Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme

Malaria Journal

Research

Nathan Smith¹  Wendy Prudhomme O'Meara²  Andrew Obala³  Chrispinus Simiyu³  Diana Menya⁴  Barasa Khwa-Otsyula⁴ 

[1] Duke Global Health Institute, Trent Hall, Durham, North Carolina, USA;Duke Global Health Institute, Trent Hall, Durham, North Carolina, USA;Webuye Demographic Surveillance Site Scientific Steering Committee, Eldoret, Kenya;Moi University School of Public Health, Nandi Rd, Eldoret, Kenya;Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA;Moi University School of Medicine, Nandi Rd, Eldoret, Kenya;Webuye Demographic Surveillance Site Scientific Steering Committee, Eldoret, Kenya;Webuye Demographic Surveillance Site Scientific Steering Committee, Eldoret, Kenya;Moi University School of Public Health, Nandi Rd, Eldoret, Kenya;

关键词: Malaria;    Quinine;    Artesunate;    Public Facility;    Public Health Facility;   

DOI  :  10.1186/1475-2875-10-316

 received in 2011-07-21, accepted in 2011-10-26,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundPoor access to prompt and effective treatment for malaria contributes to high mortality and severe morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine retailer as an important distribution point for malaria medicines has been recognized and several different strategies have been used to improve the services that these retailers provide. Despite these efforts, many mothers still purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT). One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010.MethodsIn December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered).ResultsThe average distance from a home to the nearest public health facility is 2 km, but the average distance to the nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers). More medicine retailers stocked sulphadoxine-pyramethamine (SP; 57%) than ACT (44%). Eleven percent of retailers stocked AMFm subsidized artemether-lumefantrine (AL). No retailers had chloroquine in stock and only five were selling artemisinin monotherapy. The mean price of any brand of AL, the recommended first-line drug in Kenya, was $2.7 USD. Brands purchased under the AMFm programme cost 40% less than non-AMFm brands. Artemisinin monotherapies cost on average more than twice as much as AMFm-brand AL. SP cost only $0.5, a fraction of the price of ACT.ConclusionsAMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price difference between effective and ineffective therapies is still large.

【 授权许可】

Unknown   
© Smith et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.