The Impact of Retail Sector Delivery of Artemether-Lumefantrine on Effective Malaria Treatment of Children Under Five in Kenya

Background: With a low proportion of children receiving the first line treatment for suspected malaria, it has been proposed that artemisinin based combination therapy be subsidised in the private sector in order to improve affordability and access. This thesis presents an evaluation of a pilot subsidy mechanism in Western Kenya.Methods: The primary objective was to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through trained retailers, on the coverage of prompt effective anti-malarial treatment for febrile children aged three to 59 months. I used a cluster-randomised, controlled design with nine control and nine intervention sublocations, equally distributed across three districts. Provider, mystery shopper and household cross-sectional surveys were conducted at baseline and one year later. Data were analysed based on cluster-level summaries, comparing control and intervention arms, while adjusting for covariates. On average details of 2,706 children and 564 retail outlets were captured per year.Results: Provider survey and mystery shopper data showed that at follow-up a significantly greater percentage of retailers stocked and dispensed AL, and knew that AL was the first line treatment for uncomplicated malaria in the intervention arm compared to the control. Significantly fewer retailers stocked antimalarial monotherapies. Household survey data showed that an average of 29% of children had experienced fever within the previous two weeks. Within this sample, the percentage receiving AL on the same day or following day of fever developing at follow-up was 25.0% points higher in the intervention arm than in the control arm, a statistically significant difference. However, adherence to dosing for AL purchased in the retail sector and advice given to caretakers by retailers remained unchanged post-intervention. Conclusion: Overall, subsidizing ACTs in the retail sector can significantly increase ACT coverage in rural areas. Further research is needed on ways to improve counselling and adherence as well as on the impact and cost-effectiveness of such an intervention at a national scale

Community directed approaches to promote uptake of Sulfadoxine Pyrimethamine for intermittent preventive treatment of malaria in pregnancy: Baseline findings from Kisumu and Migori counties

During pregnancy, malaria has a devastating impact on health outcomes for mothers and infants. Uptake of Sulfadoxine-Pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) is a safe and clinically proven medical intervention for the prevention of malaria in pregnancy (MiP). Despite Kenya’s adoption of this intervention in its national policies and guidelines, uptake of IPTp for MiP has been persistently low. To realize effective coverage of IPTp, the Population Council, Kenya in collaboration with Kisumu Medical and Education Trust (KMET) and County Governments, is implementing the Revive IPTp project in Kisumu and Migori counties. The project seeks to increase community engagement in IPTp and promote self-care by pregnant women. This study’s main objective is to generate baseline evidence to inform the design, monitoring, and evaluation of interventions to improve IPTp-SP uptake in two malaria endemic counties in Kenya

Webinar—From Data to Action: Informing Menstrual Health Management Programs

The Population Council’s Girl Innovation, Research, and Learning (GIRL) Center and Evidence for Gender and Education Resource (EGER) program hosted the second virtual webinar of its From Data to Action Series, “Informing Menstrual Health Management Programs” in February 2022. The webinar featured a global systematic review and results from a randomized trial in Kenya on menstrual health management (MHM) programs. ZanaAfrica shared perspectives on program implementation and how the evidence is shaping their approach

The challenges of changing national malaria drug policy to artemisinin-based combinations in Kenya

Backgound: Sulphadoxine/sulphalene-pyrimethamine (SP) was adopted in Kenya as first line therapeutic for uncomplicated malaria in 1998. By the second half of 2003, there was convincing evidence that SP was failing and had to be replaced. Despite several descriptive investigations of policy change and implementation when countries moved from chloroquine to SP, the different constraints of moving to artemisinin-based combination therapy (ACT) in Africa are less well documented. Methods: A narrative description of the process of anti-malarial drug policy change, financing and implementation in Kenya is assembled from discussions with stakeholders, reports, newspaper articles, minutes of meetings and email correspondence between actors in the policy change process. The narrative has been structured to capture the timing of events, the difficulties and hurdles faced and the resolutions reached to the final implementation of a new treatment policy. Results: Following a recognition that SP was failing there was a rapid technical appraisal of available data and replacement options resulting in a decision to adopt artemether-lumefantrine (AL) as the recommended first-line therapy in Kenya, announced in April 2004. Funding requirements were approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and over 60 million US$ were agreed in principle in July 2004 to procure AL and implement the policy change. AL arrived in Kenya in May 2006, distribution to health facilities began in July 2006 coincidental with cascade in-service training in the revised national guidelines. Both training and drug distribution were almost complete by the end of 2006. The article examines why it took over 32 months from announcing a drug policy change to completing early implementation. Reasons included: lack of clarity on sustainable financing of an expensive therapeutic for a common disease, a delay in release of funding, a lack of comparative efficacy data between AL and amodiaquine-based alternatives, a poor dialogue with pharmaceutical companies with a national interest in antimalarial drug supply versus the single sourcing of AL and complex drug ordering, tendering and procurement procedures. Conclusion: Decisions to abandon failing monotherapy in favour of ACT for the treatment of malaria can be achieved relatively quickly. Future policy changes in Africa should be carefully prepared for a myriad of financial, political and legislative issues that might limit the rapid translation of drug policy change into action

