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The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial.
Malar J. 2013 Mar 01; 12:81.MJ

Abstract

BACKGROUND

Many 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.

METHODS

The 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.

RESULTS

On 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.

CONCLUSION

Overall, 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.

Authors+Show Affiliations

Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. bethkangwana@gmail.comNo 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

Language

eng

PubMed ID

23452547

Citation

Kangwana, Beth P., et al. "The Effect of an Anti-malarial Subsidy Programme On the Quality of Service Provision of Artemisinin-based Combination Therapy in Kenya: a Cluster-randomized, Controlled Trial." Malaria Journal, vol. 12, 2013, p. 81.
Kangwana BP, Kedenge SV, Noor AM, et al. The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial. Malar J. 2013;12:81.
Kangwana, B. P., Kedenge, S. V., Noor, A. M., Alegana, V. A., Nyandigisi, A. J., Pandit, J., Fegan, G. W., Todd, J. E., Snow, R. W., & Goodman, C. A. (2013). The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial. Malaria Journal, 12, 81. https://doi.org/10.1186/1475-2875-12-81
Kangwana BP, et al. The Effect of an Anti-malarial Subsidy Programme On the Quality of Service Provision of Artemisinin-based Combination Therapy in Kenya: a Cluster-randomized, Controlled Trial. Malar J. 2013 Mar 1;12:81. PubMed PMID: 23452547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy 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,Jim E, AU - Snow,Robert W, AU - Goodman,Catherine A, Y1 - 2013/03/01/ PY - 2012/11/16/received PY - 2013/02/18/accepted PY - 2013/3/5/entrez PY - 2013/3/5/pubmed PY - 2013/9/10/medline SP - 81 EP - 81 JF - Malaria journal JO - Malar J VL - 12 N2 - BACKGROUND: Many 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. METHODS: The 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. RESULTS: On 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. CONCLUSION: Overall, 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/23452547/The_effect_of_an_anti_malarial_subsidy_programme_on_the_quality_of_service_provision_of_artemisinin_based_combination_therapy_in_Kenya:_a_cluster_randomized_controlled_trial_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-12-81 DB - PRIME DP - Unbound Medicine ER -