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The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial.
PLoS Med. 2011 May; 8(5):e1000437.PM

Abstract

BACKGROUND

It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months.

METHODS AND FINDINGS

We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL.

CONCLUSIONS

Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07.

Authors+Show Affiliations

Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kenya. bkangwana@nairobi.kemri-wellcome.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21655317

Citation

Kangwana, Beth P., et al. "The Impact of Retail-sector Delivery of Artemether-lumefantrine On Malaria Treatment of Children Under Five in Kenya: a Cluster Randomized Controlled Trial." PLoS Medicine, vol. 8, no. 5, 2011, pp. e1000437.
Kangwana BP, Kedenge SV, Noor AM, et al. The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. PLoS Med. 2011;8(5):e1000437.
Kangwana, B. P., Kedenge, S. V., Noor, A. M., Alegana, V. A., Nyandigisi, A. J., Pandit, J., Fegan, G. W., Todd, J. E., Brooker, S., Snow, R. W., & Goodman, C. A. (2011). The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. PLoS Medicine, 8(5), e1000437. https://doi.org/10.1371/journal.pmed.1000437
Kangwana BP, et al. The Impact of Retail-sector Delivery of Artemether-lumefantrine On Malaria Treatment of Children Under Five in Kenya: a Cluster Randomized Controlled Trial. PLoS Med. 2011;8(5):e1000437. PubMed PMID: 21655317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. AU - Kangwana,Beth P, AU - Kedenge,Sarah V, AU - Noor,Abdisalan M, AU - Alegana,Victor A, AU - Nyandigisi,Andrew J, AU - Pandit,Jayesh, AU - Fegan,Greg W, AU - Todd,James E, AU - Brooker,Simon, AU - Snow,Robert W, AU - Goodman,Catherine A, Y1 - 2011/05/31/ PY - 2010/08/12/received PY - 2011/04/18/accepted PY - 2011/6/10/entrez PY - 2011/6/10/pubmed PY - 2011/9/29/medline SP - e1000437 EP - e1000437 JF - PLoS medicine JO - PLoS Med VL - 8 IS - 5 N2 - BACKGROUND: It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months. METHODS AND FINDINGS: We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL. CONCLUSIONS: Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale. TRIAL REGISTRATION: Current Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/21655317/The_impact_of_retail_sector_delivery_of_artemether_lumefantrine_on_malaria_treatment_of_children_under_five_in_Kenya:_a_cluster_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -