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

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Date
2011-10-26
Authors
Smith, Nathan
Obala, Andrew
Simiyu, Chrispinus
Menya, Diana
Khwa-Otsyula, Barasa
O'Meara, Wendy Prudhomme
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Abstract
BACKGROUND: Poor 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. METHODS: In 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). RESULTS: The 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. CONCLUSIONS: AMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price difference between effective and ineffective therapies is still large.
Type
Journal article
Subject
Antimalarials
Artemisinins
Drug Combinations
Ethanolamines
Financing, Government
Fluorenes
Health Policy
Health Services Accessibility
Humans
Kenya
Malaria
Pilot Projects
Rural Population
Permalink
https://hdl.handle.net/10161/5946
Published Version (Please cite this version)
10.1186/1475-2875-10-316
Publication Info
Smith, Nathan; Obala, Andrew; Simiyu, Chrispinus; Menya, Diana; Khwa-Otsyula, Barasa; & O'Meara, Wendy Prudhomme (2011). Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme. Malar J, 10. pp. 316. 10.1186/1475-2875-10-316. Retrieved from https://hdl.handle.net/10161/5946.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

O'Meara

Wendy P O'Meara

Associate Professor of Medicine
Dr. Wendy O’Meara is an Associate Professor at Duke University School of Medicine in the Division of Infectious Diseases, visiting professor at Moi University, and the Associate Director for Research of the Duke Global Health Institute. She has been based full-time in Kenya since 2007. Dr. O’Meara’s team is interested in improving rational drug use for suspected malaria fevers through expanding the use of diagnostic tools in the community and in health facilities. As
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