Adolescent Girls Initiative–Kenya: Endline evaluation report

Early pregnancy is a challenge for girls in Kenya that often has immediate effects on their educational opportunities, future implications for their social, health, and economic outcomes, and negative impacts on their children. For girls to achieve well-being in early and late adolescence, no single-sector intervention—whether education, health, wealth creation, or prevention of violence—will be adequate. The Adolescent Girls Initiative–Kenya (AGI-K) delivered multisectoral interventions to over 6,000 girls aged 11–15 in two marginalized areas of Kenya: the Kibera informal settlement in Nairobi and Wajir County in Northeastern Kenya. These interventions were carried out for two years (2015–17) and comprised a combination of girl-level, household-level, and community-level interventions. The two-year follow-up results largely confirmed the AGI-K theory of change and held up the view that an investment in early adolescents among the right groups of marginalized girls would have short-term benefits on asset accumulation, educational attainment, and household economic status that translated into longer-term impact on delaying childbearing. This report describes the intervention and research design of AGI-K, and presents the impact findings from the two-year follow-up data

Adolescent Girls Initiative–Kenya: Midline results report

Many adolescent girls in Kenya face considerable risks and vulnerabilities that affect their education status, health, and general well-being. In addition to low educational attainment and health risks, other factors that impact education and health outcomes include household poverty, lack of economic independence, limited income-earning opportunities, illiteracy, violence, and social isolation. Younger adolescent girls who live in environments laden with these vulnerabilities are at risk of experiencing negative outcomes such as school dropout, early sexual initiation, unintended pregnancy, early marriage, and sexual and gender-based violence. The Adolescent Girls Initiative–Kenya (AGI-K) delivered multisectoral interventions to over 6,000 girls aged 11–15 in two marginalized areas of Kenya: the Kibera informal settlement in Nairobi, and Wajir County in Northeastern Kenya. This report describes both the intervention and research design of AGI-K, and presents findings from the midline data collection. The objective of the RCT is to describe and compare the impact of the different program packages. Endline data will be collected in 2019 and will reflect the impact of the program packages two years post-intervention

Gendered effects of COVID-19 school closures: Kenya case study

This brief summarizes a case study that assessed the gendered impact of COVID-19 school closures in Kenya. COVID-19 school closures escalated education inequalities especially for girls and young people in rural areas. These closures exacerbated adolescent mental health issues, food and economic insecurity, and experiences of violence. COVID-19 response programs implemented by both the Government of Kenya and non-state actors were not able to fully mitigate the impacts of school closures for adolescents, teachers, or schools. Continued efforts to understand the implications of school closures and to support vulnerable students are needed

The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements.

BACKGROUND: Many low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study, we collect contact data from residents of informal settlements around Nairobi, Kenya, to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). METHODS: We conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, 4 weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7 pm and 5 am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. RESULTS: We estimate that control measures reduced physical contacts by 62% and non-physical contacts by either 63% or 67%, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. Eighty-six percent of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. CONCLUSION: COVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the comparatively low epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term

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

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

Experiences among adults and adolescents during the COVID-19 pandemic from four locations across Kenya—Study description

To control the spread of coronavirus, the COVID-19 National Emergency Response Committee (NERC) in Kenya, chaired by the Ministry of Health (MOH), has implemented prevention and mitigation measures. To inform the Government of Kenya’s shorter- and longer-term response strategies, the Population Council COVID-19 study team utilizes rapid phone-based surveys to collect information on knowledge, attitudes, practices and needs among a longitudinal cohort of heads of household sampled from existing prospective cohort studies. The first was carried out across five Nairobi urban informal settlements; the baseline survey (n=2,009) was conducted March 30–31 with subsequent follow-up surveys conducted April 13–14 (n=1,764), May 10-11 (n=1,750), and June 13-16 (n=1,529) (to be carried out one per subsequent quarter dependent on funding). Adolescents in the Nairobi cohort (n=1,022) were also interviewed in the June round of data collection. The survey was expanded to communities with existing prospective cohort studies in Wajir County (adults n=1,322 and adolescents n=1,234), Kilifi County (adults n=1,288 and adolescents n=1,178), and Kisumu County (adults n=858 and adolescents n=973), adapted for rural settings with the first round conducted between July–August 2020, the second between February–March 2021, and the third between June–August 2021