The online version of this article (doi:10.1186/1475-2875-11-263) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AR performed data analysis and drafted the first version of the manuscript. NS participated in study design, led development of the data collection tool, collected the data, and provided revisions to the manuscript. DM participated in developing the data collection tool, and provided revisions to the manuscript. AO participated in developing the data collection tool. CS participated in data collection. BO participated in developing the data collection tool. WPO conceived the study, participated in study design and developing the data collection tool, performed analysis, and provided revisions to the manuscript. All authors read and approved the final manuscript.
Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults. Effectively managing malaria is dependent upon appropriate treatment. In Kenya, between 17 to 83 percent of febrile individuals first seek treatment for febrile illness over the counter from medicine retailers. Understanding medicine retailer knowledge and behaviour in treating suspected malaria and dispensing anti-malarials is crucial.
To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya.
Most of the medicine retailers surveyed (65%) were able to identify artemether-lumefantrine (AL) as the Kenyan Ministry of Health recommended first-line anti-malarial therapy for uncomplicated malaria. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. However, the proportion of medicine retailers who recommend the correct treatment is disappointingly low. Only 48% would recommend AL to adults, and 37% would recommend it to children. It was discovered that customer demand has an influence on retailer behaviour. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn is correlated with dispensing practices. Medicine retailer behaviour, including patient referral practice and dispensing practices, are also correlated with knowledge of the first-line anti-malarial medication. The Kenya Ministry of Health guidelines were found to influence retailer drug stocking and dispensing behaviours.
Most medicine retailers could identify the recommended first-line treatment for uncomplicated malaria, but the percentage that could not is still too high. Furthermore, knowing the MOH recommended anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training and education are both areas that could be improved. Considering the influence that patient demand has on retailer behaviour, future interventions focusing on community education may positively influence appropriate dispensing of anti-malarials.
World Health Organization: Mortality Country Fact Sheet. Kenya. 2006, [ http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=1274M]
Foster S: Treatment of malaria outside the formal health services. J Trop Med Hyg. 1995, 98: 29-34. PubMed
Chuma J, Abuya T, Memusi D, Juma E, Akhwale W, Ntwiga J, Nyandigisi A, Tetteh G, Shretta R, Amin A: Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets. Malar J. 2009, 8: 243-10.1186/1475-2875-8-243. PubMedCentralCrossRefPubMed
Okeke TA, Uzochukwu SC: Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria. Malar J. 2010, 8: 260- CrossRef
Burton DC, Flannery B, Onyango B, Larson C, Alaii J, Zhang X, Hamel MJ, Breiman RF, Feikin DR: Healthcare-seeking behavior for common infectious disease-related illnesses in rural Kenya: A community-based house-to-house survey. J Health Popul Nutr. 2011, 1: 61-70.
Smith N, Obala A, Simiyu C, Menya D, Khwa-Otsyula B, O’Meara WP: Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme. Malar J. 2010, 10: 316- CrossRef
Abuya T, Fegan G, Rowa Y, Karisa B, Ochola S, Mutemi W, March V: Impact of ministry of health interventions on private medicine retailer knowledge and practices on anti-malarial treatment in Kenya. Am J Trop Med Hyg. 2009, 80: 905-913. PubMed
World Bank: Kenya at a glance. 2011, devdata.worldbank.org/AAG/ken_aag.pdf
Simiyu CJ, Naanyu V, Obala AA, Odhiambo DO, Ayuo P, Chelagat D, Downing R, Menya D, Mwaliko E, O’Meara WP, Were EO, Shitote S, De Maeseneer J, Khwa-Otsyula BO: Establishing Webuye Health and Demographic Surveillance Site in rural western Kenya: Challenges and lessons learned. In preparation. 2012
Shililu JI, Maier WA, Seitz HM, Orago AS: Seasonal density, sporozoite rates and entomological inoculation rates of Anopheles gambiae and Anopheles funestus in a high-altitude sugarcane growing zone in western Kenya. Trop Med Int Health. 1998, 3: 706-710. 10.1046/j.1365-3156.1998.00282.x. CrossRefPubMed
ACT Watch Outlet Survey, Round 2 Questionnaire: ACTwatch Group, Population Sciences International and London School of Tropical Medicine and Hygiene. 2009
Kangwana BP, Kedenge SV, Noor AM, Alegana VA, Nuandigisi AJ, Pandit J, Fegan GW, Rodd JE, Brooker S, Snow RW, Goodman CA: 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: e10000437- CrossRef
Rusk A, Goodman C, O’Meara WP: The perceptions of challenges and benefits to implementing rapid diagnostic tests for malaria among medicine retailers in western Kenya. In preparation. 2011
Nsimba SED, Warsame M, Tomson G, Massele AY, Mbatiya ZA: A household survey of source, availability, and use of antimalarials in a rural area of Tanzania. Drug Inf J. 1999, 33: 4-
- Does anti-malarial drug knowledge predict anti-malarial dispensing practice in drug outlets? A survey of medicine retailers in western Kenya
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II