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A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013.
Malar J. 2016 07 12; 15(1):359.MJ

Abstract

BACKGROUND

Although anti-malarial medicines are free in Kenyan public health facilities, patients often seek treatment from private sector retail drug outlets. In mid-2010, the Affordable Medicines Facility-malaria (AMFm) was introduced to make quality-assured artemisinin-based combination therapy (ACT) accessible and affordable in private and public sectors.

METHODS

Private sector retail drug outlets stocking anti-malarial medications within a surveillance area of approximately 220,000 people in a malaria perennial high-transmission area in rural western Kenya were identified via a census in September 2013. A cross-sectional study was conducted in September-October 2013 to determine availability and price of anti-malarial medicines and malaria rapid diagnostic tests (RDTs) in drug outlets. A standardized questionnaire was administered to collect drug outlet and personnel characteristics and availability and price of anti-malarials and RDTs.

RESULTS

Of 181 drug outlets identified, 179 (99 %) participated in the survey. Thirteen percent were registered pharmacies, 25 % informal drug shops, 46 % general shops, 13 % homesteads and 2 % other. One hundred sixty-five (92 %) had at least one ACT type: 162 (91 %) had recommended first-line artemether-lumefantrine (AL), 22 (12 %) had recommended second-line dihydroartemisinin-piperaquine (DHA-PPQ), 85 (48 %) had sulfadoxine-pyrimethamine (SP), 60 (34 %) had any quinine (QN) formulation, and 14 (8 %) had amodiaquine (AQ) monotherapy. The mean price (range) of an adult treatment course for AL was $1.01 ($0.35-4.71); DHA-PPQ was $4.39 ($0.71-7.06); QN tablets were $2.24 ($0.12-4.71); SP was $0.62 ($0.24-2.35); AQ monotherapy was $0.42 ($0.24-1.06). The mean AL price with or without the AMFm logo did not differ significantly ($1.01 and 1.07, respectively; p = 0.45). Only 17 (10 %) drug outlets had RDTs; 149 (84 %) never stocked RDTs. The mean RDT price was $0.92 ($0.24-2.35).

CONCLUSIONS

Most outlets never stocked RDTs; therefore, testing prior to treatment was unlikely for customers seeking treatment in the private retail sector. The recommended first-line treatment, AL, was widely available. Although SP and AQ monotherapy are not recommended for treatment, both were less expensive than AL, which might have caused preferential use by customers. Interventions that create community demand for malaria diagnostic testing prior to treatment and that increase RDT availability should be encouraged.

Authors+Show Affiliations

Malaria Control Unit, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya. Field Epidemiology and Laboratory Training Programme, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya.Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK.KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA.KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.Malaria Control Unit, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya.Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA.Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA. ali3@cdc.gov. U.S. President's Malaria Initiative, United Nations Avenue, Village Market, PO Box 606, Nairobi, 00621, Kenya. ali3@cdc.gov.

Pub Type(s)

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

Language

eng

PubMed ID

27406179

Citation

Kioko, Urbanus, et al. "A Cross-sectional Study of the Availability and Price of Anti-malarial Medicines and Malaria Rapid Diagnostic Tests in Private Sector Retail Drug Outlets in Rural Western Kenya, 2013." Malaria Journal, vol. 15, no. 1, 2016, p. 359.
Kioko U, Riley C, Dellicour S, et al. A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013. Malar J. 2016;15(1):359.
Kioko, U., Riley, C., Dellicour, S., Were, V., Ouma, P., Gutman, J., Kariuki, S., Omar, A., Desai, M., & Buff, A. M. (2016). A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013. Malaria Journal, 15(1), 359. https://doi.org/10.1186/s12936-016-1404-5
Kioko U, et al. A Cross-sectional Study of the Availability and Price of Anti-malarial Medicines and Malaria Rapid Diagnostic Tests in Private Sector Retail Drug Outlets in Rural Western Kenya, 2013. Malar J. 2016 07 12;15(1):359. PubMed PMID: 27406179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013. AU - Kioko,Urbanus, AU - Riley,Christina, AU - Dellicour,Stephanie, AU - Were,Vincent, AU - Ouma,Peter, AU - Gutman,Julie, AU - Kariuki,Simon, AU - Omar,Ahmeddin, AU - Desai,Meghna, AU - Buff,Ann M, Y1 - 2016/07/12/ PY - 2016/02/02/received PY - 2016/06/17/accepted PY - 2016/7/14/entrez PY - 2016/7/14/pubmed PY - 2017/5/26/medline KW - Anti-malarials KW - Diagnostic tests KW - Kenya KW - Malaria KW - Private sector SP - 359 EP - 359 JF - Malaria journal JO - Malar J VL - 15 IS - 1 N2 - BACKGROUND: Although anti-malarial medicines are free in Kenyan public health facilities, patients often seek treatment from private sector retail drug outlets. In mid-2010, the Affordable Medicines Facility-malaria (AMFm) was introduced to make quality-assured artemisinin-based combination therapy (ACT) accessible and affordable in private and public sectors. METHODS: Private sector retail drug outlets stocking anti-malarial medications within a surveillance area of approximately 220,000 people in a malaria perennial high-transmission area in rural western Kenya were identified via a census in September 2013. A cross-sectional study was conducted in September-October 2013 to determine availability and price of anti-malarial medicines and malaria rapid diagnostic tests (RDTs) in drug outlets. A standardized questionnaire was administered to collect drug outlet and personnel characteristics and availability and price of anti-malarials and RDTs. RESULTS: Of 181 drug outlets identified, 179 (99 %) participated in the survey. Thirteen percent were registered pharmacies, 25 % informal drug shops, 46 % general shops, 13 % homesteads and 2 % other. One hundred sixty-five (92 %) had at least one ACT type: 162 (91 %) had recommended first-line artemether-lumefantrine (AL), 22 (12 %) had recommended second-line dihydroartemisinin-piperaquine (DHA-PPQ), 85 (48 %) had sulfadoxine-pyrimethamine (SP), 60 (34 %) had any quinine (QN) formulation, and 14 (8 %) had amodiaquine (AQ) monotherapy. The mean price (range) of an adult treatment course for AL was $1.01 ($0.35-4.71); DHA-PPQ was $4.39 ($0.71-7.06); QN tablets were $2.24 ($0.12-4.71); SP was $0.62 ($0.24-2.35); AQ monotherapy was $0.42 ($0.24-1.06). The mean AL price with or without the AMFm logo did not differ significantly ($1.01 and 1.07, respectively; p = 0.45). Only 17 (10 %) drug outlets had RDTs; 149 (84 %) never stocked RDTs. The mean RDT price was $0.92 ($0.24-2.35). CONCLUSIONS: Most outlets never stocked RDTs; therefore, testing prior to treatment was unlikely for customers seeking treatment in the private retail sector. The recommended first-line treatment, AL, was widely available. Although SP and AQ monotherapy are not recommended for treatment, both were less expensive than AL, which might have caused preferential use by customers. Interventions that create community demand for malaria diagnostic testing prior to treatment and that increase RDT availability should be encouraged. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/27406179/A_cross_sectional_study_of_the_availability_and_price_of_anti_malarial_medicines_and_malaria_rapid_diagnostic_tests_in_private_sector_retail_drug_outlets_in_rural_Western_Kenya_2013_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1404-5 DB - PRIME DP - Unbound Medicine ER -