Research Article: The Impact of Retail-Sector Delivery of Artemether–Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial

Date Published: May 31, 2011

Publisher: Public Library of Science

Author(s): Beth P. Kangwana, Sarah V. Kedenge, Abdisalan M. Noor, Victor A. Alegana, Andrew J. Nyandigisi, Jayesh Pandit, Greg W. Fegan, James E. Todd, Simon Brooker, Robert W. Snow, Catherine A. Goodman, Stephen John Rogerson

Abstract: In a cluster randomized trial, Beth Kangwana and colleagues find that provision of subsidized packs of the malaria therapy artemether-lumefantrine to shops more than doubled the proportion of children with fever who received drugs promptly.

Partial Text: Artemisinin-based combination treatments (ACTs) are generally accepted as the best treatment for uncomplicated Plasmodium falciparum malaria, as they have been shown to be highly effective and generally well tolerated [1]. Consequently all P. falciparum–endemic countries in Africa have adopted ACTs as national policy, but usage remains very low, with only 16% of febrile children under the age of 5 years receiving ACTs in 2008 [2]. A large gap therefore exists between the target, set by the Roll Back Malaria Partnership, that 80% of malaria cases be treated with effective treatment within 24 hours, and the situation on the ground [2].

There has been considerable debate about how access to and quality of malaria treatment can be improved [3],[10],[11],[13],[14]. This study shows that a suite of ACT subsidies, retailer training, and community awareness activities can lead to substantial improvement in the uptake of prompt effective treatment for febrile children in rural Kenya. Although coverage still fell well below the 80% target set by the RBM, the percentage of children receiving AL during a fever episode in the intervention arm was more than double that in the control arm at follow-up, with more than half of those who received AL in the intervention arm receiving Tibamal, usually on the same day or the following day after fever onset. This was accompanied by lower use of antimalarial monotherapies at follow-up in the intervention group compared with the control group, although this difference was only of borderline significance. This is likely to have reflected “crowding out” of these antimalarials by the more effective subsidised AL. However, it may also have reflected government directives to phase out monotherapies such as amodiaquine at this time (personal communication with PPB and local amodiaquine manufacturer). In most cases, subsidised AL was purchased at the recommended retail price.



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