Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme.
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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.
Published Version (Please cite this version)
Smith, Nathan, Andrew Obala, Chrispinus Simiyu, Diana Menya, Barasa Khwa-Otsyula and Wendy Prudhomme O'Meara (2011). Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme. Malar J, 10. p. 316. 10.1186/1475-2875-10-316 Retrieved from https://hdl.handle.net/10161/5946.
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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 many as 90% of fevers that seek treatment in the formal sector receive antimalarials, and it is estimated that only 20% of those buying antimalarials over-the-counter in the retail sector actually have malaria. Such overuse poses a significant threat to the continued efficacy of first-line antimalarials. Dr. O’Meara has conducted several randomized controlled trials in western Kenya to test interventions designed to improve the use of information from malaria diagnostic testing in order to target antimalarials to those with confirmed infection. In 2005, she helped to establish the Malaria Diagnostic Centre of Excellence in Kisumu, Kenya.
Dr. O’Meara is also working towards elucidating malaria transmission networks by identifying individual human-to-mosquito and mosquito-human transmission events through leveraging variability in key parasite genes (collaboration with Steve Taylor’s lab). By tracking generations of infections from humans to mosquitoes, a clearer understanding of the reservoir of infection will be possible and interventions such as ivermectin and transmission blocking vaccines can be targeted to maximizes their effectiveness.
Dr. O’Meara also has experience in marrying innovative spatial techniques with epidemiologic outcomes. Recent work includes an analysis of health systems factors that contribute to early childhood mortality in sub-Saharan Africa and the impact of malaria prevention on birth outcomes.
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