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


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.





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Publication Info

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

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Wendy P O'Meara

Professor of Medicine

Dr. Wendy O’Meara is a Professor of Medicine and Global Health at Duke University, a visiting professor at Moi University, and the Deputy Director of the Duke Global Health Institute. She divides her time between the US and Kenya.

Dr. O’Meara has dedicated the last 20 years to community-based approaches for malaria treatment and prevention in East Africa. Her team’s work focuses on expanding access to accurate diagnosis and treatment, mapping silent reservoirs of transmission using parasite genetic signatures, and tackling emerging threats to malaria control in vulnerable populations. She serves on the Strategic Advisory Group of Experts for the Africa CDC and is an advocate for data justice and equitable data governance in global research. 

Dr. O’Meara completed her PhD in Chemical Engineering at MIT. She then joined Fogarty International Center at the NIH to apply her quantitative and modeling skills to vector borne diseases. Her collaboration with KEMRI-Wellcome Trust using hospital surveillance data to understand malaria transmission led her to Kenya in 2007. The collaborative research program built with colleagues at Moi University is based in Eldoret, Kenya with hubs in western and northern Kenya. The team works closely with county health teams and frequently advises the Division of National Malaria Control. 

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