 2011 are presented and the new interventions aiming to eliminate AL stock-outs in Kenya by 2013 are highlighted
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